- COADNcoadn.org/north/files/resource/17.pdf · Tim J. Bristol, RN, PhD, CNE 1 Back to Basics with the NCLEX® Test Plan Tim Bristol, RN, PhD, CNE Walden University [email protected]

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Tim J. Bristol, RN, PhD, CNE 1

Back to Basics with the NCLEX® Test Plan

Tim Bristol, RN, PhD, CNEWalden University

[email protected] Ext. 1

NCLEX in April 2010NCLEX in April 2010What will and what will not change.

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Faculty can use the NCLEX test plan to write curriculum and develop learning activities.

TA. TrueB. FalseC. Maybe

2008RN Practice Analysis for Test Plan April, 2010

“…assists the NCSBN in evaluating the validity of the test plan that guides content distribution of the examination ”examination.

2008 RN Practice Analysis

Practice Analysis

Conducted every 3 yearsNew NCLEX® Test Plan every 3 yearsRN – April 2010 – 2013RN April 2010 2013PN – April 2008-2011Determines content of test planReevaluates Areas of Client Needs

NCLEX® RN 2008 Practice Analysis

The sample…12,000 nurses (up to 6 months post grad)2051 surveys used2051 surveys used88.3% Female (down from 91.9% in 2005)Average age 31.89 (down from 31.96 in 2005)18.6% Previous LPN/LVN (average of 5.3 years)51.7% Previous aide

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Tim J. Bristol, RN, PhD, CNE 2

Characteristics of new graduates work environment

RN’S 2005 2008

Hospitals 84% 89.2%LTC 7.6% 5.3%Community 5.5% 3.9%Other 1.3% 1.6%

Practice Setting – RN’s

2005 2008Critical Care 31.3% 34.5%Medical surgical unit 40.4% 39.5%Pediatrics/nursery 6 2% 7 4%Pediatrics/nursery 6.2% 7.4%Labor/Delivery 4.3% 3.7%Post Partum 3.4% 3.9%LTC 6.2% 5.0%

Participants could select more than 1 area of practice.

Client Ages

2005 2008Older Adult (over 85 yrs) 25.8% 24.8%Older Adult (65-85 yrs) 58% 61.6%Adult (31 64 yrs) 58 1% 60 6%Adult (31-64 yrs) 58.1% 60.6%Young adult (19-30 yrs) 23.5% 24.6Adolescents (13-18 yrs) 10.5% 11.0%NB-Children (0-12 yrs) 11.0% 11.2%

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When should we start discussing the NCLEX Test Plan with students?A. Semester 1B. Semester 2C. Final SemesterD. Other

NCLEX® RN 2008 Practice Analysis

Priority pp. 122-135 / Appx FMed Admin RightsUniversal PrecautionsClient ID

Changes for 2010 - RN2007 2010

Management of Care 13-19 16-22%

Safety & Infection Control 8-14 8-14%

Health Promotion & Maintenance 6-12 6-12%Health Promotion & Maintenance 6 12 6 12%

Psychosocial Integrity 6-12 6-12%

Basic Care & Comfort 6-12 6-12%

Pharmacological & Parenteral Therapies

13-19 13-19%

Reduction of Risk Potential 13-19 10-16%

Physiological Adaptation 11-17 11-17%

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Tim J. Bristol, RN, PhD, CNE 3

Areas of Client Needs

Safe Effective Care Environment

Management of Care ***2007 13 19% 2010 16 22%2007: 13-19% 2010: 16-22%

Safety and Infection Control2007- 8-14% 2010 – 8-14%

Management questions

Determine priority of care for a group of clients.Determine priority of care for a client.Determine where/how clients room assignments are to be made.Delegate nursing assignments to other RN’s (float, new graduate).Assign nursing care to LVN’s and CNA’sDetermine most stable client to be moved for bed space.

Areas of Client Needs

Health Promotion and Maintenance2007: 6-12% 2010: 6-12%

Psychological Integrity2007: 6-12% 2010: 6-12%

Areas of Client Needs

Physiological Integrity – cont.

