don’t strike out: hitting a grand slam with item writing€¦ · are you testing at the...
TRANSCRIPT
Disclaimer Statement
1
The presenter(s) attest that they do not have a conflict of interest bias or commercial support related to the educational activity The presenter nor any member of their immediate family have any financial relationship in which they receive salary royalty fees honoraria ownership interest or other financial benefits from an organization addressed in the educational materials They do not promote any services or products during the activity and neither the presenter nor any member of their immediate family have any financial interest in the topics presented during the educational activity
Attendees must submit a completed evaluation of the educational activity to receive their CNE certificate
DONrsquoT STRIKE OUTHITTING A GRAND SLAM WITH
ITEM WRITING
March 31st 2019Marsha S Barlow MSN-Ed RN
Terri Lemon DNP MSN RNMendy McMichael DNP MSN RN
OBJECTIVES
3
Describe the NCLEXreg detailed test plans
Discuss the various types of items included on the NCLEXreg exam
Use strategies to construct NCLEXreg style items that assess a studentrsquos critical thinking skills
THE ART OF ITEM WRITING
4
BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
5
SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
6
CHALLENGES FOR NURSING FACULTY
7
There are many ways to measure the quality of a nursing program
It is important that our graduates pass NCLEXreg
We have a responsibility to acquaint students with NCLEXreg style test items including alternate format items in their first nursing course and continue to do so throughout the program
GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
8
9
NCLEXreg ITEM TYPES LEARNING DIFFERENT PITCHES
NCLEXreg Item Types ― Multiple choice ― Alternate Format Items
bull Multiple response bull Hot Spot bull Fill-in- the blank bull Chart Exhibit bull Graphic bull Ordered response bull Audio
10
HIT A HOME RUN WITH EVERY ITEM YOU WRITE
Regardless of the type of item you write it is important to write items that are valid and serve their intended purpose
Every item on the test must be ldquosolidrdquo and contribute to the overall quality of the test
Items should contain important concepts that are relevant to entry-level nursing practice ― ldquoNice to knowrdquo vs ldquoNeed to knowrdquo
11
COMPONENTS THE HITS AND RUNS
12
DEVELOPING A GAME PLAN FOR ITEM WRITING
13
PEER REVIEW DRILLS
Development of solid test items is an ongoing process Establish peer dyads
― Reviewedit each otherrsquos items ― Reviewedit each otherrsquos tests
Review p value and point biserial index of each item after administration
14
ITEM WRITING TAKES PRACTICE
15
HAVE A CLEAR GAME PLAN
How can we stay focused on our purpose when writing items
Try asking yourselfhellip ― What contentconcept are you testing ― Does the item fit an NCLEX task ― What do students need to know to demonstrate proficiency and competency
16
BEST PRACTICE ADVICE SCORING RUNS WITH THE BIG 3
First base - Is the itemrsquos content relevant for an entry-level nurse Are you testing at the appropriate level Second base - Is the stem clear and concise Third base - Are the distractors plausible yet clearly wrong
17
WRITING ITEMS THE STEM
Describes a clinical situation in which the student must problem solve and apply the nursing process
Asks a specific question that the student must answer using nursing knowledge
Guidelines ― Always a nurse a client and context ― Relevant to entry-level practice ― Clear concise and without extraneous information ― Stated positively
18
WRITING ITEMS THE STEM
Must be relevant to entry-level practice ― Nurse-client interactions ―AssessmentData collection ― Planning ― Interventions ― Evaluation ― Documentation ― Management of care
Avoid or limit ― Definitionsterminology ― Statistical data that will change over time ― Minutia information ― Asking the student to make a medical
diagnosis
19
WRITING ITEMS THE STEM
Stem ― Client care related situation ― Provides information that students should consider when answering item ― Usually contains 2-3 sentences― Always contains a nurse client and context ― A step of the nursing process can be identified
20
WRITING ITEMS THE STEM
WRITING ITEMS THE STEM
21
WRITING ITEMS THE STEM POSSIBLE REVISION
22
WRITING ITEMS
23
Three types of items― Positively worded ― Priority setting ― Negatively worded (limit or avoid)
WRITING ITEMS
24
Positively worded item ― Answers question with correct option― One correct option ― Three incorrect options
WRITING ITEMS
25
Priority setting ― Answers questions with the ldquobestrdquo option― Four correct options― One correct option based on a priority setting framework― Should ask for best first priority etc action
WRITING ITEMS
26
Negatively worded items should be avoided ― Answers question with an incorrect option ―Three correct options― One incorrect option ― Easy for the student to read incorrectly
WRITING ITEMS
27
Avoid writing negatively stated items
Exceptions-some NCLEXreg tasks are negatively worded and require a negatively stated item Examples of when a negatively stated item is appropriate
― Evaluating delegated care or monitoring another nursersquos care ― Identifying contraindications barriers developmental delays ― Verifying prescriptions
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
OBJECTIVES
3
Describe the NCLEXreg detailed test plans
Discuss the various types of items included on the NCLEXreg exam
Use strategies to construct NCLEXreg style items that assess a studentrsquos critical thinking skills
THE ART OF ITEM WRITING
4
BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
5
SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
6
CHALLENGES FOR NURSING FACULTY
7
There are many ways to measure the quality of a nursing program
It is important that our graduates pass NCLEXreg
We have a responsibility to acquaint students with NCLEXreg style test items including alternate format items in their first nursing course and continue to do so throughout the program
GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
8
9
NCLEXreg ITEM TYPES LEARNING DIFFERENT PITCHES
NCLEXreg Item Types ― Multiple choice ― Alternate Format Items
bull Multiple response bull Hot Spot bull Fill-in- the blank bull Chart Exhibit bull Graphic bull Ordered response bull Audio
10
HIT A HOME RUN WITH EVERY ITEM YOU WRITE
Regardless of the type of item you write it is important to write items that are valid and serve their intended purpose
Every item on the test must be ldquosolidrdquo and contribute to the overall quality of the test
Items should contain important concepts that are relevant to entry-level nursing practice ― ldquoNice to knowrdquo vs ldquoNeed to knowrdquo
11
COMPONENTS THE HITS AND RUNS
12
DEVELOPING A GAME PLAN FOR ITEM WRITING
13
PEER REVIEW DRILLS
Development of solid test items is an ongoing process Establish peer dyads
― Reviewedit each otherrsquos items ― Reviewedit each otherrsquos tests
Review p value and point biserial index of each item after administration
14
ITEM WRITING TAKES PRACTICE
15
HAVE A CLEAR GAME PLAN
How can we stay focused on our purpose when writing items
Try asking yourselfhellip ― What contentconcept are you testing ― Does the item fit an NCLEX task ― What do students need to know to demonstrate proficiency and competency
16
BEST PRACTICE ADVICE SCORING RUNS WITH THE BIG 3
First base - Is the itemrsquos content relevant for an entry-level nurse Are you testing at the appropriate level Second base - Is the stem clear and concise Third base - Are the distractors plausible yet clearly wrong
17
WRITING ITEMS THE STEM
Describes a clinical situation in which the student must problem solve and apply the nursing process
Asks a specific question that the student must answer using nursing knowledge
Guidelines ― Always a nurse a client and context ― Relevant to entry-level practice ― Clear concise and without extraneous information ― Stated positively
18
WRITING ITEMS THE STEM
Must be relevant to entry-level practice ― Nurse-client interactions ―AssessmentData collection ― Planning ― Interventions ― Evaluation ― Documentation ― Management of care
Avoid or limit ― Definitionsterminology ― Statistical data that will change over time ― Minutia information ― Asking the student to make a medical
diagnosis
19
WRITING ITEMS THE STEM
Stem ― Client care related situation ― Provides information that students should consider when answering item ― Usually contains 2-3 sentences― Always contains a nurse client and context ― A step of the nursing process can be identified
20
WRITING ITEMS THE STEM
WRITING ITEMS THE STEM
21
WRITING ITEMS THE STEM POSSIBLE REVISION
22
WRITING ITEMS
23
Three types of items― Positively worded ― Priority setting ― Negatively worded (limit or avoid)
WRITING ITEMS
24
Positively worded item ― Answers question with correct option― One correct option ― Three incorrect options
WRITING ITEMS
25
Priority setting ― Answers questions with the ldquobestrdquo option― Four correct options― One correct option based on a priority setting framework― Should ask for best first priority etc action
WRITING ITEMS
26
Negatively worded items should be avoided ― Answers question with an incorrect option ―Three correct options― One incorrect option ― Easy for the student to read incorrectly
WRITING ITEMS
27
Avoid writing negatively stated items
Exceptions-some NCLEXreg tasks are negatively worded and require a negatively stated item Examples of when a negatively stated item is appropriate
― Evaluating delegated care or monitoring another nursersquos care ― Identifying contraindications barriers developmental delays ― Verifying prescriptions
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
THE ART OF ITEM WRITING
4
BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
5
SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
6
CHALLENGES FOR NURSING FACULTY
7
There are many ways to measure the quality of a nursing program
It is important that our graduates pass NCLEXreg
We have a responsibility to acquaint students with NCLEXreg style test items including alternate format items in their first nursing course and continue to do so throughout the program
GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
8
9
NCLEXreg ITEM TYPES LEARNING DIFFERENT PITCHES
NCLEXreg Item Types ― Multiple choice ― Alternate Format Items
bull Multiple response bull Hot Spot bull Fill-in- the blank bull Chart Exhibit bull Graphic bull Ordered response bull Audio
10
HIT A HOME RUN WITH EVERY ITEM YOU WRITE
Regardless of the type of item you write it is important to write items that are valid and serve their intended purpose
Every item on the test must be ldquosolidrdquo and contribute to the overall quality of the test
Items should contain important concepts that are relevant to entry-level nursing practice ― ldquoNice to knowrdquo vs ldquoNeed to knowrdquo
11
COMPONENTS THE HITS AND RUNS
12
DEVELOPING A GAME PLAN FOR ITEM WRITING
13
PEER REVIEW DRILLS
Development of solid test items is an ongoing process Establish peer dyads
― Reviewedit each otherrsquos items ― Reviewedit each otherrsquos tests
Review p value and point biserial index of each item after administration
14
ITEM WRITING TAKES PRACTICE
15
HAVE A CLEAR GAME PLAN
How can we stay focused on our purpose when writing items
Try asking yourselfhellip ― What contentconcept are you testing ― Does the item fit an NCLEX task ― What do students need to know to demonstrate proficiency and competency
16
BEST PRACTICE ADVICE SCORING RUNS WITH THE BIG 3
First base - Is the itemrsquos content relevant for an entry-level nurse Are you testing at the appropriate level Second base - Is the stem clear and concise Third base - Are the distractors plausible yet clearly wrong
17
WRITING ITEMS THE STEM
Describes a clinical situation in which the student must problem solve and apply the nursing process
Asks a specific question that the student must answer using nursing knowledge
Guidelines ― Always a nurse a client and context ― Relevant to entry-level practice ― Clear concise and without extraneous information ― Stated positively
18
WRITING ITEMS THE STEM
Must be relevant to entry-level practice ― Nurse-client interactions ―AssessmentData collection ― Planning ― Interventions ― Evaluation ― Documentation ― Management of care
Avoid or limit ― Definitionsterminology ― Statistical data that will change over time ― Minutia information ― Asking the student to make a medical
diagnosis
19
WRITING ITEMS THE STEM
Stem ― Client care related situation ― Provides information that students should consider when answering item ― Usually contains 2-3 sentences― Always contains a nurse client and context ― A step of the nursing process can be identified
