Structuring Test Items to the NCLEX Format Objective 1: Demonstrate understanding of how the NCLEX test plan guides test item writing Presented by: Pam Black RN, MSN Hurst Review Services Curriculum Director NCLEX RN Test Plan Category Changes Plan Categories / Subcategories Safe Effective Care Environment Percentage of items 2007 2010 2013 Management of Care 13-19% 16-22% 17-23% Safety and Infection Control 8-14% 8-14% 9-15% Health Promotion and Maintenance 6-12% 6-12% 6-12% Psychosocial Integrity 6-12% 6-12% 6-12% Physiological Integrity Basic Care and Comfort 6-12% 6-12% 6-12% Pharmacological and Parenteral Therapies 13-19% 13-19% 12-18% Reduction of Risk Potential 13-19% 10-16% 9-15% Physiological Adaptation 11-17% 11-17% 11-17% NCLEX-PN Test Plan Category Changes Plan Categories / Subcategories Safe Effective Care Environment Percentage of items 2011 2014 Coordination of Care 3% 13-19% 16-22% Safety and Infection Control 1% 11-17% 10-16% Health Promotion and Maintenance 7-13% 7-13% Psychosocial Integrity 1% 7-13% 8-14% Physiological Integrity Basic Care and Comfort 2% 9-15% 7-13% Pharmacological Therapies 11-17% 11-17% Reduction of Risk Potential 1% 9-15% 10-16% Physiological Adaptation 2% 9-15% 7-13% Nursing Process Caring Client Need Categories Management of Care Safety & Infection Control Health Promotion & Maintenance Psychosocial Integrity Basic Care & Comfort Pharmacological & Parenteral Therapies Reduction of Risk Potential Physiological Adaptation Communication and Documentation NCSBN Board of Directors (BOD) Voted to Raise the Passing Standard for the NCLEX-RN Examination at its Meeting on Dec. 17, 2012 Teaching and Learning 1
Standard of Passing Defined As: Standard of Passing To ensure a consistent standard of competence in nursing practice, NCSBN uses a criterion reference standard, which means that passing or failing depends solely upon a candidate s level of performance in relation to the established point that represents safe entry level competence. NCSBN Research Brief, Vol 42, January 2010. NCLEX PN 2008-0.42 to -0.37 logits 2011-0.37 to -0.27 logits NCLEX RN 2010-0.21 to -0.16 logits 2013-0.16 to -0.00 logits Passing Standard increases for past years and affect on Pass Rates: 2004 Passing Standard Increase From To Change -0.35 logits -0.28 logits 0.07 logits Pass Rate Change 2003 2004 First Time Takers 87.05% 85.3% All Candidates 71.1% 70.2% Passing Standard increases for past years and affect on Pass Rates: 2007 Passing Standard Increase From To Change -0.28 logits -0.21 logits 0.07 logits Pass Rate Change 2006 2007 First Time Takers 88.1% 85.5% All Candidates 73.8% 69.4% Passing Standard increases for past years and affect on Pass Rates: 2010 Passing Standard Increase From To Change -0.21 logits -0.16 logits 0.05 logits Pass Rate Change 2009 2010 First Time Takers 88.42% 87.41% All Candidates 73.18% 74.18% Passing Standard increases for past years and affect on Pass Rates: 2013 Passing Standard Increase From To Change -0.16 logits -0.00 logits 0.16 logits Pass Rate Change April/June2012 April/June 2013 First Time Takers 92.74% 83.00 All Candidates 82.84% 72.34% 2
Group Activity Identify the Client Needs Category for the following stems: The nurse is conducting testicular screening at a local health fair. Which finding would require follow up? 1. Management of Care 2. Basic Care and Comfort 3. Health Promotion and Maintenance 4. Psychosocial Integrity The nurse is conducting testicular screening at a local health fair. Which finding would require follow up? A client is prescribed the drug tranylcypromine (Parnate ). What dietary restriction should the client be aware of? 1. Management of Care 2. Basic Care and Comfort 3. Health Promotion and Maintenance 4. Psychosocial Integrity 1. Basic Care and Comfort 2. Physiological Adaptation 3. Pharmacology and Parenteral therapies 4. Safety and Infection control A client is prescribed the drug tranylcypromine (Parnate ). What dietary restriction should the client be aware of? 1. Basic Care and Comfort 2. Physiological Adaptation 3. Pharmacology and Parenteral therapies 4. Safety and Infection control The charge nurse is planning client care assignments for a RN and PN. Which client would be most appropriate for the RN assignment? 1. Safety and Infection Control 2. Health promotion and Maintenance 3. Management of Care 4. Reduction of Risk Potential 3