Reduction of Risk Potential ***2008: 13 19% 2010: 10 16%2008: 13-19% 2010: 10-16%

Physiological Adaptation2008:11-17% 2010: 11-17%

Level of Difficulty“Good ole” Bloom!

KnowledgeComprehensionApplicationA l iAnalysisSynthesis/Evaluation

Level of difficulty is determined by the question construction – not the level of difficulty of the content of the question.

Want to increase difficulty not adding obscure information.

Level of Difficulty“NEW” Bloom!

RememberUnderstandApplyA lAnalyzeEvaluateCreate

Want to test how they think “instead of what they know…”

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Tim J. Bristol, RN, PhD, CNE 4

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Students fail NCLEX primarily for a lack of knowledge about the content.A. TrueB. False

NCLEX Resources

ncsbn.org 2008 RN Practice Analysis, 2010 Test Plan2006 PN Practice Analysis, 2008 Test Plan

NCLEX RN Test Plan April 2010NCLEX-RN Test Plan, April 2010NCLEX RN Examination –Detailed Test Plan, 2010 (available in Jan, 2010) Candidate Bulletin Candidate Tutorial

Identification Strategies

BiometricsPicture, fingerprint, palm vein

Forms of acceptable identificationDriver’s licenseState issued identificationMilitary identificationPassport

Student Success

NCLEX Test PlanNCLEX HospitalNursing Care

Nursing Process

NCLEX Tutorial Sample Questions

No ‘Previous’ button on real examSame tutorial students will take the day of the examAny item may include charts/tables

Associate the Tutorial with something ‘happy/peaceful’

Any item may include charts/tables /graphsMultiple response (4-6 options, at least one is correct)Always tells how much rounding is required“Prescriptions” can be non-drug orders

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Tim J. Bristol, RN, PhD, CNE 5

NCLEX Questions

What kindHow many alternate formatPretest items Pretest items –RN - 15 within first 75 questionsPN – 25 within first 85 questions

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Should we have Alternate Format questions on our in class exams?A. YesB. NoC. MaybeD. All of the aboveE. None of the above

Alternate Format ***

Audio questionsHeadsets will be providedStudent will be advised when to put

headset on for questionheadset on for questionListen to audio and select an answer

from the list providedPossible content: verbal

communication, breath sounds, heart sounds

The prices of corn have been rising steadily.

The nurse is caring for a client who is having difficulty with elimination. After listening to the bowel sounds, what would be the best nursing action? (student applies head set and hears very loud gurgling bowel sounds in all 4 quadrants)1. Further assess the abdomen and anticipate client may

experience diarrhea.2 P id t b th th li t h ld2. Provide easy access to bathroom, the client should

have a normal bowel movement within next few hours.3. No action is necessary, the client’s bowel sounds are

normal. 4. Provide client with increased fluids and dietary fiber to

prevent constipation.

The nurse is caring for a 85 year old client who has a diagnosis of Mycoplasma pneumonia. What precautions will the nurse implement in assisting the client with morning care?Select all that apply:

1. Wear clean gloves.2 Remove all extra suctions supplies from the room

Alternate Format - Select all that apply:

2. Remove all extra suctions supplies from the room.3. Dispose of gown and mask in container outside client’s door4. Wear a face mask when working within 3 feet of the client5. Put on a gown prior to entering the room.6. Remove the stethoscope from the room if it did not come in contact with the client.

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Tim J. Bristol, RN, PhD, CNE 6

The nurse is caring for a 85 year old client who has a diagnosis of Mycoplasma pneumonia. What precautions will the nurse implement in assisting the client with morning care?Select all that apply:

1. Wear clean gloves.2. Remove all extra suctions supplies from the room.3. Dispose of gown and mask in container outside client’s door

4. Wear a face mask when working within 3 feet of the client.

5. Put on a gown prior to entering the room.6. Remove the stethoscope from the room if it did not come in contact with the client.