20
WRITING ITEMS THE STEM
WRITING ITEMS THE STEM
21
WRITING ITEMS THE STEM POSSIBLE REVISION
22
WRITING ITEMS
23
Three types of items― Positively worded ― Priority setting ― Negatively worded (limit or avoid)
WRITING ITEMS
24
Positively worded item ― Answers question with correct option― One correct option ― Three incorrect options
WRITING ITEMS
25
Priority setting ― Answers questions with the ldquobestrdquo option― Four correct options― One correct option based on a priority setting framework― Should ask for best first priority etc action
WRITING ITEMS
26
Negatively worded items should be avoided ― Answers question with an incorrect option ―Three correct options― One incorrect option ― Easy for the student to read incorrectly
WRITING ITEMS
27
Avoid writing negatively stated items
Exceptions-some NCLEXreg tasks are negatively worded and require a negatively stated item Examples of when a negatively stated item is appropriate
― Evaluating delegated care or monitoring another nursersquos care ― Identifying contraindications barriers developmental delays ― Verifying prescriptions
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
5
SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
6
CHALLENGES FOR NURSING FACULTY
7
There are many ways to measure the quality of a nursing program
It is important that our graduates pass NCLEXreg
We have a responsibility to acquaint students with NCLEXreg style test items including alternate format items in their first nursing course and continue to do so throughout the program
GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
8
9
NCLEXreg ITEM TYPES LEARNING DIFFERENT PITCHES
NCLEXreg Item Types ― Multiple choice ― Alternate Format Items
bull Multiple response bull Hot Spot bull Fill-in- the blank bull Chart Exhibit bull Graphic bull Ordered response bull Audio
10
HIT A HOME RUN WITH EVERY ITEM YOU WRITE
Regardless of the type of item you write it is important to write items that are valid and serve their intended purpose
Every item on the test must be ldquosolidrdquo and contribute to the overall quality of the test
Items should contain important concepts that are relevant to entry-level nursing practice ― ldquoNice to knowrdquo vs ldquoNeed to knowrdquo
11
COMPONENTS THE HITS AND RUNS
12
DEVELOPING A GAME PLAN FOR ITEM WRITING
13
PEER REVIEW DRILLS
Development of solid test items is an ongoing process Establish peer dyads
― Reviewedit each otherrsquos items ― Reviewedit each otherrsquos tests
Review p value and point biserial index of each item after administration
14
ITEM WRITING TAKES PRACTICE
15
HAVE A CLEAR GAME PLAN
How can we stay focused on our purpose when writing items
Try asking yourselfhellip ― What contentconcept are you testing ― Does the item fit an NCLEX task ― What do students need to know to demonstrate proficiency and competency
16
BEST PRACTICE ADVICE SCORING RUNS WITH THE BIG 3
First base - Is the itemrsquos content relevant for an entry-level nurse Are you testing at the appropriate level Second base - Is the stem clear and concise Third base - Are the distractors plausible yet clearly wrong
17
WRITING ITEMS THE STEM
Describes a clinical situation in which the student must problem solve and apply the nursing process
Asks a specific question that the student must answer using nursing knowledge
Guidelines ― Always a nurse a client and context ― Relevant to entry-level practice ― Clear concise and without extraneous information ― Stated positively
18
WRITING ITEMS THE STEM
Must be relevant to entry-level practice ― Nurse-client interactions ―AssessmentData collection ― Planning ― Interventions ― Evaluation ― Documentation ― Management of care
Avoid or limit ― Definitionsterminology ― Statistical data that will change over time ― Minutia information ― Asking the student to make a medical
diagnosis
19
WRITING ITEMS THE STEM
Stem ― Client care related situation ― Provides information that students should consider when answering item ― Usually contains 2-3 sentences― Always contains a nurse client and context ― A step of the nursing process can be identified
20
WRITING ITEMS THE STEM
WRITING ITEMS THE STEM
21
WRITING ITEMS THE STEM POSSIBLE REVISION
22
WRITING ITEMS
23
Three types of items― Positively worded ― Priority setting ― Negatively worded (limit or avoid)
WRITING ITEMS
24
Positively worded item ― Answers question with correct option― One correct option ― Three incorrect options
WRITING ITEMS
25
Priority setting ― Answers questions with the ldquobestrdquo option― Four correct options― One correct option based on a priority setting framework― Should ask for best first priority etc action
WRITING ITEMS
26
Negatively worded items should be avoided ― Answers question with an incorrect option ―Three correct options― One incorrect option ― Easy for the student to read incorrectly
WRITING ITEMS
27
Avoid writing negatively stated items
Exceptions-some NCLEXreg tasks are negatively worded and require a negatively stated item Examples of when a negatively stated item is appropriate
― Evaluating delegated care or monitoring another nursersquos care ― Identifying contraindications barriers developmental delays ― Verifying prescriptions
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
6
CHALLENGES FOR NURSING FACULTY
7
There are many ways to measure the quality of a nursing program
It is important that our graduates pass NCLEXreg
We have a responsibility to acquaint students with NCLEXreg style test items including alternate format items in their first nursing course and continue to do so throughout the program
GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
8
9
NCLEXreg ITEM TYPES LEARNING DIFFERENT PITCHES
NCLEXreg Item Types ― Multiple choice ― Alternate Format Items
bull Multiple response bull Hot Spot bull Fill-in- the blank bull Chart Exhibit bull Graphic bull Ordered response bull Audio
10
HIT A HOME RUN WITH EVERY ITEM YOU WRITE
Regardless of the type of item you write it is important to write items that are valid and serve their intended purpose
Every item on the test must be ldquosolidrdquo and contribute to the overall quality of the test
Items should contain important concepts that are relevant to entry-level nursing practice ― ldquoNice to knowrdquo vs ldquoNeed to knowrdquo
11
COMPONENTS THE HITS AND RUNS
12
DEVELOPING A GAME PLAN FOR ITEM WRITING
13
PEER REVIEW DRILLS
Development of solid test items is an ongoing process Establish peer dyads
― Reviewedit each otherrsquos items ― Reviewedit each otherrsquos tests
Review p value and point biserial index of each item after administration
14
ITEM WRITING TAKES PRACTICE
15
HAVE A CLEAR GAME PLAN
How can we stay focused on our purpose when writing items
Try asking yourselfhellip ― What contentconcept are you testing ― Does the item fit an NCLEX task ― What do students need to know to demonstrate proficiency and competency
16
BEST PRACTICE ADVICE SCORING RUNS WITH THE BIG 3
First base - Is the itemrsquos content relevant for an entry-level nurse Are you testing at the appropriate level Second base - Is the stem clear and concise Third base - Are the distractors plausible yet clearly wrong
17
WRITING ITEMS THE STEM
Describes a clinical situation in which the student must problem solve and apply the nursing process
Asks a specific question that the student must answer using nursing knowledge
Guidelines ― Always a nurse a client and context ― Relevant to entry-level practice ― Clear concise and without extraneous information ― Stated positively
18
WRITING ITEMS THE STEM
Must be relevant to entry-level practice ― Nurse-client interactions ―AssessmentData collection ― Planning ― Interventions ― Evaluation ― Documentation ― Management of care
Avoid or limit ― Definitionsterminology ― Statistical data that will change over time ― Minutia information ― Asking the student to make a medical
diagnosis
19
WRITING ITEMS THE STEM
Stem ― Client care related situation ― Provides information that students should consider when answering item ― Usually contains 2-3 sentences― Always contains a nurse client and context ― A step of the nursing process can be identified
20
WRITING ITEMS THE STEM
WRITING ITEMS THE STEM
21
WRITING ITEMS THE STEM POSSIBLE REVISION
22
WRITING ITEMS
23
Three types of items― Positively worded ― Priority setting ― Negatively worded (limit or avoid)
WRITING ITEMS
24
Positively worded item ― Answers question with correct option― One correct option ― Three incorrect options
WRITING ITEMS
25
Priority setting ― Answers questions with the ldquobestrdquo option― Four correct options― One correct option based on a priority setting framework― Should ask for best first priority etc action
WRITING ITEMS
26
Negatively worded items should be avoided ― Answers question with an incorrect option ―Three correct options― One incorrect option ― Easy for the student to read incorrectly
WRITING ITEMS
27
Avoid writing negatively stated items
Exceptions-some NCLEXreg tasks are negatively worded and require a negatively stated item Examples of when a negatively stated item is appropriate
― Evaluating delegated care or monitoring another nursersquos care ― Identifying contraindications barriers developmental delays ― Verifying prescriptions
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
CHALLENGES FOR NURSING FACULTY
7
There are many ways to measure the quality of a nursing program
It is important that our graduates pass NCLEXreg
We have a responsibility to acquaint students with NCLEXreg style test items including alternate format items in their first nursing course and continue to do so throughout the program
GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
8
9
NCLEXreg ITEM TYPES LEARNING DIFFERENT PITCHES
NCLEXreg Item Types ― Multiple choice ― Alternate Format Items
bull Multiple response bull Hot Spot bull Fill-in- the blank bull Chart Exhibit bull Graphic bull Ordered response bull Audio
10
HIT A HOME RUN WITH EVERY ITEM YOU WRITE
Regardless of the type of item you write it is important to write items that are valid and serve their intended purpose
Every item on the test must be ldquosolidrdquo and contribute to the overall quality of the test
Items should contain important concepts that are relevant to entry-level nursing practice ― ldquoNice to knowrdquo vs ldquoNeed to knowrdquo
11
COMPONENTS THE HITS AND RUNS
12
DEVELOPING A GAME PLAN FOR ITEM WRITING
13
PEER REVIEW DRILLS
Development of solid test items is an ongoing process Establish peer dyads
― Reviewedit each otherrsquos items ― Reviewedit each otherrsquos tests
Review p value and point biserial index of each item after administration
14
ITEM WRITING TAKES PRACTICE
15
HAVE A CLEAR GAME PLAN
How can we stay focused on our purpose when writing items
Try asking yourselfhellip ― What contentconcept are you testing ― Does the item fit an NCLEX task ― What do students need to know to demonstrate proficiency and competency
16
BEST PRACTICE ADVICE SCORING RUNS WITH THE BIG 3
First base - Is the itemrsquos content relevant for an entry-level nurse Are you testing at the appropriate level Second base - Is the stem clear and concise Third base - Are the distractors plausible yet clearly wrong
17
WRITING ITEMS THE STEM
Describes a clinical situation in which the student must problem solve and apply the nursing process
Asks a specific question that the student must answer using nursing knowledge
Guidelines ― Always a nurse a client and context ― Relevant to entry-level practice ― Clear concise and without extraneous information ― Stated positively
18
WRITING ITEMS THE STEM
Must be relevant to entry-level practice ― Nurse-client interactions ―AssessmentData collection ― Planning ― Interventions ― Evaluation ― Documentation ― Management of care
Avoid or limit ― Definitionsterminology ― Statistical data that will change over time ― Minutia information ― Asking the student to make a medical
diagnosis
19
WRITING ITEMS THE STEM
Stem ― Client care related situation ― Provides information that students should consider when answering item ― Usually contains 2-3 sentences― Always contains a nurse client and context ― A step of the nursing process can be identified
20
WRITING ITEMS THE STEM
WRITING ITEMS THE STEM
21
WRITING ITEMS THE STEM POSSIBLE REVISION
22
WRITING ITEMS
23
Three types of items― Positively worded ― Priority setting ― Negatively worded (limit or avoid)
WRITING ITEMS
24
Positively worded item ― Answers question with correct option― One correct option ― Three incorrect options
WRITING ITEMS
25
Priority setting ― Answers questions with the ldquobestrdquo option― Four correct options― One correct option based on a priority setting framework― Should ask for best first priority etc action
