iron-clad your preparation for the nclex® exam

Nursing Curricula and the Nursing Curricula and the NCLEXNCLEX®® Exam: Exam:

Traveling a Path to SuccessTraveling a Path to Success

MaryAnn Hogan, MSN, RNMaryAnn Hogan, MSN, RNWest Palm Beach, FLWest Palm Beach, FL

January 24, 2011January 24, 2011

Session Objectives:Session Objectives:

Summarize what has changed in the Summarize what has changed in the current NCLEX RN and PN test plans.current NCLEX RN and PN test plans.Describe a process for mapping nursing Describe a process for mapping nursing curricula to the NCLEX test plan to reduce curricula to the NCLEX test plan to reduce or eliminate curricular gaps or overlaps. or eliminate curricular gaps or overlaps. Explore various ways of integrating Explore various ways of integrating NCLEX style test questions into courses in NCLEX style test questions into courses in a nursing curriculum.a nursing curriculum.

Overview of the NCLEXOverview of the NCLEX®® Licensing Exam for RNs Licensing Exam for RNs

and LPN/and LPN/LVNsLVNs

Exam OverviewExam Overview

Computer adaptive test (CAT)Computer adaptive test (CAT)Each question classified by client need, Each question classified by client need, integrated process, and is assigned a level integrated process, and is assigned a level of difficulty after being pretestedof difficulty after being pretestedNumber of Questions: Number of Questions: ––

RN: 75RN: 75--265; 15 pretest items265; 15 pretest items

––

PN: 85PN: 85--205; 25 pretest items 205; 25 pretest items

Exam OverviewExam OverviewMaximum time: Maximum time: –– RN: 6 hrs; PN: 5 hrsRN: 6 hrs; PN: 5 hrs–– Time includes tutorial, sample items, Time includes tutorial, sample items,

breaks (all breaks are optional), and breaks (all breaks are optional), and examexam

Drop down calculator availableDrop down calculator availableCandidate reads question, selects and Candidate reads question, selects and confirms answer to move to next questionconfirms answer to move to next question

Exam OverviewExam Overview

Exam delivers questions until 95% certainty Exam delivers questions until 95% certainty of candidate meeting or not meeting of candidate meeting or not meeting passing standard, answers maximum # of passing standard, answers maximum # of questions or runs out of time.questions or runs out of time.Passing standard: Passing standard: ––

RN: RN: --0.16 0.16 logitslogits

2010 (2010 (--0.21 2007; 0.21 2007; --0.28 2004)0.28 2004)

––

PN: PN: --0.27 0.27 logitslogits

2011 (2011 (--0.37 2008; 0.37 2008; --0.42 2005)0.42 2005)––

LogitLogit

(log odds unit) is described at (log odds unit) is described at

https://www.ncsbn.org/02_18_05_brief.pdfhttps://www.ncsbn.org/02_18_05_brief.pdf

NCLEXNCLEX®®

Framework: Client NeedsFramework: Client Needs

Safe Effective Care Environment:Safe Effective Care Environment:––

Management of Care (RN test plan 2010)Management of Care (RN test plan 2010)

1616--22% (1322% (13--19% 2007)19% 2007)

––

Coordinated Care (PN test plan 2011)Coordinated Care (PN test plan 2011)1313--19% (1219% (12--18% 2008)18% 2008)

Safe Effective Care Environment:Safe Effective Care Environment:––

Safety and Infection Control Safety and Infection Control

RN test plan 2010: 8RN test plan 2010: 8--14% (unchanged)14% (unchanged)PN test plan 2011: 11PN test plan 2011: 11--17% (817% (8--14% in 2008)14% in 2008)

NCLEXNCLEX®®


Health Promotion and Maintenance Health Promotion and Maintenance –– RN test plan 2010: 6RN test plan 2010: 6--12% (unchanged)12% (unchanged)–– PN test plan 2011: 7PN test plan 2011: 7--13% (unchanged)13% (unchanged)

Psychosocial IntegrityPsychosocial Integrity–– RN test plan 2010: 6RN test plan 2010: 6--12% (unchanged012% (unchanged0–– PN test plan 2011: 7PN test plan 2011: 7--13% (813% (8--14% 2008)14% 2008)