Alternate Format - rankingThe nurse is caring for a client with pneumonia. He is dyspneic, his temperature is 102 º orally, and he is complaining of chest pain. In what order would the nurse provide care to this client?1. Encourage clear liquids.2. Administer humidified oxygen.3. Place client in semi-Fowler’s position.4. Administer antipyretic medication.5. Instruct client regarding risk factors

The nurse is caring for a client with pneumonia. He is dyspneic, his temperature is 102 º orally, and he is complaining of chest pain. In what order would the nurse provide care to this client?3 Place client in semi Fowler’s position3. Place client in semi-Fowler’s position.2. Administer humidified oxygen.4. Administer antipyretic medication.1. Encourage clear liquids.5. Instruct client regarding risk factors

Fill in the blank – all numbersMedication calculationsIV fluid calculationsI t k d t tIntake and outputGlascow coma scaleNo apothecary conversions

Fill in the blank

The nurse is completing the intake and output for a client who is 24 hours postoperative. The client has had the following intake and output for the shift:

4 oz orange juice 1000mL urine½ scrambled egg 120mL drainage fromgg g½ cup flavored gelatin T-tube1 cup broth400mL .45% normal saline, IVHow many milliliters should the nurse document as the

client’s intake?

Answer: 1060 Milliliters

Rules for RoundingRound answer to one decimal place.Perform rounding at the end of the calculation.

Calculator – type the numbers slowly, Calculator type the numbers slowly, make sure calculator registers all numbers typed in.

Units of measurement will be provided

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Tim J. Bristol, RN, PhD, CNE 7

Hot Spot GraphicThe nurse is caring for a

client who is receiving Digoxin .25 mg every morning. On the graphic identify the correct location where the nurse Xlocation where the nurse would place the stethoscope to identify the client’s pulse.

Graphics

Chart/ExhibitA postoperative client tells the nurse he is hurting, the nurse assesses the client and determines the pain is in the abdomen around the area of the incision, pain level is 6. It is 6pm in the evening and the nurse is determining what can be done regarding the client’s pain. Select the best answer based on the information in the chart. 1 Give 10mg morphine sulfate IM now

Exhibit 1

N N t1. Give 10mg morphine sulfate, IM now.2. Medication cannot be administered. 3. Give 15mg morphine sulfate, IM now. 4. Give hydrocodone (Vicodan) 10mg PO

Nurses Notes

Exhibit 2Physician orders

Exhibit 3Medication administration record.

Exhibit 1 – Nurses notes

Information:7am – complaining of abdominal pain around area of incision; pain level 6, pain medication administered.11am - sleeping throughout the day, lethargic, but easily aroused.1pm – complaining of abdominal pain around incisional area, pain level 5, pain medication administered, was free of pain and resting comfortably within 30 minutes.4pm - remains comfortable.5pm - beginning to complain of abdominal incisional pain.

Exhibit 2 – Physicians orders

Physicians orders: Orders for the last 24 hours include:Morphine sulfate 10-15 mg, IM, every 3-4 hours for severe pain.hours for severe pain.Hydrocodone (Vicodan) 10mg PO, every 3-4 hours moderate pain.

Exhibit 3

Medication administration record (MAR)Morphine sulfate 10 IM administered at 7amHydrocodone 10mg, PO administered at

11pm

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Tim J. Bristol, RN, PhD, CNE 8

Chart/ExhibitA postoperative client tells the nurse he is

hurting, the nurse assesses the client and determines the pain is in the abdomen around the area of the incision, pain level is 6. It is 6pm in the evening and the nurse is determining what can be done regarding the client’s pain.

Select the best answer based on the information in the chart.

1 Give 10mg morphine sulfate IM nowExhibit 1

N N t1. Give 10mg morphine sulfate, IM now.2. Medication cannot be administered. 3. Give 15mg morphine sulfate, IM now. 4. Give Hydrocodone (Vicodan) 10mg PO

now

Nurses Notes

Exhibit 2Physician orders

Exhibit 3Medication administration record.