WRITING ITEMS
26
Negatively worded items should be avoided ― Answers question with an incorrect option ―Three correct options― One incorrect option ― Easy for the student to read incorrectly
WRITING ITEMS
27
Avoid writing negatively stated items
Exceptions-some NCLEXreg tasks are negatively worded and require a negatively stated item Examples of when a negatively stated item is appropriate
― Evaluating delegated care or monitoring another nursersquos care ― Identifying contraindications barriers developmental delays ― Verifying prescriptions
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
8
9
NCLEXreg ITEM TYPES LEARNING DIFFERENT PITCHES
NCLEXreg Item Types ― Multiple choice ― Alternate Format Items
bull Multiple response bull Hot Spot bull Fill-in- the blank bull Chart Exhibit bull Graphic bull Ordered response bull Audio
10
HIT A HOME RUN WITH EVERY ITEM YOU WRITE
Regardless of the type of item you write it is important to write items that are valid and serve their intended purpose
Every item on the test must be ldquosolidrdquo and contribute to the overall quality of the test
Items should contain important concepts that are relevant to entry-level nursing practice ― ldquoNice to knowrdquo vs ldquoNeed to knowrdquo
11
COMPONENTS THE HITS AND RUNS
12
DEVELOPING A GAME PLAN FOR ITEM WRITING
13
PEER REVIEW DRILLS
Development of solid test items is an ongoing process Establish peer dyads
― Reviewedit each otherrsquos items ― Reviewedit each otherrsquos tests
Review p value and point biserial index of each item after administration
14
ITEM WRITING TAKES PRACTICE
15
HAVE A CLEAR GAME PLAN
How can we stay focused on our purpose when writing items
Try asking yourselfhellip ― What contentconcept are you testing ― Does the item fit an NCLEX task ― What do students need to know to demonstrate proficiency and competency
16
BEST PRACTICE ADVICE SCORING RUNS WITH THE BIG 3
First base - Is the itemrsquos content relevant for an entry-level nurse Are you testing at the appropriate level Second base - Is the stem clear and concise Third base - Are the distractors plausible yet clearly wrong
17
WRITING ITEMS THE STEM
Describes a clinical situation in which the student must problem solve and apply the nursing process
Asks a specific question that the student must answer using nursing knowledge
Guidelines ― Always a nurse a client and context ― Relevant to entry-level practice ― Clear concise and without extraneous information ― Stated positively
18
WRITING ITEMS THE STEM
Must be relevant to entry-level practice ― Nurse-client interactions ―AssessmentData collection ― Planning ― Interventions ― Evaluation ― Documentation ― Management of care
Avoid or limit ― Definitionsterminology ― Statistical data that will change over time ― Minutia information ― Asking the student to make a medical
diagnosis
19
WRITING ITEMS THE STEM
Stem ― Client care related situation ― Provides information that students should consider when answering item ― Usually contains 2-3 sentences― Always contains a nurse client and context ― A step of the nursing process can be identified
20
WRITING ITEMS THE STEM
WRITING ITEMS THE STEM
21
WRITING ITEMS THE STEM POSSIBLE REVISION
22
WRITING ITEMS
23
Three types of items― Positively worded ― Priority setting ― Negatively worded (limit or avoid)
WRITING ITEMS
24
Positively worded item ― Answers question with correct option― One correct option ― Three incorrect options
WRITING ITEMS
25
Priority setting ― Answers questions with the ldquobestrdquo option― Four correct options― One correct option based on a priority setting framework― Should ask for best first priority etc action
WRITING ITEMS
26
Negatively worded items should be avoided ― Answers question with an incorrect option ―Three correct options― One incorrect option ― Easy for the student to read incorrectly
WRITING ITEMS
27
Avoid writing negatively stated items
Exceptions-some NCLEXreg tasks are negatively worded and require a negatively stated item Examples of when a negatively stated item is appropriate
― Evaluating delegated care or monitoring another nursersquos care ― Identifying contraindications barriers developmental delays ― Verifying prescriptions
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
9
NCLEXreg ITEM TYPES LEARNING DIFFERENT PITCHES
NCLEXreg Item Types ― Multiple choice ― Alternate Format Items
bull Multiple response bull Hot Spot bull Fill-in- the blank bull Chart Exhibit bull Graphic bull Ordered response bull Audio
10
HIT A HOME RUN WITH EVERY ITEM YOU WRITE
Regardless of the type of item you write it is important to write items that are valid and serve their intended purpose
Every item on the test must be ldquosolidrdquo and contribute to the overall quality of the test
Items should contain important concepts that are relevant to entry-level nursing practice ― ldquoNice to knowrdquo vs ldquoNeed to knowrdquo
11
COMPONENTS THE HITS AND RUNS
12
DEVELOPING A GAME PLAN FOR ITEM WRITING
13
PEER REVIEW DRILLS
Development of solid test items is an ongoing process Establish peer dyads
― Reviewedit each otherrsquos items ― Reviewedit each otherrsquos tests
Review p value and point biserial index of each item after administration
14
ITEM WRITING TAKES PRACTICE
15
HAVE A CLEAR GAME PLAN
How can we stay focused on our purpose when writing items
Try asking yourselfhellip ― What contentconcept are you testing ― Does the item fit an NCLEX task ― What do students need to know to demonstrate proficiency and competency
16
BEST PRACTICE ADVICE SCORING RUNS WITH THE BIG 3
First base - Is the itemrsquos content relevant for an entry-level nurse Are you testing at the appropriate level Second base - Is the stem clear and concise Third base - Are the distractors plausible yet clearly wrong
17
WRITING ITEMS THE STEM
Describes a clinical situation in which the student must problem solve and apply the nursing process
Asks a specific question that the student must answer using nursing knowledge
Guidelines ― Always a nurse a client and context ― Relevant to entry-level practice ― Clear concise and without extraneous information ― Stated positively
18
WRITING ITEMS THE STEM
Must be relevant to entry-level practice ― Nurse-client interactions ―AssessmentData collection ― Planning ― Interventions ― Evaluation ― Documentation ― Management of care
Avoid or limit ― Definitionsterminology ― Statistical data that will change over time ― Minutia information ― Asking the student to make a medical
diagnosis
19
WRITING ITEMS THE STEM
Stem ― Client care related situation ― Provides information that students should consider when answering item ― Usually contains 2-3 sentences― Always contains a nurse client and context ― A step of the nursing process can be identified
20
WRITING ITEMS THE STEM
WRITING ITEMS THE STEM
21
WRITING ITEMS THE STEM POSSIBLE REVISION
22
WRITING ITEMS
23
Three types of items― Positively worded ― Priority setting ― Negatively worded (limit or avoid)
WRITING ITEMS
24
Positively worded item ― Answers question with correct option― One correct option ― Three incorrect options
WRITING ITEMS
25
Priority setting ― Answers questions with the ldquobestrdquo option― Four correct options― One correct option based on a priority setting framework― Should ask for best first priority etc action
WRITING ITEMS
26
Negatively worded items should be avoided ― Answers question with an incorrect option ―Three correct options― One incorrect option ― Easy for the student to read incorrectly
WRITING ITEMS
27
Avoid writing negatively stated items
Exceptions-some NCLEXreg tasks are negatively worded and require a negatively stated item Examples of when a negatively stated item is appropriate
― Evaluating delegated care or monitoring another nursersquos care ― Identifying contraindications barriers developmental delays ― Verifying prescriptions
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
10
HIT A HOME RUN WITH EVERY ITEM YOU WRITE
Regardless of the type of item you write it is important to write items that are valid and serve their intended purpose
Every item on the test must be ldquosolidrdquo and contribute to the overall quality of the test
Items should contain important concepts that are relevant to entry-level nursing practice ― ldquoNice to knowrdquo vs ldquoNeed to knowrdquo
11
COMPONENTS THE HITS AND RUNS
12
DEVELOPING A GAME PLAN FOR ITEM WRITING
13
PEER REVIEW DRILLS
Development of solid test items is an ongoing process Establish peer dyads
― Reviewedit each otherrsquos items ― Reviewedit each otherrsquos tests
Review p value and point biserial index of each item after administration
14
ITEM WRITING TAKES PRACTICE
15
HAVE A CLEAR GAME PLAN
How can we stay focused on our purpose when writing items
Try asking yourselfhellip ― What contentconcept are you testing ― Does the item fit an NCLEX task ― What do students need to know to demonstrate proficiency and competency
16
BEST PRACTICE ADVICE SCORING RUNS WITH THE BIG 3
First base - Is the itemrsquos content relevant for an entry-level nurse Are you testing at the appropriate level Second base - Is the stem clear and concise Third base - Are the distractors plausible yet clearly wrong
17
WRITING ITEMS THE STEM
Describes a clinical situation in which the student must problem solve and apply the nursing process
Asks a specific question that the student must answer using nursing knowledge
Guidelines ― Always a nurse a client and context ― Relevant to entry-level practice ― Clear concise and without extraneous information ― Stated positively
18
WRITING ITEMS THE STEM
Must be relevant to entry-level practice ― Nurse-client interactions ―AssessmentData collection ― Planning ― Interventions ― Evaluation ― Documentation ― Management of care
Avoid or limit ― Definitionsterminology ― Statistical data that will change over time ― Minutia information ― Asking the student to make a medical
diagnosis
19
WRITING ITEMS THE STEM
Stem ― Client care related situation ― Provides information that students should consider when answering item ― Usually contains 2-3 sentences― Always contains a nurse client and context ― A step of the nursing process can be identified
20
WRITING ITEMS THE STEM
WRITING ITEMS THE STEM
21
WRITING ITEMS THE STEM POSSIBLE REVISION
22
WRITING ITEMS
23
Three types of items― Positively worded ― Priority setting ― Negatively worded (limit or avoid)
WRITING ITEMS
24
Positively worded item ― Answers question with correct option― One correct option ― Three incorrect options
WRITING ITEMS
25
Priority setting ― Answers questions with the ldquobestrdquo option― Four correct options― One correct option based on a priority setting framework― Should ask for best first priority etc action
WRITING ITEMS
26
Negatively worded items should be avoided ― Answers question with an incorrect option ―Three correct options― One incorrect option ― Easy for the student to read incorrectly
WRITING ITEMS
27
Avoid writing negatively stated items
Exceptions-some NCLEXreg tasks are negatively worded and require a negatively stated item Examples of when a negatively stated item is appropriate
― Evaluating delegated care or monitoring another nursersquos care ― Identifying contraindications barriers developmental delays ― Verifying prescriptions
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
11
COMPONENTS THE HITS AND RUNS
12
DEVELOPING A GAME PLAN FOR ITEM WRITING
13
PEER REVIEW DRILLS
Development of solid test items is an ongoing process Establish peer dyads
― Reviewedit each otherrsquos items ― Reviewedit each otherrsquos tests
Review p value and point biserial index of each item after administration
14
ITEM WRITING TAKES PRACTICE
15
HAVE A CLEAR GAME PLAN
How can we stay focused on our purpose when writing items
Try asking yourselfhellip ― What contentconcept are you testing ― Does the item fit an NCLEX task ― What do students need to know to demonstrate proficiency and competency
16
BEST PRACTICE ADVICE SCORING RUNS WITH THE BIG 3
First base - Is the itemrsquos content relevant for an entry-level nurse Are you testing at the appropriate level Second base - Is the stem clear and concise Third base - Are the distractors plausible yet clearly wrong
17
WRITING ITEMS THE STEM
Describes a clinical situation in which the student must problem solve and apply the nursing process
Asks a specific question that the student must answer using nursing knowledge
Guidelines ― Always a nurse a client and context ― Relevant to entry-level practice ― Clear concise and without extraneous information ― Stated positively
18
WRITING ITEMS THE STEM
Must be relevant to entry-level practice ― Nurse-client interactions ―AssessmentData collection ― Planning ― Interventions ― Evaluation ― Documentation ― Management of care