The charge nurse is planning client care assignments for a RN and PN. Which client would be most appropriate for the RN assignment? 1. Safety and Infection Control 2. Health promotion and Maintenance 3. Management of Care 4. Reduction of Risk Potential The nurse is providing discharge teaching for the family of a client with a total hip replacement. Which statement by the family concerning hip flexion would indicate successful teaching? 1. Safety and Infection Control 2. Psychosocial Integrity 3. Basic care and Comfort 4. Pharmacology and Parenteral therapies The nurse is providing discharge teaching for the family of a client with a total hip replacement. Which statement by the family concerning hip flexion would indicate successful teaching? 1. Safety and Infection Control 2. Psychosocial Integrity 3. Basic care and Comfort 4. Pharmacology and Parenteral therapies A client is pacing the hallway, mumbling, and occasionally yelling stop it. Which action by the nurse is most appropriate? 1. Psychosocial Integrity 2. Reduction of Risk Potential 3. Physiological Adaptation 4. Safety and Infection Control A client is pacing the hallway, mumbling, and occasionally yelling stop it. Which action by the nurse is most appropriate? A client reports that they are having difficulty falling and staying asleep. Which strategy is most appropriate for the nurse to teach this client? 1. Psychosocial Integrity 2. Reduction of Risk Potential 3. Physiological Adaptation 4. Safety and Infection Control 1. Reduction of Risk Potential 2. Basic Care and Comfort 3. Psychosocial Integrity 4. Management of Care 4
A client reports that they are having difficulty falling and staying asleep. Which strategy is most appropriate for the nurse to teach this client? 1. Reduction of Risk Potential 2. Basic Care and Comfort 3. Psychosocial Integrity 4. Management of Care Your client had a cardiac catheterization 3 hours ago. Which finding would require immediate follow-up? 1. Physiological Adaptation 2. Reduction of risk Potential 3. Safety and infection control 4. Health Promotion and maintenance Your client had a cardiac catheterization 3 hours ago. Which finding would require immediate follow-up? The nurse is assessing the client with hyperthyroidism. Which finding would the nurse expect to observe? 1. Physiological Adaptation 2. Reduction of risk Potential 3. Safety and infection control 4. Health Promotion and maintenance 1. Physiological Adaptation 2. Reduction of Risk Potential 3. Basic Care and Comfort 4. Safety and Infection Control The nurse is assessing the client with hyperthyroidism. Which finding would the nurse expect to observe? 1. Physiological Adaptation 2. Reduction of Risk Potential 3. Basic Care and Comfort 4. Safety and Infection Control Visual Representation of Client Need Categories and Content Client Need Categories Related Content Areas Related Activity Statements 5
Scavenger Hunt Let s Scavenger through the NCLEX Needs Categories and find at least one activity statement that you could use to write a question on a Diabetes section. Now let s look at how NCLEX recommends that you take these statements and generate a test item. Classroom tests should follow the same rules as the NCLEX test. Objective 2: Utilize NCLEX item writing standards on nursing school test. 1. No names 2. Use the words: client, primary healthcare provider, and prescription 3. Use non-gender writing 4. No scenarios Rules: Continued 5. Items should be independent of each other 6. Remove of the following 7. Item should end in a question whenever possible. 8. Distracters should be equal in length and chronologically correct Rules continued: 9. No negative questions (except) 10. Discontinue use of NANDA Nursing Diagnosis on test 11. If the information is not essential to answering the questions, remove it!! 12. Question should be answered in 1-2 minutes 6
Rules continued: 13. The readability level is assessed by Lexiles: PN has no more than 1200 Lexiles, i.e. Animal Farm RN has no more that 1300 Lexiles, i.e. Swiss Family Robinson 14. Bold the words: best, most, initial, first, etc Group Activity Editing Test items Using the NCLEX Item Writing Rules #1 Corrected #2 Corrected The nurse is caring for a client admitted with GI bleeding and the primary healthcare provider prescribes two units of whole blood. While assessing the client during the second unit of blood, the nurse reports an increase in baseline blood pressure and distended neck veins. What is the priority nursing intervention? A client is admitted with a diagnosis of schizophrenia. The nurse is planning a teaching session for this client who experiences auditory hallucinations. Which client comment indicates the use of a positive coping strategy? #3 Corrected #4 Corrected The nurse is caring for a client in the ED with chest pain. The client arrests and attempts at resuscitation are unsuccessful. Which statement to the family is an example of therapeutic communication skills by the nurse? A client has chemical burns on the forearms and is experiencing severe pain. The occupational health nurse should initiate which intervention first? 7
