1. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 26 NCLEX-RN ® Examination

2. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. NCLEX-RN Examination  Required to receive a license to practice as an RN  United States  U.S. territories

3. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. NCLEX-RN Examination  Successful completion demonstrates competence to provide effective nursing care.  Graduates from the three types of nursing programs take the same examination.  People taking the exam must have graduated from a school of nursing approved by the state board of nursing.

4. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Purpose of the NCLEX-RN Examination  Safeguards the public from unsafe practitioners  Assists state boards of nursing in determining candidates’ capabilities for performing in entry-level RN positions

5. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Characteristics of the NCLEX-RN  Computerized pass-fail exam  Uses computerized-adaptive testing (CAT)  Determines competency on the basis of difficulty of questions answered—not on how many questions were answered correctly  Adapts to the level of knowledge, skills, and ability as questions are answered  Candidates may request assistance with the use of the computer at any time.

6. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Characteristics of the NCLEX-RN  Questions  Traditional multiple choice with two formats One question with four possible answers One question with four possible answers Three-component question: The left side of the computer screen contains information needed to answer the question, such as background or short case study; right side of the computer screen contains the actual question with four possible answers. Three-component question: The left side of the computer screen contains information needed to answer the question, such as background or short case study; right side of the computer screen contains the actual question with four possible answers. All options may be correct, but one choice is “more correct.” All options may be correct, but one choice is “more correct.” Most common type of format used Most common type of format used

7. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Characteristics of the NCLEX-RN  Alternate-item format Multiple choice/multiple response Multiple choice/multiple response  Question is presented with four or more responses.  Candidate is asked to check all correct responses. Fill-in-the-blank Fill-in-the-blank  Answer to the question is typed in rather than selected from among options.  Candidates may be asked to calculate values.

8. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Characteristics of the NCLEX-RN Identification Identification  Picture or graphic image is presented.  Candidate is asked to identify a particular area. Prioritize Prioritize  A set of responses to a question is presented.  Candidate is asked to place them in order of priority.

9. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Characteristics of the NCLEX-RN  Candidates may not receive alternate-item format questions on their examination.  Skipping questions and changing answers are not allowed.  All information needed to answer a question appears on a single computer screen.

10. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Characteristics of the NCLEX-RN  Questions based on Bloom’s four cognitive levels Knowledge: remembering or recalling information Knowledge: remembering or recalling information Comprehension: ability to grasp or understand information or material Comprehension: ability to grasp or understand information or material Application: ability to use learned information in new situations Application: ability to use learned information in new situations Analysis: ability to reduce information to its elemental parts, so its design and structure may be understood Analysis: ability to reduce information to its elemental parts, so its design and structure may be understood

11. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Characteristics of the NCLEX-RN  Composed of 3000 questions of varying levels of difficulty  Candidates will answer a minimum of 75 questions to a maximum of 265. Length is based on performance. Length is based on performance.

12. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Characteristics of the NCLEX-RN Results obtained after the minimum number of questions are answered Results obtained after the minimum number of questions are answered  If clearly above passing standard, examination ends and candidate passes.  If clearly below passing standard, examination ends and candidate fails.  If competency level is close to the passing standard but not definite, questions will continue until a clear pass- fail decision can be determined, the maximum number of questions is reached, or time runs out.

13. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Components of the NCLEX-RN Test Plan  Test plan  Based on the current nursing practice of entry-level RNs  Framed by four major categories of client needs: Safe and effective care environment Safe and effective care environment Health promotion and maintenance Health promotion and maintenance Psychosocial integrity Psychosocial integrity Physiologic integrity Physiologic integrity

14. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Client needs  Safe, effective care environment 13% to 19% of questions address the management of client care. 13% to 19% of questions address the management of client care. 8% to 14% of questions address client safety and infection control. 8% to 14% of questions address client safety and infection control. Components of the NCLEX-RN Test Plan

15. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Health promotion and maintenance Focuses on prevention/early detection of disease and achieving optimal health Focuses on prevention/early detection of disease and achieving optimal health 6% to 12% of questions address health promotion and maintenance. 6% to 12% of questions address health promotion and maintenance. Components of the NCLEX-RN Test Plan

16. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Psychosocial integrity Promoting and supporting the emotional, mental, and social well-being of clients Promoting and supporting the emotional, mental, and social well-being of clients 6% to 12% of questions address psychosocial integrity. 6% to 12% of questions address psychosocial integrity. Components of the NCLEX-RN Test Plan

17. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Physiologic Integrity 6% to 12% of questions address basic client care and comfort. 6% to 12% of questions address basic client care and comfort. 13% to 19% of questions address pharmacologic and parenteral therapies. 13% to 19% of questions address pharmacologic and parenteral therapies. 13% to 19% of questions address reduction in risk potential. 13% to 19% of questions address reduction in risk potential. 11% to 17% of questions address physiologic adaptation. 11% to 17% of questions address physiologic adaptation. Components of the NCLEX-RN Test Plan

18. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Four integrated processes  Nursing process  Caring  Communication and documentation  Teaching/learning Components of the NCLEX-RN Test Plan

19. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Process  Success on NCLEX-RN relies on a sound knowledge of the nursing process.  Assessment Establishes a database for the client (individual, group, family, community) Establishes a database for the client (individual, group, family, community) Sources of data Sources of data Client, family, significant others Client, family, significant others Lab/x-ray reports Lab/x-ray reports Medical records Medical records Other caregivers Other caregivers Data classified as subjective or objective Data classified as subjective or objective Includes verification and communication of data Includes verification and communication of data

20. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Process  Analysis Assessment data are classified and grouped to identify actual or potential client problems. Assessment data are classified and grouped to identify actual or potential client problems. Includes data validation, interpretation, and identifying the need for additional data Includes data validation, interpretation, and identifying the need for additional data Nursing diagnoses are determined and communicated. Nursing diagnoses are determined and communicated. Congruency is required between client needs and nurse’s ability to realistically meet needs. Congruency is required between client needs and nurse’s ability to realistically meet needs.

21. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Process  Planning Setting realistic, measurable goals Setting realistic, measurable goals Designing strategies to meet or resolve identified needs Designing strategies to meet or resolve identified needs Modifying goals as necessary Modifying goals as necessary Ranking nursing diagnoses Ranking nursing diagnoses Documenting expected outcomes Documenting expected outcomes Setting realistic target dates Setting realistic target dates Communicating the plan of care Communicating the plan of care Collaborating with other members of the health care team Collaborating with other members of the health care team

22. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Process  Implementation Organizing and managing care Organizing and managing care Actually providing care Actually providing care Overseeing and coordinating the delivery of care Overseeing and coordinating the delivery of care Delegating actions to other workers Delegating actions to other workers Teaching or counseling Teaching or counseling Communicating and exchanging client-related information Communicating and exchanging client-related information

23. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Process  Evaluation Comparing what actually happened with anticipated outcomes or goals Comparing what actually happened with anticipated outcomes or goals Data must be collected during this phase so progress can be evaluated. Data must be collected during this phase so progress can be evaluated. Resolve the plan because the client has achieved the goal. Resolve the plan because the client has achieved the goal. Continue the plan because the client is still making satisfactory progress. Continue the plan because the client is still making satisfactory progress. Revise the plan because the client is not making satisfactory progress. Revise the plan because the client is not making satisfactory progress.

24. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Other Integrated Processes  Caring  Interactions between nurse and client to achieve desired outcomes  Communication and documentation  Verbal, nonverbal, and written interactions between nurse and client, client’s significant others, and other members of the health care team

25. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Other Integrated Processes  Teaching/learning  Nurse’s role in facilitating the acquisition of knowledge, skills, and attitudes to promote clients’ behavior change

26. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Steps in preparation  Perform a needs assessment: Determine areas of strength and weakness. Determine areas of strength and weakness. Look at previous academic experiences and coursework. Look at previous academic experiences and coursework. Talk with faculty. Talk with faculty. Be honest: The foundation for success or failure may lie here. Be honest: The foundation for success or failure may lie here. Preparing for the NCLEX-RN Examination

27. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Determine the number of days or weeks necessary for review.  Decide what method of review will be used: Personal study Personal study  Strong points—Total control over content and time spent in review  Weak points—No immediate resources to explain or assist with difficult concepts; difficulty sticking to review schedule Preparing for the NCLEX-RN Examination

28. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Group study Group study  Strong points--Group support; learning from others  Weak points--Lack of preparation of some group members; weak members holding the rest back; socializing rather than reviewing Preparing for the NCLEX-RN Examination

29. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Decide what materials or resources will be used. Textbooks and class notes Textbooks and class notes NCLEX-RN review books NCLEX-RN review books Talk with nursing faculty about available preparation aids. Talk with nursing faculty about available preparation aids. Preparing for the NCLEX-RN Examination

30. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Structure review time: Schedule review during peak performance times. Schedule review during peak performance times. Learning is enhanced when one reviews for short blocks of time (50 minutes). Learning is enhanced when one reviews for short blocks of time (50 minutes). Preparing for the NCLEX-RN Examination

31. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Control the review environment: Keep noise and distraction to a minimum. Keep noise and distraction to a minimum. Have all materials close at hand. Have all materials close at hand. Have adequate space and lighting, and comfortable room temperature. Have adequate space and lighting, and comfortable room temperature. Ask not to be interrupted. Ask not to be interrupted. Preparing for the NCLEX-RN Examination

32. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Develop a review schedule and stick to it.  Learn concepts and principles—not isolated facts.  Use learning techniques that have proved successful in the past.  Seek qualified help when you are reviewing information that is difficult. Preparing for the NCLEX-RN Examination

33. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Preparing for the NCLEX-RN Examination  Practice taking NCLEX-type examinations. Learn to take about 1 minute per question. Learn to take about 1 minute per question. Pay attention to reasons for correct and incorrect answers. Pay attention to reasons for correct and incorrect answers.  Use the Internet to access numerous resources that may aid in preparation for the NCLEX-RN examination.  Avoid the use of stimulants to increase review time.  Maintain a healthy, positive attitude toward reviewing and taking the examination.

34. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Preparing for the NCLEX-RN Examination  Selecting an NCLEX-RN review course:  Determine qualifications of the instructor. May be taught by nurses who are nursing school faculty May be taught by nurses who are nursing school faculty May be taught by a person with no nursing background May be taught by a person with no nursing background  Check financial incentives: may be expensive and may last from 1 to 5 days  Ask the school of nursing faculty for guidance.  Compare and contrast written information obtained from several courses.