Structuring Test Items to the NCLEX Format

(1)

Structuring Test

Items to the

NCLEX® Format

Presented by: Pam Black RN, MSN

Hurst Review Services Curriculum Director

Objective 1: Demonstrate

understanding of how the

NCLEX® test plan guides test

item writing

NCLEX RN® Test Plan Category Changes

Plan Categories / Subcategories Percentage of items

2007 2010 2013

Safe Effective Care Environment

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 Percentage of items

2011 2014

Safe Effective Care Environment

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%

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 Nursing Process Communication and Documentation Teaching and Learning Caring

NCSBN Board of Directors

(BOD) Voted to Raise the

Passing Standard for the

NCLEX-RN Examination at its

Meeting on

Dec. 17, 2012

(2)

Standard of Passing Defined As:

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.

Standard of Passing

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%

years and affect on Pass Rates:

From

To

Change

Pass Rate Change

2006

2007

First Time Takers

88.1%

85.5%

All Candidates

73.8%

69.4%

From

To

Change

Pass Rate Change

2009

2010

First Time Takers

88.42%

87.41%

All Candidates

73.18%

74.18%

From

To

Change

Pass Rate Change

April/June2012 April/June 2013

First Time Takers

92.74%

83.00

(3)

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?

1. Management of Care 2. Basic Care and Comfort

3. Health Promotion and Maintenance

4. Psychosocial Integrity

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

A client is prescribed the drug

tranylcypromine (Parnate®).

What dietary restriction should

the client be aware of?

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

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The charge nurse is planning

client care assignments for a RN

and PN. Which client would be

most appropriate for the RN

assignment?

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?

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?

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?

2. Reduction of Risk Potential

3. Physiological Adaptation

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. Reduction of Risk Potential 2. Basic Care and Comfort 3. Psychosocial Integrity 4. Management of Care

(5)

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?

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?

2. Reduction of risk Potential 3. Safety and infection control

4. Health Promotion and maintenance

The nurse is assessing the client

with hyperthyroidism. Which

finding would the nurse expect

to observe?

The nurse is assessing the client

with hyperthyroidism. Which

finding would the nurse expect

to observe?

1. Physiological Adaptation 2. Reduction of Risk Potential

Visual Representation of Client

Need Categories and Content

Client Need

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.

Objective 2: Utilize NCLEX®

item writing standards on

nursing school test.

Classroom tests should follow the

same rules as the NCLEX 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

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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

Editing Test items Using the

NCLEX® Item Writing Rules

Group Activity

#1 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 prioritynursing intervention?

#2 Corrected

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



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 ?

#4 Corrected



A client has chemical burns on

the forearms and is

experiencing severe pain. The

occupational health nurse

should initiate which

intervention

first

?

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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?

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

Single Option Multiple Choice

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

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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?

What percentage breakdown should you

have of application questions as the courses progress

Objective 5: Develop student

learning experiences that reflect

the content areas of the

NCLEX-RN® test plan

(10)

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…

owhat would you report.. owhat 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????

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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.”