Chapter 9 NCLEX Test Plan Joseph T. Catalano

National Council Licensure Examination (NCLEX) Computerized exam Taken at Pearson Professional testing sites

NCLEX Test Plan Each question is assigned a difficulty value on a 7 logit scale (Rasch scale). Starts out with medium-difficulty level questions. The difficulty level is somewhat relative and determined by Where it is taught in the program Complexity of the material

Number of Questions 75 questions minimum (only 60 count; 15 are trial questions for next exam) 265 questions maximum (250 count) No students are randomly selected to take all 265 Can pass or fail in 75 questions Can pass or fail in 265 questions Can pass or fail with any number of questions between 75 and 265

Pool of Questions Computer selects questions from a pool of about 4,000–6,000 questions. Selection is based on difficulty level and test plan. Each examination is different—unique to the person taking it. Many questions in one topic area may mean Those questions are being trial-tested. You’re having trouble in one area.

Difficulty Level It’s a good sign if you’re getting a lot of questions that seem to be very hard! You are probably in the upper-difficulty level questions. Remember The smartest instructor you had in school probably couldn’t answer some of the highest (+3) difficulty level questions! It’s designed so no one gets 100%.

Difficulty Level (cont’d) Anything you know REALLY well will NOT be on the NCLEX exam. There are NO “happy” questions on the NCLEX—there is always something wrong, and if it’s in the question, you need to worry about it!

NCLEX Measures Nursing Knowledge 1. Integrated, coordinated, safe, and ethical care 2. Expected stages of growth and development 3. Recognizing and assisting clients to cope with health alterations and promote health practices 4. Promote and support physical, psychological, spiritual, and social well-being 5. Managing care related to the administration of medications and parenteral therapies 6. Managing care for clients with acute, chronic, or life-threatening health conditions

NCLEX: Minimum Level of Competency; Protects the Public! NCLEX is a licensure exam. Establishes a minimum level of competency Protects the public from unsafe nurses Does NOT mean you are a “super-nurse” Means you probably won’t kill someone the first time you take care of a client!

Minimum Level of Competency NCLEX asks “entry-level” type questions. NCLEX questions tend to be very “textbook-ish.” Look for the expected—textbook-type knowledge. Don’t look for exceptions.

Grading the NCLEX Exam If you take 75 to 264 questions in 6 hours or less, you are measured against the pass criteria on the Rasch scale. If you take 265 questions in 6 hours or less, your score is calculated on the total you got correct (need about 60%). If you take fewer than 265 questions but run out of time, the computer looks at the whole exam; if majority are above the pass criterion, you pass.

NCLEX Exam Procedures You will either have a 6-hour morning or 6-hour afternoon session. 10 to 15 graduates take the test at the same time; each has his or her own computer. Leave all your belongings at the door in a locker. Digital fingerprints, digital picture, and digital signature are taken when you enter. You are a prisoner of the testing center for the next 6 hours!

NCLEX Exam Procedures (cont’d) Sit at the computer with your picture. You have two chances to complete the tutorial. Tight security All sessions are taped; proctor remains in room. Be careful not to look like you’re cheating!

Mouse Used to Select Most Answers: Little Keyboard Use Tutorial on mouse use Left-click on answer to select Two buttons on bottom of screen Click on Next (N) button to confirm selection and move to next question No going back to change answers

Pop-Up Calculator A pop-up calculator is available. It can be accessed for calculation problems. Click on the calculator icon on button bar at bottom of screen. Calculation problems will likely be more difficult than in the past. Magic slate may be used for scrap paper.

Time Limit for NCLEX No minimum time limit Maximum time limit is 6 hours Mandatory break after 2 and 1/2 hours Optional break after 4 hours

Time Limit for NCLEX (cont’d) Not strictly a “timed exam”; can spend all 6 hours on question 1—no minimum Average number of questions: approximately 120 Average time for all takers: approximately 122 minutes Most people average 45 seconds per question. Calculate time for 1 minute per question. Keep an eye on the “Time Remaining” box. If taking more than 2 minutes on any question, put down an answer and move on.