Avoid or limit ― Definitionsterminology ― Statistical data that will change over time ― Minutia information ― Asking the student to make a medical
diagnosis
19
WRITING ITEMS THE STEM
Stem ― Client care related situation ― Provides information that students should consider when answering item ― Usually contains 2-3 sentences― Always contains a nurse client and context ― A step of the nursing process can be identified
20
WRITING ITEMS THE STEM
WRITING ITEMS THE STEM
21
WRITING ITEMS THE STEM POSSIBLE REVISION
22
WRITING ITEMS
23
Three types of items― Positively worded ― Priority setting ― Negatively worded (limit or avoid)
WRITING ITEMS
24
Positively worded item ― Answers question with correct option― One correct option ― Three incorrect options
WRITING ITEMS
25
Priority setting ― Answers questions with the ldquobestrdquo option― Four correct options― One correct option based on a priority setting framework― Should ask for best first priority etc action
WRITING ITEMS
26
Negatively worded items should be avoided ― Answers question with an incorrect option ―Three correct options― One incorrect option ― Easy for the student to read incorrectly
WRITING ITEMS
27
Avoid writing negatively stated items
Exceptions-some NCLEXreg tasks are negatively worded and require a negatively stated item Examples of when a negatively stated item is appropriate
― Evaluating delegated care or monitoring another nursersquos care ― Identifying contraindications barriers developmental delays ― Verifying prescriptions
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
12
DEVELOPING A GAME PLAN FOR ITEM WRITING
13
PEER REVIEW DRILLS
Development of solid test items is an ongoing process Establish peer dyads
― Reviewedit each otherrsquos items ― Reviewedit each otherrsquos tests
Review p value and point biserial index of each item after administration
14
ITEM WRITING TAKES PRACTICE
15
HAVE A CLEAR GAME PLAN
How can we stay focused on our purpose when writing items
Try asking yourselfhellip ― What contentconcept are you testing ― Does the item fit an NCLEX task ― What do students need to know to demonstrate proficiency and competency
16
BEST PRACTICE ADVICE SCORING RUNS WITH THE BIG 3
First base - Is the itemrsquos content relevant for an entry-level nurse Are you testing at the appropriate level Second base - Is the stem clear and concise Third base - Are the distractors plausible yet clearly wrong
17
WRITING ITEMS THE STEM
Describes a clinical situation in which the student must problem solve and apply the nursing process
Asks a specific question that the student must answer using nursing knowledge
Guidelines ― Always a nurse a client and context ― Relevant to entry-level practice ― Clear concise and without extraneous information ― Stated positively
18
WRITING ITEMS THE STEM
Must be relevant to entry-level practice ― Nurse-client interactions ―AssessmentData collection ― Planning ― Interventions ― Evaluation ― Documentation ― Management of care
Avoid or limit ― Definitionsterminology ― Statistical data that will change over time ― Minutia information ― Asking the student to make a medical
diagnosis
19
WRITING ITEMS THE STEM
Stem ― Client care related situation ― Provides information that students should consider when answering item ― Usually contains 2-3 sentences― Always contains a nurse client and context ― A step of the nursing process can be identified
20
WRITING ITEMS THE STEM
WRITING ITEMS THE STEM
21
WRITING ITEMS THE STEM POSSIBLE REVISION
22
WRITING ITEMS
23
Three types of items― Positively worded ― Priority setting ― Negatively worded (limit or avoid)
WRITING ITEMS
24
Positively worded item ― Answers question with correct option― One correct option ― Three incorrect options
WRITING ITEMS
25
Priority setting ― Answers questions with the ldquobestrdquo option― Four correct options― One correct option based on a priority setting framework― Should ask for best first priority etc action
WRITING ITEMS
26
Negatively worded items should be avoided ― Answers question with an incorrect option ―Three correct options― One incorrect option ― Easy for the student to read incorrectly
WRITING ITEMS
27
Avoid writing negatively stated items
Exceptions-some NCLEXreg tasks are negatively worded and require a negatively stated item Examples of when a negatively stated item is appropriate
― Evaluating delegated care or monitoring another nursersquos care ― Identifying contraindications barriers developmental delays ― Verifying prescriptions
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
13
PEER REVIEW DRILLS
Development of solid test items is an ongoing process Establish peer dyads
― Reviewedit each otherrsquos items ― Reviewedit each otherrsquos tests
Review p value and point biserial index of each item after administration
14
ITEM WRITING TAKES PRACTICE
15
HAVE A CLEAR GAME PLAN
How can we stay focused on our purpose when writing items
Try asking yourselfhellip ― What contentconcept are you testing ― Does the item fit an NCLEX task ― What do students need to know to demonstrate proficiency and competency
16
BEST PRACTICE ADVICE SCORING RUNS WITH THE BIG 3
First base - Is the itemrsquos content relevant for an entry-level nurse Are you testing at the appropriate level Second base - Is the stem clear and concise Third base - Are the distractors plausible yet clearly wrong
17
WRITING ITEMS THE STEM
Describes a clinical situation in which the student must problem solve and apply the nursing process
Asks a specific question that the student must answer using nursing knowledge
Guidelines ― Always a nurse a client and context ― Relevant to entry-level practice ― Clear concise and without extraneous information ― Stated positively
18
WRITING ITEMS THE STEM
Must be relevant to entry-level practice ― Nurse-client interactions ―AssessmentData collection ― Planning ― Interventions ― Evaluation ― Documentation ― Management of care
Avoid or limit ― Definitionsterminology ― Statistical data that will change over time ― Minutia information ― Asking the student to make a medical
diagnosis
19
WRITING ITEMS THE STEM
Stem ― Client care related situation ― Provides information that students should consider when answering item ― Usually contains 2-3 sentences― Always contains a nurse client and context ― A step of the nursing process can be identified
20
WRITING ITEMS THE STEM
WRITING ITEMS THE STEM
21
WRITING ITEMS THE STEM POSSIBLE REVISION
22
WRITING ITEMS
23
Three types of items― Positively worded ― Priority setting ― Negatively worded (limit or avoid)
WRITING ITEMS
24
Positively worded item ― Answers question with correct option― One correct option ― Three incorrect options
WRITING ITEMS
25
Priority setting ― Answers questions with the ldquobestrdquo option― Four correct options― One correct option based on a priority setting framework― Should ask for best first priority etc action
WRITING ITEMS
26
Negatively worded items should be avoided ― Answers question with an incorrect option ―Three correct options― One incorrect option ― Easy for the student to read incorrectly
WRITING ITEMS
27
Avoid writing negatively stated items
Exceptions-some NCLEXreg tasks are negatively worded and require a negatively stated item Examples of when a negatively stated item is appropriate
― Evaluating delegated care or monitoring another nursersquos care ― Identifying contraindications barriers developmental delays ― Verifying prescriptions
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
14
ITEM WRITING TAKES PRACTICE
15
HAVE A CLEAR GAME PLAN
How can we stay focused on our purpose when writing items
Try asking yourselfhellip ― What contentconcept are you testing ― Does the item fit an NCLEX task ― What do students need to know to demonstrate proficiency and competency
16
BEST PRACTICE ADVICE SCORING RUNS WITH THE BIG 3
First base - Is the itemrsquos content relevant for an entry-level nurse Are you testing at the appropriate level Second base - Is the stem clear and concise Third base - Are the distractors plausible yet clearly wrong
17
WRITING ITEMS THE STEM
Describes a clinical situation in which the student must problem solve and apply the nursing process
Asks a specific question that the student must answer using nursing knowledge
Guidelines ― Always a nurse a client and context ― Relevant to entry-level practice ― Clear concise and without extraneous information ― Stated positively
18
WRITING ITEMS THE STEM
Must be relevant to entry-level practice ― Nurse-client interactions ―AssessmentData collection ― Planning ― Interventions ― Evaluation ― Documentation ― Management of care
Avoid or limit ― Definitionsterminology ― Statistical data that will change over time ― Minutia information ― Asking the student to make a medical
diagnosis
19
WRITING ITEMS THE STEM
Stem ― Client care related situation ― Provides information that students should consider when answering item ― Usually contains 2-3 sentences― Always contains a nurse client and context ― A step of the nursing process can be identified
20
WRITING ITEMS THE STEM
WRITING ITEMS THE STEM
21
WRITING ITEMS THE STEM POSSIBLE REVISION
22
WRITING ITEMS
23
Three types of items― Positively worded ― Priority setting ― Negatively worded (limit or avoid)
WRITING ITEMS
24
Positively worded item ― Answers question with correct option― One correct option ― Three incorrect options
WRITING ITEMS
25
Priority setting ― Answers questions with the ldquobestrdquo option― Four correct options― One correct option based on a priority setting framework― Should ask for best first priority etc action
WRITING ITEMS
26
Negatively worded items should be avoided ― Answers question with an incorrect option ―Three correct options― One incorrect option ― Easy for the student to read incorrectly
WRITING ITEMS
27
Avoid writing negatively stated items
Exceptions-some NCLEXreg tasks are negatively worded and require a negatively stated item Examples of when a negatively stated item is appropriate
― Evaluating delegated care or monitoring another nursersquos care ― Identifying contraindications barriers developmental delays ― Verifying prescriptions
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
15
HAVE A CLEAR GAME PLAN
How can we stay focused on our purpose when writing items
Try asking yourselfhellip ― What contentconcept are you testing ― Does the item fit an NCLEX task ― What do students need to know to demonstrate proficiency and competency
16
BEST PRACTICE ADVICE SCORING RUNS WITH THE BIG 3
First base - Is the itemrsquos content relevant for an entry-level nurse Are you testing at the appropriate level Second base - Is the stem clear and concise Third base - Are the distractors plausible yet clearly wrong
17
WRITING ITEMS THE STEM
Describes a clinical situation in which the student must problem solve and apply the nursing process
Asks a specific question that the student must answer using nursing knowledge
Guidelines ― Always a nurse a client and context ― Relevant to entry-level practice ― Clear concise and without extraneous information ― Stated positively
18
WRITING ITEMS THE STEM
Must be relevant to entry-level practice ― Nurse-client interactions ―AssessmentData collection ― Planning ― Interventions ― Evaluation ― Documentation ― Management of care
Avoid or limit ― Definitionsterminology ― Statistical data that will change over time ― Minutia information ― Asking the student to make a medical
diagnosis
19
WRITING ITEMS THE STEM
Stem ― Client care related situation ― Provides information that students should consider when answering item ― Usually contains 2-3 sentences― Always contains a nurse client and context ― A step of the nursing process can be identified
20
WRITING ITEMS THE STEM
WRITING ITEMS THE STEM
21
WRITING ITEMS THE STEM POSSIBLE REVISION
22
WRITING ITEMS
23
Three types of items― Positively worded ― Priority setting ― Negatively worded (limit or avoid)
WRITING ITEMS
24
Positively worded item ― Answers question with correct option― One correct option ― Three incorrect options
WRITING ITEMS
25
Priority setting ― Answers questions with the ldquobestrdquo option― Four correct options― One correct option based on a priority setting framework― Should ask for best first priority etc action
WRITING ITEMS
26
Negatively worded items should be avoided ― Answers question with an incorrect option ―Three correct options― One incorrect option ― Easy for the student to read incorrectly
WRITING ITEMS
27
Avoid writing negatively stated items
Exceptions-some NCLEXreg tasks are negatively worded and require a negatively stated item Examples of when a negatively stated item is appropriate
