1/2/2014
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
Percentage of items
2007
2010
13 - 19%
8 - 14%
6 - 12%
6 - 12%
16 - 22%
8 - 14%
6 - 12%
6 - 12%
17 - 23%
9 - 15%
6 - 12%
6 - 12%
6 - 12%
13 - 19%
13 - 19%
11 - 17%
6 - 12%
13 - 19%
10 - 16%
11 - 17%
6 - 12%
12 - 18%
9 - 15%
11 - 17%
NCLEX-PN® Test Plan Category Changes
Plan Categories / Subcategories
Percentage of items
2013
2011
Safe Effective Care Environment
Management of Care
Safety and Infection Control
Health Promotion and Maintenance
Psychosocial Integrity
Coordination of Care
3%
Safety and Infection Control
1%
Health Promotion and Maintenance
Psychosocial Integrity
Physiological Integrity
Basic Care and Comfort
Pharmacological and Parenteral Therapies
Reduction of Risk Potential
Physiological Adaptation
2014
Safe Effective Care Environment
1%
13 - 19%
11 - 17%
7 - 13%
7 - 13%
16 - 22%
10 - 16%
7 - 13%
8 - 14%
9- 15%
11 - 17%
9 - 15%
9 - 15%
7 - 13%
11 - 17%
10 - 16%
7 - 13%
Physiological Integrity
Basic Care and Comfort
2%
Pharmacological Therapies
Reduction of Risk Potential
Physiological Adaptation
1%
2%
Nursing Process
Client Need Categories
Caring
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
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1/2/2014
Standard of Passing Defined As:
Standard of Passing
NCLEX PN®

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.
2008
2011
-0.42 to -0.37 logits
-0.37 to -0.27 logits
NCLEX RN®
2010
2013
-0.21 to -0.16 logits
-0.16 to -0.00 logits
Passing Standard increases for past
years and affect on Pass Rates:
Passing Standard increases for past
years and affect on Pass Rates:
2004 Passing Standard Increase
2007 Passing Standard Increase
From
To
From
-0.35 logits
-0.28 logits 0.07 logits
Change
Pass Rate Change
To
Change
-0.28 logits -0.21 logits 0.07 logits
Pass Rate Change
First Time Takers
2003
87.05%
2004
85.3%
First Time Takers
2006
88.1%
2007
85.5%
All Candidates
71.1%
70.2%
All Candidates
73.8%
69.4%
Passing Standard increases for past
years and affect on Pass Rates:
Passing Standard increases for past
years and affect on Pass Rates:
2010 Passing Standard Increase
2013 Passing Standard Increase
From
From
To
Change
To
Change
-0.21 logits -0.16 logits 0.05 logits
-0.16 logits -0.00 logits 0.16 logits
Pass Rate Change
Pass Rate Change
First Time Takers
2009
88.42%
2010
87.41%
All Candidates
73.18%
74.18%
April/June2012
April/June 2013
First Time Takers
92.74%
83.00
All Candidates
82.84%
72.34%
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1/2/2014
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.
2.
3.
4.
Management of Care
Basic Care and Comfort
Health Promotion and Maintenance
Psychosocial Integrity
A client is prescribed the drug
tranylcypromine (Parnate®).
What dietary restriction should
the client be aware of?
The nurse is conducting
testicular screening at a local
health fair. Which finding would
require follow up?
1.
2.
3.
4.
Management of Care
Basic Care and Comfort
Health Promotion and Maintenance
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
The charge nurse is planning
client care assignments for a RN
and PN. Which client would be
most appropriate for the RN
assignment?
1.
Basic Care and Comfort
1.
Safety and Infection Control
2.
Physiological Adaptation
2.
3.
Pharmacology and Parenteral
therapies
Health promotion and
Maintenance
3.
Management of Care
4.
Safety and Infection control
4.
Reduction of Risk Potential
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1/2/2014
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?
Safety and Infection Control
2. Psychosocial Integrity
3. Basic care and Comfort
4. Pharmacology and Parenteral
therapies
1.
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
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?
Safety and Infection Control
Psychosocial Integrity
3. Basic care and Comfort
4. Pharmacology and Parenteral
therapies
1.
2.
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 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
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1/2/2014
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?
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
The nurse is assessing the client
with hyperthyroidism. Which
finding would the nurse expect
to observe?
Physiological Adaptation
1.
Physiological Adaptation
2.
Reduction of risk Potential
2.
Reduction of Risk Potential
3.
Safety and infection control
3.
Basic Care and Comfort
Health Promotion and
maintenance
4.
Safety and Infection Control
1.
4.
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
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1/2/2014
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
Rules continued:
 5.
 9.
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
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
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1/2/2014
Rules continued:
Group Activity
 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”
Editing Test items Using the
NCLEX® Item Writing Rules
 14.
Bold the words: best, most,
initial, first, etc
#1 Corrected
#2 Corrected
 The
 A client
#3 Corrected
#4 Corrected
 The
 A client
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?
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 ?
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?
has chemical burns on
the forearms and is
experiencing severe pain. The
occupational health nurse
should initiate which
intervention first?
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1/2/2014
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
o
 2.
Tables and graphs
Graphics and pictures
 4. Audio and Video
 3.
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.

Majority of the questions
What students are most
familiar with
o Hardest because they have to
narrow to one (priority
questions)
o Circles are used to identify
options
o
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
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1/2/2014
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
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
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
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 NCLEXRN® test plan
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1/2/2014
Hurst Critical Thinking
Strategies
of the first steps in developing a
critical thinking mind is developing a
sense of inquisitiveness.

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.
 One
 We
believe if you understand the “why”
you can apply this knowledge to any
scenario or problem.
Hurst Critical Thinking
Strategies
Teaching answers along with
questions. . .
Instead of saying, “Blood
pressure goes up in fluid volume
excess.”
Hurst says:
Hurst Critical Thinking
Strategies
Learning Styles / Strategies
Auditory Learner -
Visual Learner -
 Lecture
 Graphics
 Podcast
 Student
 Record
 Videos
yourself as
you study
 Group
 Ask
discussion
 Follow
 Trace
manual in outline form
along with me
with your finger
a friend
 Music
“What happens to BP in FVE?
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????
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1/2/2014
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.”
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