Most Are Multiple-Choice Questions Each multiple-choice question has two or three parts. Case study (client situation)—optional Stem question Four distracters (answers): only one is correct

NCLEX Plan Type of Questions The National Council of State Boards of Nursing (NCSBN) has started using “alternative” format test items. Each graduate is supposed to correctly answer at least two of the items no matter how many questions are taken. Latest information indicates that they will count toward the final grade.

Alternative Format Questions Fill in the blank: word or calculation Sequencing items: drag and drop Multiple answer Hot spot questions Chart or exhibit items (Type I) Exhibit items (Type II) Audio items Graphic items

NCLEX Test Plan Three major components Levels of cognitive ability Integrated concepts and processes Client health needs

NCLEX Test Plan Levels of Cognitive Ability Bloom’s taxonomy Level 1: Recall or memory (knowledge; comprehension) Level 2: Analysis (application) Level 3: Synthesis; evaluation (judgment)

NCLEX Test Plan Levels of Cognitive Ability (cont’d) Level 1: Recall/memory Most basic way to learn Forms the basis for other types of learning and information processing Teacher-made tests tend to have a lot of these questions—easy to make up Very few, if any, of this level question on the NCLEX

NCLEX Test Plan Levels of Cognitive Ability (cont’d) Level 2: Analysis, application Analysis/application requires the student not only to remember but to use the basic information. Separate knowledge into key parts. Interpret the knowledge and decide what it means or implies. Common questions: nursing, diagnosis, lab values, ECG interpretation

NCLEX Test Plan Levels of Cognitive Ability (cont’d) Level 3: Synthesis/evaluation Synthesis, evaluation, and judgment take the process one step further. Students are asked to know more than one fact, AND Apply rules, methods, principles, or theories to a situation, AND Make judgments and decisions about patient care (cont’d)

NCLEX Test Plan: Levels of Cognitive Ability (cont’d) Level 3 (cont’d) Students must be able to process two or more facts, concepts, theories, rules, or principles of care to answer the question. Question may ask the student to discriminate between four plausible answers by priority (best, first, highest priority, etc.). These types of questions are the best indicators of critical thinking. These types of questions are used frequently by NCLEX.

NCLEX Test Plan Integrated Concepts and Processes Integrated concepts and processes include Nursing process Caring Communication and documentation Cultural awareness Self-care Teaching and learning These are asked throughout the exam.

NCLEX Test Plan: Integrated Concepts and Processes (cont’d) Focus on nursing process Five-step process of NCLEX Assessment Analysis Planning Intervention (implementation) Evaluation

NCLEX Test Plan Nursing Process Assessment questions Process of gathering information about the client from History Physical assessment Laboratory tests Complaints Vital signs Environmental elements

NCLEX Test Plan Nursing Process (cont’d) Analysis Involves developing and using nursing diagnosis NCLEX uses North American Nursing Diagnosis Association (NANDA) nursing diagnosis system May ask the student to prioritize nursing diagnosis Remember Maslow and ABCs

NCLEX Test Plan Nursing Process (cont’d) Planning Directed toward Goal setting Determining expected outcomes Setting priorities for goals and care Anticipating client needs based on the assessment Goals should be Realistic, time limited, measurable, client-centered May be asked to prioritize goals

NCLEX Test Plan Nursing Process (cont’d) Intervention/implementation Identifies nursing actions needed to achieve goals, including Medication administration; drug calculations Basic care; delegation; supervision Carrying out procedures; giving treatments Charting/recordkeeping Teaching; therapeutic communication Monitoring for changes, etc.

NCLEX Test Plan Nursing Process (cont’d) Evaluation Determines if goals were achieved Ties the nursing process together Includes Actual versus expected outcomes Verification of assessment data Evaluation of nursing actions Client responses to treatments, teaching, etc. Client’s level of knowledge and understanding

NCLEX Test Plan The Four Client Health Needs Safe and Effective Care Environment Physiological Integrity Psychosocial Needs Health Promotion and Maintenance

NCLEX Test Plan Client Health Needs (cont’d) % of Questions 21–33% 13–19% 8–14% 6–12% 38–62% 11–17% A. Safe and Effective Care Environment Management of Care Safety & Infection Control B. Health Promotion and Maintenance C. Psychosocial Needs D. Physiological Integrity Basic Care and Comfort Pharmacology and Parenteral Therapies Reduction of Risk Potential Physiological Adaptation

NCLEX Test Plan Client Health Needs (cont’d) Changes started in 2013 Increase the pass difficulty level by 0.05 logits (from 0.21 logits to 0.16 logits). Increase questions dealing with management and management issues to 22% (highest percentage of any single type of question). Increase pharmacology-related questions to 19%.