NCLEXNCLEX®®


Physiological IntegrityPhysiological Integrity–– Basic Care and ComfortBasic Care and Comfort

RN test plan 2010: 6RN test plan 2010: 6--12% (unchanged)12% (unchanged)PN test plan 2011: 9PN test plan 2011: 9--15% (1115% (11--17% 2008)17% 2008)

–– Pharmacological and Pharmacological and ParenteralParenteral TherapiesTherapies

RN test plan 2010: 13RN test plan 2010: 13--19% (unchanged)19% (unchanged)PN test plan 2011: 11PN test plan 2011: 11--17% (917% (9--15% 2008)15% 2008)

NCLEXNCLEX®®


Physiological IntegrityPhysiological Integrity–– Reduction of Risk PotentialReduction of Risk Potential

RN test plan 2010: 10RN test plan 2010: 10--16% (1316% (13--19% 2007)19% 2007)PN test plan 2011: 9PN test plan 2011: 9--15% (1015% (10--16% 2008)16% 2008)

–– Physiological AdaptationPhysiological AdaptationRN test plan 2010: 11RN test plan 2010: 11--17% (unchanged)17% (unchanged)PN test plan 2011: 9PN test plan 2011: 9--15% (1115% (11--17% 2008)17% 2008)

Integrated Processes (IP)Integrated Processes (IP)

A second framework used for test itemsA second framework used for test itemsFour processes:Four processes:––

Nursing process (RN) or clinical problem Nursing process (RN) or clinical problem solving process (PN)solving process (PN)

––

CaringCaring––

Communication and documentationCommunication and documentation

––

Teaching/LearningTeaching/LearningEach question addresses 1 of these but Each question addresses 1 of these but IPsIPs

are not assigned percentages on test planare not assigned percentages on test plan

Test Item TypesTest Item TypesStandard 4Standard 4--option multiple choice option multiple choice (with or without added graphics)(with or without added graphics)Alternate item formatsAlternate item formats–– Multiple responseMultiple response–– FillFill--inin--thethe--blankblank–– Hot spotHot spot–– Chart/ExhibitChart/Exhibit–– Drag and drop/Ordered responseDrag and drop/Ordered response–– AudioAudio–– Graphic OptionsGraphic Options

Example: Multiple ResponseExample: Multiple ResponseThe nurse admits a client from the emergency The nurse admits a client from the emergency department who has a left ventricular myocardial department who has a left ventricular myocardial infarction. To detect onset of left sided heart failure, infarction. To detect onset of left sided heart failure, the nurse assesses this client for which the nurse assesses this client for which manifestations? Select all that apply.manifestations? Select all that apply.□□

Jugular venous distentionJugular venous distention

□□

HepatomegalyHepatomegaly□□

DyspneaDyspnea

□□

CracklesCrackles□□

TachycardiaTachycardia

□□

Right upper quadrant painRight upper quadrant pain

Example: FillExample: Fill--inin--thethe--BlankBlankThe nurse completes a fluid balance record for a client The nurse completes a fluid balance record for a client resuming a diet on the 2nd postoperative day. The client has resuming a diet on the 2nd postoperative day. The client has the following data recorded for the shift. How many the following data recorded for the shift. How many milliliters should the nurse document as intake?milliliters should the nurse document as intake?

Intake:Intake:

6 oz orange juice6 oz orange juice 4 oz water4 oz water

640 640 mLmL

5% Dextrose in Water IV5% Dextrose in Water IV 4 oz chicken broth4 oz chicken broth

Output: Output: 850 850 mLmL

urineurine 60 60 mLmL

HemovacHemovac

drainagedrainage

Answer: Answer: mLmL1060

Example: Hot Spot ItemExample: Hot Spot ItemThe nurse receives a The nurse receives a telephone report from telephone report from radiology that a client radiology that a client has a 10% has a 10% pneumothoraxpneumothorax

on the on the

right. The nurse would right. The nurse would expect to hear absent expect to hear absent breath sounds in what breath sounds in what area if the clientarea if the client’’s head s head of bed is elevated 60 of bed is elevated 60 degrees?degrees?

Chart ExhibitChart ExhibitA client is admitted to the nursing unit. After reviewing the

client’s chart, which laboratory test would be most important for the nurse to monitor?

1.

Serum potassium2.

Blood urea nitrogen

3.