― Evaluating delegated care or monitoring another nursersquos care ― Identifying contraindications barriers developmental delays ― Verifying prescriptions
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
16
BEST PRACTICE ADVICE SCORING RUNS WITH THE BIG 3
First base - Is the itemrsquos content relevant for an entry-level nurse Are you testing at the appropriate level Second base - Is the stem clear and concise Third base - Are the distractors plausible yet clearly wrong
17
WRITING ITEMS THE STEM
Describes a clinical situation in which the student must problem solve and apply the nursing process
Asks a specific question that the student must answer using nursing knowledge
Guidelines ― Always a nurse a client and context ― Relevant to entry-level practice ― Clear concise and without extraneous information ― Stated positively
18
WRITING ITEMS THE STEM
Must be relevant to entry-level practice ― Nurse-client interactions ―AssessmentData collection ― Planning ― Interventions ― Evaluation ― Documentation ― Management of care
Avoid or limit ― Definitionsterminology ― Statistical data that will change over time ― Minutia information ― Asking the student to make a medical
diagnosis
19
WRITING ITEMS THE STEM
Stem ― Client care related situation ― Provides information that students should consider when answering item ― Usually contains 2-3 sentences― Always contains a nurse client and context ― A step of the nursing process can be identified
20
WRITING ITEMS THE STEM
WRITING ITEMS THE STEM
21
WRITING ITEMS THE STEM POSSIBLE REVISION
22
WRITING ITEMS
23
Three types of items― Positively worded ― Priority setting ― Negatively worded (limit or avoid)
WRITING ITEMS
24
Positively worded item ― Answers question with correct option― One correct option ― Three incorrect options
WRITING ITEMS
25
Priority setting ― Answers questions with the ldquobestrdquo option― Four correct options― One correct option based on a priority setting framework― Should ask for best first priority etc action
WRITING ITEMS
26
Negatively worded items should be avoided ― Answers question with an incorrect option ―Three correct options― One incorrect option ― Easy for the student to read incorrectly
WRITING ITEMS
27
Avoid writing negatively stated items
Exceptions-some NCLEXreg tasks are negatively worded and require a negatively stated item Examples of when a negatively stated item is appropriate
― Evaluating delegated care or monitoring another nursersquos care ― Identifying contraindications barriers developmental delays ― Verifying prescriptions
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
17
WRITING ITEMS THE STEM
Describes a clinical situation in which the student must problem solve and apply the nursing process
Asks a specific question that the student must answer using nursing knowledge
Guidelines ― Always a nurse a client and context ― Relevant to entry-level practice ― Clear concise and without extraneous information ― Stated positively
18
WRITING ITEMS THE STEM
Must be relevant to entry-level practice ― Nurse-client interactions ―AssessmentData collection ― Planning ― Interventions ― Evaluation ― Documentation ― Management of care
Avoid or limit ― Definitionsterminology ― Statistical data that will change over time ― Minutia information ― Asking the student to make a medical
diagnosis
19
WRITING ITEMS THE STEM
Stem ― Client care related situation ― Provides information that students should consider when answering item ― Usually contains 2-3 sentences― Always contains a nurse client and context ― A step of the nursing process can be identified
20
WRITING ITEMS THE STEM
WRITING ITEMS THE STEM
21
WRITING ITEMS THE STEM POSSIBLE REVISION
22
WRITING ITEMS
23
Three types of items― Positively worded ― Priority setting ― Negatively worded (limit or avoid)
WRITING ITEMS
24
Positively worded item ― Answers question with correct option― One correct option ― Three incorrect options
WRITING ITEMS
25
Priority setting ― Answers questions with the ldquobestrdquo option― Four correct options― One correct option based on a priority setting framework― Should ask for best first priority etc action
WRITING ITEMS
26
Negatively worded items should be avoided ― Answers question with an incorrect option ―Three correct options― One incorrect option ― Easy for the student to read incorrectly
WRITING ITEMS
27
Avoid writing negatively stated items
Exceptions-some NCLEXreg tasks are negatively worded and require a negatively stated item Examples of when a negatively stated item is appropriate
― Evaluating delegated care or monitoring another nursersquos care ― Identifying contraindications barriers developmental delays ― Verifying prescriptions
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
18
WRITING ITEMS THE STEM
Must be relevant to entry-level practice ― Nurse-client interactions ―AssessmentData collection ― Planning ― Interventions ― Evaluation ― Documentation ― Management of care
Avoid or limit ― Definitionsterminology ― Statistical data that will change over time ― Minutia information ― Asking the student to make a medical
diagnosis
19
WRITING ITEMS THE STEM
Stem ― Client care related situation ― Provides information that students should consider when answering item ― Usually contains 2-3 sentences― Always contains a nurse client and context ― A step of the nursing process can be identified
20
WRITING ITEMS THE STEM
WRITING ITEMS THE STEM
21
WRITING ITEMS THE STEM POSSIBLE REVISION
22
WRITING ITEMS
23
Three types of items― Positively worded ― Priority setting ― Negatively worded (limit or avoid)
WRITING ITEMS
24
Positively worded item ― Answers question with correct option― One correct option ― Three incorrect options
WRITING ITEMS
25
Priority setting ― Answers questions with the ldquobestrdquo option― Four correct options― One correct option based on a priority setting framework― Should ask for best first priority etc action
WRITING ITEMS
26
Negatively worded items should be avoided ― Answers question with an incorrect option ―Three correct options― One incorrect option ― Easy for the student to read incorrectly
WRITING ITEMS
27
Avoid writing negatively stated items
Exceptions-some NCLEXreg tasks are negatively worded and require a negatively stated item Examples of when a negatively stated item is appropriate
― Evaluating delegated care or monitoring another nursersquos care ― Identifying contraindications barriers developmental delays ― Verifying prescriptions
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
19
WRITING ITEMS THE STEM
Stem ― Client care related situation ― Provides information that students should consider when answering item ― Usually contains 2-3 sentences― Always contains a nurse client and context ― A step of the nursing process can be identified
20
WRITING ITEMS THE STEM
WRITING ITEMS THE STEM
21
WRITING ITEMS THE STEM POSSIBLE REVISION
22
WRITING ITEMS
23
Three types of items― Positively worded ― Priority setting ― Negatively worded (limit or avoid)
WRITING ITEMS
24
Positively worded item ― Answers question with correct option― One correct option ― Three incorrect options
WRITING ITEMS
25
Priority setting ― Answers questions with the ldquobestrdquo option― Four correct options― One correct option based on a priority setting framework― Should ask for best first priority etc action
WRITING ITEMS
26
Negatively worded items should be avoided ― Answers question with an incorrect option ―Three correct options― One incorrect option ― Easy for the student to read incorrectly
WRITING ITEMS
27
Avoid writing negatively stated items
Exceptions-some NCLEXreg tasks are negatively worded and require a negatively stated item Examples of when a negatively stated item is appropriate
― Evaluating delegated care or monitoring another nursersquos care ― Identifying contraindications barriers developmental delays ― Verifying prescriptions
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
20
WRITING ITEMS THE STEM
WRITING ITEMS THE STEM
21
WRITING ITEMS THE STEM POSSIBLE REVISION
22
WRITING ITEMS
23
Three types of items― Positively worded ― Priority setting ― Negatively worded (limit or avoid)
WRITING ITEMS
24
Positively worded item ― Answers question with correct option― One correct option ― Three incorrect options
WRITING ITEMS
25
Priority setting ― Answers questions with the ldquobestrdquo option― Four correct options― One correct option based on a priority setting framework― Should ask for best first priority etc action
WRITING ITEMS
26
Negatively worded items should be avoided ― Answers question with an incorrect option ―Three correct options― One incorrect option ― Easy for the student to read incorrectly
WRITING ITEMS
27
Avoid writing negatively stated items
Exceptions-some NCLEXreg tasks are negatively worded and require a negatively stated item Examples of when a negatively stated item is appropriate
― Evaluating delegated care or monitoring another nursersquos care ― Identifying contraindications barriers developmental delays ― Verifying prescriptions
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING ITEMS THE STEM
21
WRITING ITEMS THE STEM POSSIBLE REVISION
22
WRITING ITEMS
23
Three types of items― Positively worded ― Priority setting ― Negatively worded (limit or avoid)
WRITING ITEMS
24
Positively worded item ― Answers question with correct option― One correct option ― Three incorrect options
WRITING ITEMS
25
Priority setting ― Answers questions with the ldquobestrdquo option― Four correct options― One correct option based on a priority setting framework― Should ask for best first priority etc action
WRITING ITEMS
26
Negatively worded items should be avoided ― Answers question with an incorrect option ―Three correct options― One incorrect option ― Easy for the student to read incorrectly
WRITING ITEMS
27
Avoid writing negatively stated items
Exceptions-some NCLEXreg tasks are negatively worded and require a negatively stated item Examples of when a negatively stated item is appropriate
― Evaluating delegated care or monitoring another nursersquos care ― Identifying contraindications barriers developmental delays ― Verifying prescriptions
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING ITEMS THE STEM POSSIBLE REVISION
22
WRITING ITEMS
23
Three types of items― Positively worded ― Priority setting ― Negatively worded (limit or avoid)
WRITING ITEMS
24
Positively worded item ― Answers question with correct option― One correct option ― Three incorrect options
WRITING ITEMS
25
Priority setting ― Answers questions with the ldquobestrdquo option― Four correct options― One correct option based on a priority setting framework― Should ask for best first priority etc action
WRITING ITEMS
26
Negatively worded items should be avoided ― Answers question with an incorrect option ―Three correct options― One incorrect option ― Easy for the student to read incorrectly
WRITING ITEMS
27
Avoid writing negatively stated items
Exceptions-some NCLEXreg tasks are negatively worded and require a negatively stated item Examples of when a negatively stated item is appropriate
― Evaluating delegated care or monitoring another nursersquos care ― Identifying contraindications barriers developmental delays ― Verifying prescriptions
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING ITEMS
23
Three types of items― Positively worded ― Priority setting ― Negatively worded (limit or avoid)
WRITING ITEMS
24
Positively worded item ― Answers question with correct option― One correct option ― Three incorrect options
WRITING ITEMS
25
Priority setting ― Answers questions with the ldquobestrdquo option― Four correct options― One correct option based on a priority setting framework― Should ask for best first priority etc action
WRITING ITEMS
26
Negatively worded items should be avoided ― Answers question with an incorrect option ―Three correct options― One incorrect option ― Easy for the student to read incorrectly
WRITING ITEMS
27
Avoid writing negatively stated items
Exceptions-some NCLEXreg tasks are negatively worded and require a negatively stated item Examples of when a negatively stated item is appropriate
― Evaluating delegated care or monitoring another nursersquos care ― Identifying contraindications barriers developmental delays ― Verifying prescriptions
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING ITEMS
24
Positively worded item ― Answers question with correct option― One correct option ― Three incorrect options
WRITING ITEMS
25
Priority setting ― Answers questions with the ldquobestrdquo option― Four correct options― One correct option based on a priority setting framework― Should ask for best first priority etc action
WRITING ITEMS
26
Negatively worded items should be avoided ― Answers question with an incorrect option ―Three correct options― One incorrect option ― Easy for the student to read incorrectly