NCLEX Test Plan Client Health Needs (cont’d) Safe and Effective Care Environment

NCLEX Test Plan Client Health Needs (cont’d) Safe and Effective Care Environment Management of care Coordinate care; quality assurance Delegation Management and leadership Safety and infection control Medication administration; lab tests Preventing injuries; restraints Safety measures Types of isolation Legal and ethical issues

NCLEX Test Plan Client Health Needs (cont’d) Physiological Integrity

NCLEX Test Plan Client Health Needs (cont’d) Physiological Integrity Basic care and comfort Pharmacology and parenteral therapies Reduction of risk potential Physiological adaptation Includes adult medical/surgical and pediatrics All major disease processes Genetic disorders Basic care (mobility, comfort, hygiene, etc.)

NCLEX Test Plan Client Health Needs (cont’d) Psychosocial Needs

NCLEX Test Plan Client Health Needs (cont’d) Psychosocial Needs Coping and adaptation Coping skills versus defense mechanisms Therapeutic communication Crisis intervention Psychosocial adaptation All the major psychological disorders Anxiety disorders; depression; schizophrenia Personality disorders; organic mental disorders (OMD) Drug abuse and treatment modes

NCLEX Test Plan Client Health Needs (cont’d) Health Promotion and Maintenance

NCLEX Test Plan Client Health Needs (cont’d) Health Promotion and Maintenance Growth and development through the life span Erikson’s stages; Piaget Normal growth and development Prevention and early detection of disease Normal OB and complications STD Women’s health Newborn care and complications

Reporting of NCLEX Results The computer knows when it shuts off if you passed or failed. At the end of the day, results are downloaded electronically to the NCSBN in Chicago. Next business day, they notify the state board of nursing electronically and send a hard copy. It is up to the state board of nursing to notify graduate. Many do it electronically Some still wait until they get the hard copy

Pass or Fail Only on NCLEX No numerical score

With Fail Score You Get Additional Information 10 content areas are listed and described. For each area, one of the following is used to describe graduate performance Above the passing standard Near the passing standard Below the passing standard Use to study for retake

Retaking the NCLEX Exam Must wait 45 days to retake the exam First-time takers have preference for dates and times Some states have limits on the number of times it can be retaken

Examination Study Tips Contact the National Council of State Boards of Nursing website for information on recent changes in NCLEX, sample tutorial, and sample questions: http://www.ncsbn.org NCLEX

Study Tips for the NCLEX Formal NCLEX reviews Similar content Different formats Look for pass rate after review Look for guarantee Only as good as the presenter

Study Tips for the NCLEX (cont’d) Do 3,000 to 5,000 questions. Complete a 265-item test in one sitting in 6 hours. Practice on the computer. Practice computer tests: Google “NCLEX practice test.”

Study Tips for the NCLEX (cont’d) Take the NCLEX as soon as possible after you graduate. Studies show Less than 26 days: 89% pass rate 27 to 39 days: 80% pass rate 40 to 62 days: 72% pass rate 62 days to 4 years: 45% pass rate

Night Before the Exam No movie—only light entertainment. Drive to the test site. Review formulas, common medications, and information presented in tables, cards, and lists. Don’t try to study everything! Go to bed at a reasonable hour. Rest does not = sleep Think positive!

Day of the NCLEX Exam Avoid excessive oral intake of your preferred caffeine beverage: coffee, tea, soft drinks.

Day of the NCLEX Exam (cont’d) Cigarettes If you smoke, this is not a good day to quit! If you don’t smoke, this is not a good day to start!

Day of the NCLEX Exam (cont’d) Do increase intake of foods with high-quality protein and complex carbohydrates. Do arrive 30 to 45 minutes early.

Day of the NCLEX Exam (cont’d) Don’t let security fluster you. They take A digital picture A digital thumb print A digital signature

Day of the NCLEX Exam (cont’d) Wear comfortable clothes. Think positive!