Serum ammonia 4.

Serum osmolality

Client’s Chart

Medications History&Physical Diagnostic Tests

An adult client is admitted to the medical-surgical nursing unit. After reviewing the client’s chart, the nurse would place highest priority on monitoring which laboratory test result? Click on the Exhibit button below for additional information.

Select the best response. Click the Next button (N) or the Enter key to confirm answer and proceed.

Previous (P) Next (N) Exhibit (E) Calculator (C)

1. Serum potassium

2. Blood urea nitrogen

3. Serum ammonia

4. Serum osmolality




1. Serum potassium


3. Serum ammonia

4. Serum osmolality

History Medications Signs

1 of 3

Close (L)

Tile (T)

Cirrhosis of the liver

Diabetes Mellitus

Peripheral arterial disease

Glaucoma




1. Serum potassium


3. Serum ammonia

4. Serum osmolality


2 of 3

Close (L)

Tile (T)

lactulose (Cephulac) 30 mL po three times daily

glyburide (DiaBeta) 5 mg po daily

clopidogrel (Plavix) 75 mg po daily

betaxolol (Betoptic) 2 drops right eye daily




1. Serum potassium


3. Serum ammonia

4. Serum osmolality


3 of 3

Close (L)

Tile (T)

Time Neurological Signs8:00 A.M. Awake but disoriented

to time and place

8:00 P.M. Awake but disoriented to time and place

8:00 A.M. Lethargic, arouses withrepeated verbalstimulation




1. Serum potassium


3. Serum ammonia

4. Serum osmolality

Drag and Drag and Drop(clickDrop(click)/)/ Ordered ResponseOrdered Response

The client does not respond or move when the nurse The client does not respond or move when the nurse verbally calls the clientverbally calls the client’’s name upon entering the room. s name upon entering the room. What sequence of actions would the nurse use to What sequence of actions would the nurse use to resuscitate the client?resuscitate the client?

Establish unresponsivenessEstablish unresponsivenessOpen the airwayOpen the airwayCheck for breathingCheck for breathingGive two breathsGive two breathsCheck carotid pulseCheck carotid pulsePerform chest compressionsPerform chest compressions

NCLEX Question FormatsNCLEX Question Formats #7 Audio or Media #7 Audio or Media ((““NewNew””))

(Audio/media control buttons go here)(Audio/media control buttons go here)In tutorial, examinee is told to put on headset and click play bIn tutorial, examinee is told to put on headset and click play button to utton to listen to listen to audioclipaudioclip. Adjust volume if needed by moving slider. Click play . Adjust volume if needed by moving slider. Click play to repeat if needed.to repeat if needed.

After listening to the clientAfter listening to the client’’s heart sounds, which abnormal s heart sounds, which abnormal heart sound would the nurse report to the health care heart sound would the nurse report to the health care provider?provider?oo 1. S31. S3oo 2. S42. S4oo 3. Systolic murmur3. Systolic murmuroo 4. Diastolic murmur4. Diastolic murmur

NCLEX Question Formats #8 Graphic NCLEX Question Formats #8 Graphic ((““NewNew””)) A neonate was born with a ventricular A neonate was born with a ventricular septalseptal

defect. Which diagram would the nurse use to defect. Which diagram would the nurse use to teach the parents about the newbornteach the parents about the newborn’’s condition?s condition?

Where to find more?Where to find more?

See other examples at See other examples at https://www.ncsbn.org/2007_NCLEX_RN_https://www.ncsbn.org/2007_NCLEX_RN_

Detailed_Test_Plan_Candidate.pdfDetailed_Test_Plan_Candidate.pdfor or https://www.ncsbn.org/2008_PN_Detailedhttps://www.ncsbn.org/2008_PN_Detailed

_Test_Plan_Candidate.pdf_Test_Plan_Candidate.pdf

https://www.ncsbn.org/2007_NCLEX_RN_Detailed_Test_Plan_Candidate.pdf

https://www.ncsbn.org/2007_NCLEX_RN_Detailed_Test_Plan_Candidate.pdf

https://www.ncsbn.org/2008_PN_Detailed_Test_Plan_Candidate.pdf

https://www.ncsbn.org/2008_PN_Detailed_Test_Plan_Candidate.pdf

Mapping a Curriculum to the Mapping a Curriculum to the NCLEXNCLEX®®

Test PlanTest Plan


Test PlanTest Plan

Advantages:Advantages:––

Ensures licensing exam content is addressed Ensures licensing exam content is addressed in the nursing programin the nursing program

––

Provides one measure of ongoing QI that may Provides one measure of ongoing QI that may help with accreditationhelp with accreditation

––

Should help achieve higher pass rates on Should help achieve higher pass rates on NCLEXNCLEX®®

licensing exam (but this is licensing exam (but this is

multifactorialmultifactorial!)!)


