6 Steps of Item Writing 1. Select a Nursing concept: Refer to NCLEX test plan 2. Identify the lesson objective being tested. 3. Write a stem a. What style will the question be? i. Multiple choice ii. Select all that apply iii. Hot spot b. What level will the question be? Refer to Blooms Taxonomy 4. Write the key or correct response with rational 5. Write the distractors or incorrect answers with rationale 6. Complete and review the item. Fill in the following as you develop each of your questions 1. Nursing Concept: Safety and Effective Care Management 2. Lesson Objective being tested: Objective 4: State the importance of nursing documentation; and its requirements for specific aspects of care including; critical diagnostic results, medications, non-conforming patient behavior, pain, patient and family involvement in care, restraints, prevention of falls, elopement and suicide risk. 3. Style of Question: Multi Choice 4. Level of Question: Knowledge 5. Question Stem: What is the purpose of nursing documentation? 6. Key: to communicate patient information to other health care providers 7. Distractor: to provide legal protection of the nurse 8. Distractor: to collect data for quality improvement 9. Distractor: to allow the generation of appropriate coeds for billing Fill in the following as you develop each of your questions: 1. Nursing concept: Safety and Effective Care Management 2. Lesson Objective being tested: Objective 6: Define standard of Care 3. Style Question: Multi Choice 4. Level Questions: Knowledge 5. Question Stem: Standards of care are derived from all of the following except: 6. Key: Nurse Manager: Rationale Professional nursing associations such as the ANA, federal state and local laws governing nursing practice and an entities policies and procedures identify standards of care. 7. Distractor: Professional nursing associations 8. Distractor: Policy and procedures 9. Distractor: State boards of Nursing Fill in the following as you develop each of your questions 1. Nursing Concept: Safe and effective care management 2. Lesson Objective being tested: Objective 2: Discuss the “Doctrine of Respondeat Superior” 3. Style of Question: Multi Choice 4. Level of Question: Analysis 5. Question Stem: The MD ordered that a recently intubated patient’s ET tube to remain in place for 5 days. The standard is 2 days. The same nurse took care of this patient for five consecutive days. The hospital settled the law suit with the patient because his larynx was irreparably damaged. What led the court ruling against the hospital for negligence of the nurse? 6. Key: the employer is responsible for the actions of an employee. Rational the doctrine of Respondeat Superior states that the employer is responsible for its employee’s action. The other choices support the cause of the nurse’s liability but the hospital was required to pay the settlement because of the actions of the nurse. Tort law is an act or omission that gives rise to injury or harm to another and amounts to a civil wrong where courts impose liability and our damages. 7. Distractor: the nurse failed to follow the order 8. Distractor: the employee is not responsible for the action of an employer 9. Distractor: the nurse failed to question the order Fill in the following as you develop each of your questions 1. Nursing Concept: Safe and effective care management 2. Lesson Objective being tested: Objective 6: Define standards of care 3. Style of Question: Multi Choice 4. Level of Question: Analysis 5. Question Stem: The nurse witnessed their patient having a grand mal seizure. What chart entry should they include in their documentation? Chose the best answer. 6. Key: The patient was turned to the right side. Rational: Turning the patient to the side is an appropriate nursing intervention that meets standards of care for convulsing patients. Documentation by the nurse should demonstrate standards of care. The other two options do not support a nursing intervention. 7. Distractor: The patient was administered an anticonvulsant. 8. Distractor: The patients’ bed side rails were raised on both sides. 9. Distractor: The patient’s course of the seizure. Fill in the following as you develop each of your questions 1. Nursing Concept: Safe and effective care management 2. Lesson Objective being tested: Objective 4: State the importance of nursing documentation for specific aspects of nursing care including: critical diagnostic results, medications, nonconforming patient behavior, pain, patient and family involvement in care, restraints, prevention of falls and elopement and suicide risk. 3. Style of Question: Multi Choice 4. Level of Question: Application 5. Question Stem: A patient with heart failure receives treatment of intravenous furosemide (Lasix). Which nursing entry reflects appropriate charting that requires physician notification. Choose the most appropriate answer. 6. Key: Patient was in sinus rhythm and no has an irregular heart rhythm. Rationale: Charting a change of condition is an aspect of a good quality documentation. All the other choices reflect an appropriate physiological response after administration of Lasix. 7. Distractor: Patient had a weight loss of 4 lbs over 2 days 8. Distractor: Patient had 1000 mls of urine output in 8 hours 9. Distractor: Patients’ blood pressure changed from 140/70 to 120/60 Fill in the following as you develop each of your questions 1. Nursing Concept: Safe and effective care management 2. Lesson Objective being tested: Objective 5: Explain and give examples of key elements of medical malpractice and negligence. 3. Style of Question: Multi Choice 4. Level of Question: Application 5. Question Stem: Emily RN is testifying in a case where Mr. Jones was her patient. Mr. Jones had a fall because of a wet floor and suffered a brain injury. In Emily’s deposition and in the medical record she stated that she noticed the floor in Mr. Jones room was wet and she contacted housekeeping to mop up the floor and she also notified the charge nurse. Mr. Jones’ attorney posed these questions: a. Where you the nurse taking care of Mr. Jones on Dec 16 2019? b. On December 16, 2019 were you an employee of ABC hospital? c. Have you been a certified emergency room nurse and have been a nurse for 10 years. Why did Mr. Jones attorney ask Emily these questions? 