WRITING ITEMS
27
Avoid writing negatively stated items
Exceptions-some NCLEXreg tasks are negatively worded and require a negatively stated item Examples of when a negatively stated item is appropriate
― Evaluating delegated care or monitoring another nursersquos care ― Identifying contraindications barriers developmental delays ― Verifying prescriptions
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING ITEMS
25
Priority setting ― Answers questions with the ldquobestrdquo option― Four correct options― One correct option based on a priority setting framework― Should ask for best first priority etc action
WRITING ITEMS
26
Negatively worded items should be avoided ― Answers question with an incorrect option ―Three correct options― One incorrect option ― Easy for the student to read incorrectly
WRITING ITEMS
27
Avoid writing negatively stated items
Exceptions-some NCLEXreg tasks are negatively worded and require a negatively stated item Examples of when a negatively stated item is appropriate
― Evaluating delegated care or monitoring another nursersquos care ― Identifying contraindications barriers developmental delays ― Verifying prescriptions
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING ITEMS
26
Negatively worded items should be avoided ― Answers question with an incorrect option ―Three correct options― One incorrect option ― Easy for the student to read incorrectly
WRITING ITEMS
27
Avoid writing negatively stated items
Exceptions-some NCLEXreg tasks are negatively worded and require a negatively stated item Examples of when a negatively stated item is appropriate
― Evaluating delegated care or monitoring another nursersquos care ― Identifying contraindications barriers developmental delays ― Verifying prescriptions
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING ITEMS
27
Avoid writing negatively stated items
Exceptions-some NCLEXreg tasks are negatively worded and require a negatively stated item Examples of when a negatively stated item is appropriate
― Evaluating delegated care or monitoring another nursersquos care ― Identifying contraindications barriers developmental delays ― Verifying prescriptions
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
Discussion of Negative Tasks with Examples
28
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
THE STEM KEY WORDS
29
What are key words ― Critical words or phrases in an item ― Important for students to be able to recognize these ― Key words can be in scenario and question ― Options can be developed around alternate key word
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
A nurse is creating a plan of care for a client who had a chest tube inserted 1 hr ago Which of the following interventions should the nurse include
TEAMWORK IDENTIFY KEY WORDS
30
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
BEST PRACTICE APPROPRIATE LEVEL
31
Remember the population taking the test Students do not have years of experience or specialized knowledge Students will not have textbooks available during the test Keep the content relevant to entry-level practice
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
BEST PRACTICE CLEAR AND CONCISE
32
Omit unnecessary text Do not confuse student about what you are asking Get to the point but present sufficient information for the student to respond (takes
practice) Remember that item difficulty should not lie in the stem but rather in selecting the
correct response action or decision
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
USING NCLEXreg STYLE TERMINOLOGY
33
USE Avoid
Client ldquoreportsrdquo Client ldquocomplains ofrdquoFocus on the clientldquoA client who has diabetesrdquo
Do not label the clientldquoA diabetic clientrdquo
Only relevant information Gender age marital status racial references (unless pertinent to testing point)
Prescription OrderProvider Physician doctor nurse practitioner physician assistant
Medication generic namesldquoWarfarinrdquo
Medication trade namesldquoCoumadinrdquo
Active present tense Passive tenseClear questions Awkward and wordy sentencesA nurseA client
Personal pronouns
Full wordsldquoHypertensionrdquo
AbbreviationsldquoHTNrdquo
Clinical terminologyldquoHypotensionrdquo
Laymanrsquos terminologyldquoLow blood pressurerdquo
Equipment generic termsldquoIndwelling urinary catheterrdquo
Equipment trade namesldquoFoley catheterrdquo
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
TEAMWORK ndash THE STEM
34
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
GROUP REVIEW ndash STEM
35
A nurse is caring for a 72-year old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN Heis scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
TEAMWORK ndash THE STEM
36
A nurse is caring for a 72-year-old male cardiac client who was admitted from the emergency department to the medical unit 4 hr ago The client has a history of HTN He is scheduled for a cardiac catheterization on the next shift using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Revised ItemA nurse is caring for a client who is scheduled for a cardiac catheterization using a radiopaque dye When checking for food allergies which of the following findings is the nursersquos priority
Original Item
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
PEER REVIEW DRILL ndash THE STEM
37
Agility Training First and Second Base
Review the stems of the items that you brought today
Review stems using ATI Item Writing Decision-Making Tree
Compare stems and suggested edits with peer
Compare stems and suggested edits with consultant
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING ITEMS FOUR OPTIONS
38
Key― One correct answer
Distractors― Three wrong answers X X X
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
39
Key― Correct option
bull 1 key for multiple choice and priority itemsbull 2 or more for multiple response items
― Answers question posed in the stem― Clearly defensible in the rationale
Distractor― ldquoDistractsrdquo students from correct answer― Plausible and likely for students to choose ― Not too close to the truth or arguably correct
(Oermann and Gaberson 2017)
WRITING ITEMS OPTIONS
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING ITEMS OPTIONS
Positively worded stem― 1 correct option― 3 incorrect options
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following actions should the nurse takeA Use sterile gloves to remove the old dressing
B Place old dressing in the clientrsquos trash canC Open sterile dressings before putting on sterile gloves
D Write date and time on dressing with a marker
40
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING ITEMS OPTIONS
Priority setting ― Answers question with ldquobestrdquo answer
A nurse is changing the dressing for a client who is postoperative following a colon resection Which of the following action should the nurse take firstA Place the old dressing in a disposable bagB Use clean gloves to remove the old dressingC Open sterile dressings before putting on sterile glovesD Write date and time on the dressing with a pen
41
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
BEST PRACTICE PLAUSIBLE DISTRACTORS
42
No throwaway distractors
Students who donrsquot know the content should be the only ones to select the distractors
Distractors should sound like the truth without getting too close to the truth
3rd
Base
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
PLAUSIBLE DISTRACTORS
43
A nurse is preparing to perform a sterile procedure Which of the following actions should the nurse take to maintain surgical asepsisA Keep splashes on the sterile field to a minimumB Cover the nose and mouth with gloved hands if a sneeze is imminentC Pour liquids from a clean container after donning sterile gloves
D Consider the outer 1 inch of the sterile field contaminated
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
TIPS FOR WRITING PLAUSIBLE DISTRACTORS
44
As you create items consider student misconceptions ― What are common mistakes a weak student would make
― Ideally distractors should diagnose levels of understanding for remediation
Use terms they may have heard but are not certain about― Clinical terms
Use friendly positive-sounding language in the distractors
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
TIPS FOR WRITING OPTIONS
45
Avoid these strikes― Notify the provider― Notify the charge nurse― Always only never every― All of the above― None of the above― Multiple multiples
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
TIPS FOR WRITING OPTIONS
46
Donrsquot swing at bad pitches― Obvious keys― Strive for symmetry in the four options ― Avoid mutually exclusive options― Avoid using samesimilar terms in stem and key― Donrsquot introduce new information― Write options that are independent― Avoid creating subsets― Include no more than two ldquoelementsrdquo per option― Avoid options that are partially or could arguably be correct― Avoid cues by having a number only in the key
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
47
If an option simply reads like something impossible to disagree with then it is probably the key
Answers like these will attract students who are test-wiseminus ldquohellip within legal guidelinesrdquominus ldquohellipaccording to established safety proceduresrdquominus ldquohellipuse appropriate hand-washing techniquerdquominus ldquohellipaccording to protocolrdquo
WRITING OPTIONS OBVIOUS KEYS
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
OBVIOUS KEYS EXAMPLE
48
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
OBVIOUS KEYS EXAMPLE
49
A nurse manager is conducting an in-service about disaster management with a group of newly-hired nurses The nurse manager should include that which of the following actions is the nursersquos priorityA Make sure the clients on the unit are safe
B Follow instructions from the charge nurseC Switch electrical equipment to battery functionD Implement a client location tracking system
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING OPTIONS SYMMETRY
Strive for symmetry in the four options
STEMShort sentence
Short sentence
Medium length sentence
Really long and wordy sentence
50
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING OPTIONS SYMMETRY
51
STEM
Apple
Orange
Banana
Hammer
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING OPTIONS SYMMETRY
52
STEM
Apple
Orange
Wrench
Hammer
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
SYMMETRY EXAMPLE
A nurse is reviewing laboratory values for a client who has anemia Which of the following findings should the nurse expect A Decreased luteinizing hormoneB Elevated testosteroneC Decreased hemoglobinD Elevated acid phosphatase
53
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
A nurse is reviewing the laboratory values for a client who has anemia Which of the following findings should the nurse expect
A Decreased luteinizing hormone B Elevated testosterone C Decreased hemoglobinD Elevated acid phosphatase
54
SYMMETRY EXAMPLE
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING OPTIONS MUTUALLY EXCLUSIVE
55
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressing
B Keep the wound open to air
C Irrigate the wound with povidone-iodine
D Apply lidocaine gel to the wound
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING OPTIONS MUTUALLY EXCLUSIVE
56
A nurse is planning to provide wound care Which of the following actions should the nurse include in the plan of care A Cover the wound with a dry dressingB Keep the wound open to airC Irrigate the wound with povidone-iodineD Apply lidocaine gel to the wound
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
57
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING OPTIONS SAME TERMS
A nurse is caring for a client who is grieving the recent death of her partner Which of the following actions should the nurse takeA Develop a trusting relationship by offering the client sympathy
B Encourage the client to talk about the death of her partner
C Remind the client that she will feel better in a few months
D Tell the client about a recent loss of a loved one
58
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING OPTIONS NEW INFORMATION
A nurse is teaching a client about management of diabetes Which of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
59
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING OPTIONS NEW INFORMATION
A nurse is providing instruction about management of diabetes to a clientWhich of the following information should the nurse include A Self-administer insulin lispro at bedtimeB Limit intake of foods high in fiberC Take metformin extended release with the evening meal D Avoid eating before strenuous exercise