Test PlanTest Plan

Disadvantages/blocks to plan for:Disadvantages/blocks to plan for:––

Lack of clerical help to set up template gridsLack of clerical help to set up template grids

––

Time consuming process if thoughtfully doneTime consuming process if thoughtfully done––

May compete with other current May compete with other current responsibilities of facultyresponsibilities of faculty

––

May or may not be seen as a priority by May or may not be seen as a priority by facultyfaculty

Process for Mapping a Curriculum Process for Mapping a Curriculum to the NCLEXto the NCLEX®®

Test PlanTest Plan

Design grid for completion at course levelDesign grid for completion at course level


Test PlanTest Plan

Design summary grid of all courses in curriculumDesign summary grid of all courses in curriculum


Test PlanTest Plan

Identify areas of excessive overlap (rather Identify areas of excessive overlap (rather than planned reinforcement) and consider than planned reinforcement) and consider reducingreducingIdentify gaps and plan for inclusion of Identify gaps and plan for inclusion of insufficient or missing contentinsufficient or missing contentDocument (committee minutes) curricular Document (committee minutes) curricular revisions for future reference and as revisions for future reference and as evidence of ongoing program evaluationevidence of ongoing program evaluationFollow up to ensure planned changes take Follow up to ensure planned changes take place and place and ““stickstick””

Integrating NCLEX Style Test Integrating NCLEX Style Test Questions into Courses in a Questions into Courses in a

Nursing CurriculumNursing Curriculum

Designing Appropriate Designing Appropriate Level Test Questions:Level Test Questions:

What BloomWhat Bloom’’s Taxonomy s Taxonomy Level to Use?Level to Use?

Cognitive Levels: BloomCognitive Levels: Bloom’’s s TaxonomyTaxonomy

OldOld NewNewEvaluation CreatingEvaluation CreatingSynthesis EvaluatingSynthesis EvaluatingAnalysis Analyzing Analysis Analyzing Application ApplyingApplication ApplyingComprehension UnderstandingComprehension UnderstandingKnowledgeKnowledge

RememberingRemembering

Cognitive LevelsCognitive Levels

NCLEXNCLEX®®

exam items: predominantly at exam items: predominantly at application and analysis levels (critical application and analysis levels (critical thinking)thinking)Critically important to introduce students to Critically important to introduce students to difficult questions systematically during difficult questions systematically during nursing programnursing programCan be accomplished using questions Can be accomplished using questions interjected in class and on teacherinterjected in class and on teacher--made made teststests

Remembering (Knowledge) Remembering (Knowledge) LevelLevel

Remember or recognize terminology, Remember or recognize terminology, facts, ideas, materials, trends, sequences, facts, ideas, materials, trends, sequences, methodology, principles, and methodology, principles, and generalizations.generalizations.Fundamentally useful in testing studentsFundamentally useful in testing students’’

acquisition of factual information about acquisition of factual information about health and illness during a coursehealth and illness during a courseThis level is NOT tested on the NCLEXThis level is NOT tested on the NCLEX®®

examsexams

Understanding Understanding (Comprehension) Level(Comprehension) Level

Understand directions, written Understand directions, written communications, reports, tables, communications, reports, tables, diagrams, and regulationsdiagrams, and regulationsUseful in determining that student can Useful in determining that student can draw inferences from information (but not draw inferences from information (but not necessarily relate it to other material or necessarily relate it to other material or see its fullest implications)see its fullest implications)There are few of these items on the There are few of these items on the NCLEXNCLEX®®

exam and they would generally exam and they would generally

have a lower difficulty levelhave a lower difficulty level

Sample (Understanding) Sample (Understanding) Comprehension Level QuestionComprehension Level Question

A client is admitted with diarrhea caused by A client is admitted with diarrhea caused by vancomycinvancomycin

resistant resistant enterococcusenterococcus. What . What

precautions should the nurse initiate for this precautions should the nurse initiate for this client?client?