6. Key: to establish duty: Rational: to establish duty there is an established relationship between the plaintiff and defendant (patient and nurse). The other choice are elements of malpractice. 7. Distractor: to establish causation 8. Distractor: to establish negligence 9. Distractor: to establish breach of duty Fill in the following as you develop each of your questions 1. Nursing Concept: Safe and effective care management 2. Lesson Objective being tested: Objective 8 Give and identify examples of important nursing documentation in addition to the patient’s medical record which might establish the nurse’s competencies, presence, responsibilities and compliance with an entities policies and procedures. 3. Style of Question: Multi Choice 4. Level of Question: Application 5. Question Stem: Read the following nursing notes: 0800: Lung sounds are clear to auscultation bilaterally and the patient’s Pox is 99% room air. Patient’s vs: 136/78, 85, 18, 99%. Patient tolerated 90% of his breakfast with no complaints of nausea or evidence of emesis. 0830: Patient ambulated 50 feet down the hallway with one person assist. VS before ambulation were 128/72, 80, 20, 99%. VS after ambulation were 146/83, 97, 22, 99%. 0900: Patient voided 500 mls of clear yellow urine using the urinal while standing at the bedside. These nursing notes demonstrates (pick all that apply). 6. Key: factual & objective Rational: according to the ANA principals of nursing documentation should be clear, concise, evidence based, chronological, factual and clear. Subjective data is the opinion of the writer, evidence based is practices based on evidence for a particular condition. Documentation of pre and post vital signs is objective data. 7. Distractor: subjective 8. Distractor: objective 9. Distractor: factual Fill in the following as you develop each of your questions 1. Nursing Concept: Safe and effective care management 2. Lesson Objective being tested: Objective 7: List the basic categories of torts and the four elements of medical malpractice. 3. Style of Question: Multi Choice 4. Level of Question: Application 5. Question Stem: Nurse Rebeca was taking care of patient Mr. Smith. Mr. Smith suffered an extravasation to his left arm after nurse Rebeca pushed IV Dilantin in a left hand IV. During Rebeca’s deposition and her nurse’s notes confirmed that the IV was sluggish to flush and there was not blood return noted. Mr. Jones had to have an amputation of his left arm from the elbow down. Mr. Jones was awarded a large settlement from the court. Mr. Jones was able to prevail in his court case because? Choose the best answer. 6. Key: tort law. Rationale: a tort is a civil wrong committed against a person or property (real or personal) and is punishable by damages rather than imprisonment. Negligence is failure to as a reasonable prudent nurse. Causation is breach of duty that caused the patients injury. Gross negligence is intentional omission of proper care or its delivery. 7. Distractor: negligence 8. Distractor: causation 9. Distractor: respondeat superior Fill in the following as you develop each of your questions 1. Nursing Concept: Safe and effective care management. 2. Lesson Objective being tested: Objective 8 & 4. Give examples of important nursing documentation in addition to the patient’s medical record which might establish the nurse’s competencies, presence, responsibilities and compliance with an entities policies and procedures. State the importance of nursing documentation requirements for specific aspects of care including: critical diagnostic results, medications, non-conforming patient behavior, pain, patient and family involvement in care, restraints, prevention of falls and elopement and suicide risk. 3. Style of Question: Multi Choice 4. Level of Question: Application 5. Question Stem: While the nurse is caring for a patient that was admitted for CHF exacerbation, the patient becomes acutely diaphoretic. The nurse obtains VS: 178/97, 104, 24, 92%. After placing the patient on 2L of oxygen via a NC, the next step the nurse would do for documentation would be: 6. Key: Document that Dr. Smith was called and given VS 178/97, 104, 24 92% telephone order received to give 40 mg IV Lasix. Order was verified and read back to Dr. Smith. Patient was placed on 2L oxygen via nasal cannula. 7. Distractor: Document that Dr. Smith was called and given VS 178/97, 104, 24, 92% telephone order received to give 40 mg IV Lasix. 8. Distractor: Document that Dr. Smith was called and given VS 178/97, 104, 24, 92%, patient was placed on 2 L oxygen via nasal cannula. 9. Distractor: Document that Dr. Smith was called and given VS 178/97, 104, 24, 92%. Fill in the following as you develop each of your questions 1. Nursing Concept: Safe and effective care management. 2. Lesson Objective being tested: Objective 8: Give examples of important nursing documentation in addition to the patient’s medical record which might establish the nurse’s competencies, presence, responsibilities and compliance with an entities policies and procedures 3. Style of Question: Multi Choice 4. Level of Question: Application 5. Question Stem: In the world of nursing litigation and malpractice, a defensive attitude has become necessary, that is document factually but defensively as well. This involves knowing all of the following (select all that apply) 6. Key: hospital policies and procedures, how to chart, when to chart 7. Distractor: policies and procedures 8. Distractor: using the electronic medical record to chart 9. Distractor: when to chart 10. Distractor: how to chart 11. Distractor: subjectively chart