60
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
61
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING OPTIONS INDEPENDENT OPTIONS
During a mass casualty drill a nurse is taking care of a client who is in shock Which of the following actions should the nurse takeA Lower the clientrsquos body temperatureB Cool the clientrsquos skinC Elevate the clientrsquos legsD Offer the client oral liquids
62
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
63
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING OPTIONS SUBSETS
A nurse is preparing to admit a client to the unit following surgery Which of the following should the nurse assess upon the clientrsquos arrival
A Vital signsB Blood pressureC Heart rateD Temperature
64
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING OPTIONS MULTIPLE ELEMENTS
65
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipation
B Insomnia weight gain diarrhea
C Fatigue diaphoresis weight loss
D Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING OPTIONS MULTIPLE ELEMENTS
66
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gain constipationB Insomnia weight gain diarrheaC Fatigue diaphoresis weight lossD Palpitations increased appetite constipation
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING OPTIONS MULTIPLE ELEMENTS
67
A nurse is assessing a client who has hypothyroidism Which of the following findings should the nurse expectA Fatigue weight gainB Insomnia diarrheaC Diaphoresis weight lossD Palpitations increased appetite
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING OPTIONS GIVING NUMBER CUES
A nurse is providing discharge instructions to a client who is postoperative following a cataract extraction Which of the following instructions should the nurse includeA Bend at the waist to pick up an object from the floorB Do not lift an object that weighs more than 10 poundsC Remove your eye shield before going to bedD Lie on your operative side when resting
68
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING OPTIONS CUES
A nurse is providing discharge instruction to a client who is postoperative from a cataract extraction Which of the following instructions should the nurse include
A Bend at the waist to pick up an object from the floor
B Do not lift an object that weighs more than 10 pounds
C Remove your eye shield before going to bed
D Lie on your operative side when resting
69
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Keep options homogenous
bull All nursing interventions medications lab values etc
bull Comparable level of technical language and complexity
70
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
WRITING ITEMS OPTIONS
Other pearls for writing strong options― Vary placement of correct answers― Place in a logical order (alphabetical
numerical)
71
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
ROUNDING THE BASES THE BIG 3
72
1st Base
Write items at a nursing student
level
2nd Base
Be clear and brief in the stem
3rd Base
Write plausible but wrong distractors
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
PEER REVIEW DRILL ndash OPTIONS
Review the items that you brought today Review options of items using ATI Item Writing Decision-Making Tree Compare options and suggested edits with peer Compare options and suggested edits with consultant
73
Agility Training Third Base
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
74
Strategies for the
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
75
TAGGING UP LEVEL OF THINKING
bull Rememberbull Understand
Foundational Thinking
bull Apply bull Analyzebull Evaluatebull Create
Critical Thinking Clinical Judgment
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
76
Next
Priority
Immediate
FirstInitial
Greatest Risk
Best
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
77
NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
Which of the following actions should the nurse take first Which of the following assessment findings should the nurse report to the
provider immediately Which of the following actions is the nursersquos priority Which of the following clients should the nurse assess first Which of the following methods is the best
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
78
FRAMEWORKS TO GET IN SCORING POSITION
Maslowrsquos Hierarchy of NeedsAirway - Breathing - Circulation
Safety and Risk Reduction
Nursing Process
Least RestrictiveLeast InvasiveAcute vs ChronicUnstable vs Stable
Urgent vs Non UrgentSurvival Potential
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
79
MASLOWrsquoS HIERARCHY OF NEEDS
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
80
MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
A nurse on a medical-surgical unit is caring for four clients The nurse should provide care for which of the following clients firstA A client who requires initiation of enteral tube feedingsB A client who needs discharge instructions about how to use a walkerC A client who is ready to verbalize his concerns about a below-the-knee amputation D A client who has cancer and is asking for community resources
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
81
MASLOWrsquoS HIERARCHY RATIONALES
A The priority action the nurse should take when using Maslowrsquos hierarchy of needs is to meet a clientrsquos physiological need for food and fluids Therefore the nurse should first care for the client who requires initiation of enteral tube feedings
B Giving a client instructions about how to use a walker is important to promote client safety however there is another client the nurse should care for firstC Providing a client an opportunity to verbalize his concerns about his below-the-knee amputation is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for firstD Providing a client with community resources is important to meet the clientrsquos need for love and belonging however there is another client the nurse should care for first
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
82
AIRWAY BREATHING CIRCULATION (ABC)
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
83
AIRWAY BREATHING CIRCULATION EXAMPLE
A nurse is caring for a client who just developed a pulmonary embolus Which of the following actions should the nurse take firstA Start a peripheral intravenous infusion
B Initiate oxygen therapy by a mask
C Reassure the client
D Administer morphine
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
AIRWAY BREATHING CIRCULATION RATIONALES
84
A The nurse should initiate a peripheral intravenous infusion to promote circulation however there is another action the nurse should take first
B The first action the nurse should take when using the airway breathing circulation approach to client care is administer oxygen by mask to reducethe clientrsquos risk of hypoxia
C The nurse should reduce the clientrsquos anxiety by providing reassurancehowever there is another action the nurse should take first
D The nurse should administer morphine to reduce the clientrsquos chest discomfort however there is another action the nurse should take first
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
85
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
86
SAFETY AND RISK REDUCTION EXAMPLE
A nurse is caring for a child who has conduct disorder The child suddenly begins to throw objects and kick others Which of the following actions is the nursersquos priorityA Encourage the client to express feelings
B Promote attendance at an assertiveness training group
C Teach the client to perform relaxation breathing
D Use a therapeutic holding technique with the client
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
87
SAFETY AND RISK REDUCTION RATIONALES
A The nurse should encourage the client to express his feelings to allow him an alternative way to communicate but another action is the nursersquos priority
B The nurse should promote attendance at an assertiveness training group so the client will learn appropriate strategies for expressing feelings but another action is the nursersquos priority
C The nurse should teach the client to perform relaxation breathing to reduce tension but another action is the nursersquos priority
D The clientrsquos behavior indicates that he is at greatest risk for harming others therefore the priority action the nurse should take is to use a therapeutic holding technique
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
88
NURSING PROCESS
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
89
NURSING PROCESS EXAMPLE
A nurse is caring for a client who is receiving IV therapy The client reports pain at the insertion site Which of the following actions should the nurse take first
A Remove the catheter
B Apply a warm compress to the insertion site
C Place a new catheter in the opposite arm
D Check for redness at the insertion site
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
NURSING PROCESS RATIONALES
90
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse
should take first
B The nurse should apply a warm compress to the intravenous insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos left arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
91
LEAST RESTRICTIVELEAST INVASIVE
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
NURSING PROCESS RATIONALES
92
A The nurse should remove the catheter if there is redness at the insertionsite because this indicates phlebitis however there is another action the nurse should take first
B The nurse should apply a warm compress to the insertion site if the assessment reveals phlebitis however there is another action the nurse should take first
C The nurse should insert a new catheter in the clientrsquos opposite arm if the assessment reveals phlebitis however there is another action the nurse should take first
D The first action the nurse should take using the nursing process is to assesscollect data from the client The nurse should assess the clientrsquos intravenous site for indications of complications of intravenous therapy such as infiltration and phlebitis
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
93
LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
A nurse is caring for a client who had a vaginal birth 8 hr ago The client reports feeling weak and dizzy The nurse notes that the clientrsquos perineal pad is soaked with blood Which of the following actions should the nurse take firstA Provide an IV bolus of lactated RingerrsquosB Insert an indwelling urinary catheterC Perform a fundal massageD Administer oxytocin
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
94
LEAST RESTRICTIVELEAST INVASIVE RATIONALESA Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to provide an IV bolus of lactated Ringerrsquos however the nurse should use a less invasive intervention firsthellip B Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to insert and indwelling urinary catheter however the nurse should use a less invasive intervention firstC Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness When providing client care the nurse should first use the least invasive intervention therefore the first action the nurse should take is to perform a fundal massage D Manifestations of postpartum hemorrhage include saturation of the perineal pad as well as dizziness and weakness The nurse may need to administer oxytocin however the nurse should use a less invasive intervention first
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
95
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
96
ACUTE VS CHRONIC EXAMPLE
A nurse on a medical unit is assessing four clients Which of the following findings should the nurse identify as the priorityA A client who has Parkinsonrsquos disease reports that his tremors have increased
B A client who has myasthenia gravis reports increased difficulty swallowing
C A client who has Cushingrsquos disease has petechiae on his arms
D A client who has cirrhosis has a distended abdomen
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
97
ACUTE VS CHRONIC RATIONALES
A Parkinsonrsquos disease is a chronic disorder and tremors is an expected finding therefore the nurse should identify another finding as the priority
B Using the acute vs chronic approach to client care the nurse should identify the priority the as the client who has myasthenia gravis and increased difficulty swallowing Difficulty swallowing is a manifestation of myasthenia gravis that places the client at risk for aspiration
C Cushingrsquos disease is a chronic disorder and petechiae is an expected finding therefore the nurse should identify another finding as the priority
D Cirrhosis is a chronic disorder and a distended abdomen is an expected finding therefore the nurse should identify another finding as the priority