1.1. Droplet precautionsDroplet precautions

2.2. Airborne precautionsAirborne precautions

3.3. Contact precautionsContact precautions

4.4. NeutropenicNeutropenic

precautionsprecautions

Applying (Application) LevelApplying (Application) Level

Apply principles, procedures, methods, Apply principles, procedures, methods, formulas, theories or ideas in job (nursing formulas, theories or ideas in job (nursing practice) related situationspractice) related situationsUseful to perform a task, solve a problem, Useful to perform a task, solve a problem, or obtain a particular resultor obtain a particular resultFrequently tested on NCLEXFrequently tested on NCLEX®®

exam as exam as

this simulates a this simulates a ““realreal--worldworld””

situation in situation in nursing and these questions can be nursing and these questions can be written at varying difficulty levelswritten at varying difficulty levels

Sample Application Level QuestionSample Application Level Question

The nurse is assigned to the care of a client with The nurse is assigned to the care of a client with diarrhea caused by diarrhea caused by vancomycinvancomycin

resistant resistant

enterococcusenterococcus. What action would the nurse take?. What action would the nurse take?

1. Keep the door to the client1. Keep the door to the client’’s room closed.s room closed.2. Place disposable masks outside the client2. Place disposable masks outside the client’’s room.s room.3. Put on a disposable gown before giving the client 3. Put on a disposable gown before giving the client

a bath*a bath*4. Move the client to a room with negative air 4. Move the client to a room with negative air

pressurepressure

Analyzing (Analysis) LevelAnalyzing (Analysis) LevelBreak down information or material into parts and Break down information or material into parts and detect relationship of those parts and the way detect relationship of those parts and the way they are organizedthey are organizedUseful to dissect and analyze information Useful to dissect and analyze information presented, and/or distinguish between critical and presented, and/or distinguish between critical and nonnon--critical datacritical dataAt leastAt least two or more pieces of data are gathered two or more pieces of data are gathered and interpreted usually before deciding a course and interpreted usually before deciding a course of actionof actionTend to be most difficult level of question overall; Tend to be most difficult level of question overall; targeted area for NCLEXtargeted area for NCLEX®®

test item developmenttest item development

Sample Analysis Level QuestionSample Analysis Level QuestionThe nurse would intervene after seeing an The nurse would intervene after seeing an

unlicensed assistive person (UAP) take which unlicensed assistive person (UAP) take which action?action?

1. Elevate the head of bed for a client who just had 1. Elevate the head of bed for a client who just had abdominal surgery for bowel obstructionabdominal surgery for bowel obstruction

2. Assist a client with Parkinson2. Assist a client with Parkinson’’s disease to s disease to ambulate to the bathroomambulate to the bathroom

3. Apply mask and gloves to bathe a client with a 3. Apply mask and gloves to bathe a client with a vancomycinvancomycin

resistant resistant enterococcusenterococcus

infection*infection*

4. Give a cup of ice cream to a client who has a 4. Give a cup of ice cream to a client who has a white blood cell count of 3500/mmwhite blood cell count of 3500/mm33

Infusing Critical Thinking Infusing Critical Thinking into Test Itemsinto Test Items

Design questions that use multi-logical thinking–

“Thinking that requires knowledge of more than one fact to logically and systematically apply concepts to a clinical problem”

–

Must know more than one concept or fact to answer the question

–

Cannot find the answer on a single page of textbook

–

Apply concepts to clinical scenarios in questions

Samples of Critical Thinking Samples of Critical Thinking Imbedded in Test ItemsImbedded in Test Items

Discriminate important from unimportant dataDiscriminate important from unimportant dataAnalyze information and predict an outcomeAnalyze information and predict an outcomeDevelop a plan of care Develop a plan of care Apply standard of careApply standard of carePrioritize interventions and job responsibilitiesPrioritize interventions and job responsibilitiesDelegate careDelegate careEvaluate interventions and teachingEvaluate interventions and teaching

Critical Thinking: Critical Thinking: Word Clues in Question Stems Word Clues in Question Stems