Alternate Format Questions Alternate Format Questions The National Council of State Boards of Nursing (NCSBN) includes the following alternate format questions: 1. multiple response (Select all that apply) 2. fill-in-the-blank calculations 3. drag and drop (sequencing) 4. hot spot What about multimedia? Single Option Multiple Choice Any of these types of questions can include multimedia: 1. Charts and Exhibits 2. Tables and graphs 3. Graphics and pictures 4. Audio and Video o Majority of the questions o What students are most familiar with o Hardest because they have to narrow to one (priority questions) o Circles are used to identify options Fill-in-the-blank Any kind of calculation Will tell student exactly how far to carry out decimal Round off at the end only Want only numbers and decimal points, no units of measure No apothecary system Calculator button on bottom right hand corner of screen or can use white writing board. Exhibit Item Exhibit is just a media form that can be in any type of question Don t have to open to answer the question, but will probably miss it if they don t Just click on the tab and the exhibit comes up 8
Hot Spot Question with a picture or diagram Must click very accurately on the spot they request Have had concerns with, but they are back Multiple Response Bold Select all that apply Has boxes by the options Has more than 4 options Always requires more that 1 answer but it is never all the options Drag and Drop/Ordered Response Place options in an order You click on an option and drag it to the correct order - OR - Highlight and click arrow to move the proper direction All options must be used What About Media: You can have pictures as options Pictures in the stem Audio/Video NCLEX can ask the material in any way and use any format What about the test blueprint? Can you include in your blueprint the NCLEX categories and percentages by categorizing the objectives to category? Can you start coding your questions according to the NCLEX categories as well as Bloom s and question format? Objective 5: Develop student learning experiences that reflect the content areas of the NCLEX- RN test plan What percentage breakdown should you have of application questions as the courses progress 9
Hurst Critical Thinking Strategies One of the first steps in developing a critical thinking mind is developing a sense of inquisitiveness. We believe if you understand the why you can apply this knowledge to any scenario or problem. Hurst Critical Thinking Strategies Hurst s goal is to create an atmosphere of interaction that allows the student to realize it is ok not to be right all the time. When students hear both right and wrong answers, they can begin to evaluate why something is right and why other choices are wrong. Hurst Critical Thinking Strategies Teaching answers along with questions... Instead of saying, Blood pressure goes up in fluid volume excess. Hurst says: What happens to BP in FVE? Learning Styles / Strategies Auditory Learner - Lecture Podcast Record yourself as you study Group discussion Ask a friend Music Visual Learner - Graphics Student manual in outline form Videos Follow along with me Trace with your finger Let s brainstorm about the classroom!!!! Already talked about testing Should they be aware of the 2013 categories and statements? What course do they see the information in those first 5 important statements???? When teaching interventions, what could you include? Always include the safety points in lecture o what would you report.. o what would require follow-up Let s brainstorm about clinical!! Are there any documents on the unit that would reinforce learning?? What opportunities are there to teach them management and delegation? Pharmacology and lab values???? Do they understand why? A&P???? 10
NCSBN Curriculum Statement NCSBN states Since nursing practice is a continually evolving discipline and practice analyses are conducted every three years, it may not be practical to revise curriculum based on the minor changes in the 2013 RN NCLEX Test Plan. The test plan, however, may be a useful product for nursing programs to consider when reviewing a curriculum because the test plan is based upon the knowledge, skills and abilities that are needed to practice nursing safely and effectively at the entry level. 11