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
98
STABLE VS UNSTABLE EXAMPLE
A nurse in a providerrsquos office is reviewing the laboratory values for four clients Which of the following clientrsquos should the nurse assess firstA A client who takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL
B A client who is taking lithium carbonate for bipolar disorder and has a serum lithium level of 18 mEqL
C A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL
D A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
99
STABLE VS UNSTABLE RATONALES
A A client who has takes levothyroxine for hypothyroidism and has a TSH level of 03 microunitsmL is stable therefore there is another client the nurse should assess firstB A plasma lithium level of 18 mEqL indicates toxicity for a client who has bipolar disorder and takes lithium carbonate therefore this client is unstable and is the client the nurse should assess firstC A client who is undergoing testing for diabetes and has a fasting blood glucose of 100 mgdL is stable therefore there is another client the nurse should assess firstD A client who has benign prostatic hyperplasia and has a PSA of 29 ngmL is stable therefore there is another client the nurse should assessfirst
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
100
URGENT VS NONURGENT EXAMPLE
A nurse received change-of-shift report on four clients Which of the following clients should the nurse assess firstA A client who has a renal calculus and has been unable to void for the last 4 hours
B A client who is taking rifampin for tuberculosis and reports orange-tinged urine
C A client who is 2 hr postoperative and has an oral temperature of 375degC (995degF)
D A client whose skin is dry and cracked following external radiation therapy
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
101
URGENT VS NONURGENT RATIONALES
A When using the urgent vs nonurgent approach to client care the nurse determines that the priority finding is a client who has a renal calculus and is unable to void This can indicate an obstruction which requires immediate intervention therefore this is the priority finding B Reports of orange-tinged urine is a non-urgent finding because it is an expected finding for a client who has tuberculosis and is taking rifampin therefore there is another finding that is the priorityC Low-grade fever is a non-urgent finding because it is an expected finding for a client who is 2 hr postoperative therefore there is another finding that is the priorityD Dry cracked skin is a non-urgent finding because it is an expected finding for a client whose treatment includes external radiation therapy therefore there is another finding that is the priority
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
102
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
103
SURVIVAL POTENTIAL EXAMPLE
A nurse is assessing clients during a mass casualty event Which of the following clients should the nurse recommend for first transport to a health care facility A A client who has chest pain with radiation down the left arm
B A client who has compound fractures of both legs and reports having thirst C A client who has multiple lacerations 2 inches in length to both arms and lower legsD A client who has blood draining from both ears and agonal respirations
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
104
SURVIVAL POTENTIAL-RATIONALE
A A client who chest pain radiating down his left arm is probably having a myocardial infarction which requires immediate intervention for survival therefore when using the survival approach to client care the nurse should recommend this client for first transportB A client who has compound fractures of both legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportC A client who has multiple lacerations 2 inches in length to both arms and lower legs does not have an immediate threat to life and can wait for treatment therefore the nurse should recommend another client for first transportD A client who has blood draining from both ears with agonal respirationshas a minimal chance of survival even with intervention therefore the nurse should recommend another client for first transport
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
105
TEAMWORK DRILL ndash OPTIONSAgility Training Priority Setting Items Rejoin your group and rewrite items
so they are priority setting items
Identify the priority setting framework for the items you rewrite
Compare options and suggested edits with members of group
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
107
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
108
MULTIPLE RESPONSE
5-6 options At least 2 options must be correct At least 1 option must be incorrect
Hint― Use for easy concepts― Concepts that naturally come in a group ― Writers block
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
109
MULTIPLE RESPONSE EXAMPLE
A nurse is preparing to administer immunizations to a 1-year-old toddler who has received all prior immunizations according to schedule Which of the following immunizations should the nurse plan to administer A Varicella (VAR)
B Tetanus diphtheria amp acellular pertussis (Tdap)
C Measles Mumps Rubella (MMR)
D Rotavirus (RV)
E Haemophilus influenzae type b (HIB)
F Hepatitis A (HepA)
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
110
ORDERED RESPONSE
All options need to be correct 4-5 options Must be an order
Hint― Numbered items in references donrsquot always follow an order― Bulleted information isnrsquot necessarily in order
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
111
ORDERED RESPONSE EXAMPLE
A nurse is caring for a client when a small trash can fire starts Which of the following actions should the nurse take (Move the steps into the box on the right placing them in the order of performance Use all the steps) A Activate the alarm
B Use an extinguisher
C Evacuate clients who are in immediate danger
D Close doors and windows
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
112
FILL-IN-THE-BLANK
Dosage Calculations― Number of tablets― Milliliters to administer― Rate of IV infusion― gttsmin
IampO Estimated date of delivery
Hint― Develop a standard format― Include rounding instructions on each item
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
113
FILL-IN-THE-BLANK EXAMPLE
A nurse is preparing to administer phenytoin suspension 250 mg PO to a client The dose available is 125 mg5mL suspension How many mL should the nurse administer (Round the answer to the nearest whole number)
mL
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
114
GRAPHIC OPTION
Written like a multiple choice item Use graphics instead of words for options
Hint― Make sure the items in the image are identifiable
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
115
GRAPHIC OPTION EXAMPLE
Write a stem for these options
A B C D
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
116
HOT SPOT
3-4 sites to choose from 1 or more areas can be correct
Hint― Give instructions to the student
bull (You will find ldquoHot Spotsrdquo to select in the artwork below Select only the hotspot that corresponds to your answer)
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
117
HOT SPOT EXAMPLE
Write a stem for this image
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
118
CHART EXHIBIT
Written like a multiple choice item 3 tabs (simulated medical record) Students are advised to look at tabs to answer question
Hint― Ensure the student needs to use the tabs to answer the item― Donrsquot add too much information to confuse the student― All options need to have content in the tabs that will draw the student
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
119
CHART EXHIBIT EXAMPLE
A nurse is caring for a client who has cystic fibrosis Which of the following actions should the nurse take (Click on the exhibit button for additional information about the client There are three tabs that contain separate categories of data)A Initiate oxygen via face mask
B Place the client in contact isolation precautions
C Give the lowest dose of pancreatic enzymes
D Prepare the client for a blood transfusion
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
120
BRINGING IN THE CLOSERhellip
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
121
QUESTIONS
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-
122
References Anderson L W amp Krathwohl D R (2001) A taxonomy for learning teaching and assessing A revision of Bloomrsquos taxonomyof educational objectives Boston MA Pearson Education Group
Billings D amp Halstead J (2016) Teaching in nursing A guide for faculty (5th ed) St Louis MO Elsevier
Bloom BS amp Krathwohl D R (1956) Taxonomy of educational objectives The classification of educational goals by a committee of college and university examiners Handbook I Cognitive domain New York NY Longmans Green
National Council of State Boards of Nursing (2019) NCLEX-RNreg Examination Test plan for the National Council licensure examination for registered nurses Retrieved from httpswwwncsbnorgRN_Test_Plan_2019_Finalpdf
National Council of State Boards of Nursing (2017) NCLEX-PNreg Examination Test plan for the National Council licensure examination for nurses Retrieved from httpswwwncsbnorg2017_PN_TestPlanpdf
Oermann M amp Gaberson K (2017) Evaluation and testing in nursing education (5th ed) New York NY Springer
- Slide Number 1
- DONrsquoT STRIKE OUT HITTING A GRAND SLAM WITHITEM WRITING
- OBJECTIVES
- THE ART OF ITEM WRITING
- BEGIN WITH A WIN IN SIGHT NCLEXreg RN TEST PLAN
- SLIDING INTO HOME PLATEhellip NCLEXreg PN TEST PLAN
- CHALLENGES FOR NURSING FACULTY
- GAME FUNDAMENTALSCOMPONENTS OF THE TEST PLAN
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- WRITING ITEMS THE STEM
- WRITING ITEMS THE STEM POSSIBLE REVISION
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- WRITING ITEMS
- Slide Number 28
- THE STEM KEY WORDS
- TEAMWORK IDENTIFY KEY WORDS
- BEST PRACTICE APPROPRIATE LEVEL
- BEST PRACTICE CLEAR AND CONCISE
- USING NCLEXreg STYLE TERMINOLOGY
- TEAMWORK ndash THE STEM
- GROUP REVIEW ndash STEM
- TEAMWORK ndash THE STEM
- PEER REVIEW DRILL ndash THE STEM
- WRITING ITEMS FOUR OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- BEST PRACTICE PLAUSIBLE DISTRACTORS
- PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING PLAUSIBLE DISTRACTORS
- TIPS FOR WRITING OPTIONS
- TIPS FOR WRITING OPTIONS
- WRITING OPTIONS OBVIOUS KEYS
- OBVIOUS KEYS EXAMPLE
- OBVIOUS KEYS EXAMPLE
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- WRITING OPTIONS SYMMETRY
- SYMMETRY EXAMPLE
- Slide Number 54
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS MUTUALLY EXCLUSIVE
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS SAME TERMS
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS NEW INFORMATION
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS INDEPENDENT OPTIONS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS SUBSETS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS MULTIPLE ELEMENTS
- WRITING OPTIONS GIVING NUMBER CUES
- WRITING OPTIONS CUES
- WRITING ITEMS OPTIONS
- WRITING ITEMS OPTIONS
- ROUNDING THE BASES THE BIG 3
- PEER REVIEW DRILL ndash OPTIONS
- Hey Batter Batter Hey Batter Batter Swing
- TAGGING UP LEVEL OF THINKING
- GOING THE DISTANCE WITH PRIORITY SETTING ITEMS
- NO WILD PITCHES FOCUS ON PRIORITY QUESTIONS
- FRAMEWORKS TO GET IN SCORING POSITION
- MASLOWrsquoS HIERARCHY OF NEEDS
- MASLOWrsquoS HIERACHY OF NEEDS EXAMPLE
- MASLOWrsquoS HIERARCHY RATIONALES
- AIRWAY BREATHING CIRCULATION (ABC)
- AIRWAY BREATHING CIRCULATION EXAMPLE
- AIRWAY BREATHING CIRCULATION RATIONALES
- Slide Number 85
- SAFETY AND RISK REDUCTION EXAMPLE
- SAFETY AND RISK REDUCTION RATIONALES
- NURSING PROCESS
- NURSING PROCESS EXAMPLE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE
- NURSING PROCESS RATIONALES
- LEAST RESTRICTIVELEAST INVASIVE EXAMPLE
- LEAST RESTRICTIVELEAST INVASIVE RATIONALES
- Slide Number 95
- ACUTE VS CHRONIC EXAMPLE
- ACUTE VS CHRONIC RATIONALES
- STABLE VS UNSTABLE EXAMPLE
- STABLE VS UNSTABLE RATONALES
- URGENT VS NONURGENT EXAMPLE
- URGENT VS NONURGENT RATIONALES
- Slide Number 102
- SURVIVAL POTENTIAL EXAMPLE
- SURVIVAL POTENTIAL-RATIONALE
- TEAMWORK DRILL ndash OPTIONS
- Baseball Diamond Review Priority SETTING ITEMS
- Extra Innings Alternate Items
- MULTIPLE RESPONSE
- MULTIPLE RESPONSE EXAMPLE
- ORDERED RESPONSE
- ORDERED RESPONSE EXAMPLE
- FILL-IN-THE-BLANK
- FILL-IN-THE-BLANK EXAMPLE
- GRAPHIC OPTION
- GRAPHIC OPTION EXAMPLE
- HOT SPOT
- HOT SPOT EXAMPLE
- CHART EXHIBIT
- CHART EXHIBIT EXAMPLE
- BRINGING IN THE CLOSERhellip
- QUESTIONS
- References
-