FirstFirstInitiallyInitiallyMostMost

EssentialEssentialHighest priorityHighest priorityBestBest

Checklist to Ensure Critical Checklist to Ensure Critical Thinking Test ItemsThinking Test Items

Written at application or analysis levelWritten at application or analysis levelIs clear and easy to readIs clear and easy to readRequires multiRequires multi--logical thinking to answerlogical thinking to answerContains Contains ““critical wordscritical words””All options are plausible (these can be difficult to All options are plausible (these can be difficult to write!); high level of discrimination is needed to write!); high level of discrimination is needed to choose correctlychoose correctlyTextbook supports all correct answers (may Textbook supports all correct answers (may need multiple pages to verify)need multiple pages to verify)

Designing Test BlueprintsDesigning Test Blueprints

Why Use a Test Blueprint?Why Use a Test Blueprint?

Identifies objective/skills to be measuredIdentifies objective/skills to be measuredStates the number of items per objective, States the number of items per objective, avoiding underavoiding under--

or overor over--representation of representation of

areasareasEnsures content validityEnsures content validitySpecifies range of item difficulty for Specifies range of item difficulty for questionsquestionsMore likely to include questions that More likely to include questions that measure important content and skills, measure important content and skills, instead of ones that are instead of ones that are ““easy to writeeasy to write””

Sample Blueprint: Study Questions Sample Blueprint: Study Questions Based on Class ObjectivesBased on Class Objectives

What are the etiology and/or risk factors for this health What are the etiology and/or risk factors for this health problem? problem? What are the associated nursing assessment and lab What are the associated nursing assessment and lab findings for this health problem? findings for this health problem? What nursing care and teaching are associated with the What nursing care and teaching are associated with the diagnostic studies for this health problem? diagnostic studies for this health problem? What are appropriate nursing diagnoses and goals of What are appropriate nursing diagnoses and goals of care for this health problem? care for this health problem? What is the expected and appropriate therapeutic What is the expected and appropriate therapeutic (medical or surgical) management for this health (medical or surgical) management for this health problem?problem?What would be included in the nursing care and What would be included in the nursing care and management of a client with this health problem? management of a client with this health problem? What client teaching is appropriate for someone with this What client teaching is appropriate for someone with this health problem?health problem?

Sample Blueprint: Senior Level Sample Blueprint: Senior Level Adult Health Unit TestAdult Health Unit Test

Final Thoughts on Test BlueprintingFinal Thoughts on Test Blueprinting

Very difficult questions can also be used as Very difficult questions can also be used as bonus questions in a testbonus questions in a testCognitive level blueprinting can be done Cognitive level blueprinting can be done across nursing courses with increasing across nursing courses with increasing numbers of higher level questions with numbers of higher level questions with progression in the curriculumprogression in the curriculumIs not a perfect scienceIs not a perfect science--problems with test problems with test items often become evident after useitems often become evident after use

Final Thoughts on Test ItemsFinal Thoughts on Test Items

Find flaws by examining item analysis and revise Find flaws by examining item analysis and revise questions immediately (while fresh in mind) for questions immediately (while fresh in mind) for future usefuture use––

Too difficultToo difficult

––

Too easyToo easy––

More than one correct answerMore than one correct answer

Hint: also make decisions about such items and Hint: also make decisions about such items and adjust grade in current test before releasing grade adjust grade in current test before releasing grade and test review; avoids being defensive with and test review; avoids being defensive with students and reduces student tendency to argue students and reduces student tendency to argue about questionsabout questions

Final Thoughts on Test ItemsFinal Thoughts on Test Items

Use textbook test bank items carefully; they Use textbook test bank items carefully; they can have flawscan have flawsRevise a known flawed question before Revise a known flawed question before using them in your test (up to 5 times faster using them in your test (up to 5 times faster to revise a nonfunctional test item than to to revise a nonfunctional test item than to write a new one; ex: 6 minutes versus 30)write a new one; ex: 6 minutes versus 30)Insert sample questions at beginning, Insert sample questions at beginning, during and end of class to enhance student during and end of class to enhance student engagement and aid application of engagement and aid application of knowledge (donknowledge (don’’t use on actual test)t use on actual test)

Discussion and QuestionsDiscussion and Questions

iron-clad your preparation for the nclex® exam

Documents