Your CurriculumImplications – Client Needs

Safe and Effective Care EnvironmentManagement of CareSafety and Infection Control

Health Promotion and MaintenancePsychosocial IntegrityPhysiological Integrity

Basic Care and ComfortPharmacological and Parenteral TherapiesReduction of Risk PotentialPhysiological Adaptation

Your CurriculumImplications – Integrated Processes

Nursing ProcessCaringCommunication and DocumentationTeaching/Learning

Questions?

Tim J. Bristol, RN, PhD, CNE 1

Back to BasicsHigher Order Thinking

Creative Learning Strategies

Tim Bristol, RN, PhD, CNEWalden University

[email protected] Ext. 1

HIGHER ORDER THINKINGAim for

Level of Difficulty“NEW” Bloom!

RememberUnderstandApplyA lAnalyzeEvaluateCreate

Want to test how they think “instead of what they know…”

CR x CR = CR2

Clinical Reasoning is the goalComplex Relationships is the process

Varied sources of dataSimilar optionsPrioritizationTeaching

IPO – Instructional Design

InputData collection/analysis

ProcessAnalysis/synthesis

OutputImplementation/AssessmentSelf-reflection / Thinking-reflection

IPO - Input

Varied InputAnticipatory Set – get readyTextbooks / Quiz / RememberingMediaExperiences

InterprofessionalCollaboration

Tim J. Bristol, RN, PhD, CNE 2

IPO - Process

Analyze/Evaluate/CreateInterpersonal/CollaborationRealistic

Tech/Sim/Academia INVISIBLE

IPO - Output

Can be simultaneous with ‘Process’Analyze/Evaluate/CreateInterpersonal/CollaborationRealistic

Tech/Sim/Academia INVISIBLE

Process-Collaboration

Chat, Quiz, VoteLiveclasstech.comClick on Join PresentationT i l dType in class code

Real Time Data

10

‘CLICKERs’Plugs into MAC or PC with no installationCan be imported into CMS gradebookCan be used to track attendance (give points for attendance)points for attendance)Can be used over any screen on the computer (Web Spreadsheet)Students can register their clicker during class or online.Saves images of Each Vote

EngageTurn On Your Clickers

Tim J. Bristol, RN, PhD, CNE 3

CREATIVE LEARNING STRATEGIESAim for

R-VARK Strategies

RealisticVisualAural

Try to use multiple strategies at once

and try to vary usage within the

course.

Read/WriteKinesthetic

VARK – Adapted from Neil Fleminghttp://www.vark-learn.com/english/page.asp?p=advice

Realistic

Look at practice / Involve practice(National Council does)

What are the key issues?Remember/Understand is best for independent learningIf using complex tools, try to simplify or repeat use

Visual

Image / VideoCreated by - Vendor, Faculty, Student, OtherConcept Maps – Paper/Digital

Read/Write

Can be handwritten or typingCan be digital or paperWorks best when combined with another strategy (realistic, visual, aural)Sometimes considered kinesthetic

Kinesthetic

From writing to walkingPsychomotorThink about students in the classroom and onlineConnect Lab/Clinical/Classroom

Tim J. Bristol, RN, PhD, CNE 4

Realistic – in Class

nTrackKnowledge Management tools

Questions?

Tim J. Bristol, RN, PhD, CNE 1

Back to BasicsLearning Activities

NCLEX Test Plan

Tim Bristol, RN, PhD, CNEWalden University

[email protected] Ext. 1

Activities based on…Safe and Effective Care Environment

Management of CareSafety and Infection Control

Health Promotion and MaintenancePsychosocial IntegrityPhysiological Integrity

Basic Care and ComfortPharmacological and Parenteral TherapiesReduction of Risk PotentialPhysiological Adaptation

Management of CareDelegation Debate

Teams of 6; each team chooses 3 nursing interventions/tasks; Half the team argues for delegating the 3 tasks; Half the team argues against delegating. Teams post their final findings in an online discussion for further review. Can get as formal as you like (ie. Opening argument, counter, closing, etc. AND professional references to include BON/BNE position statements); May want to assign the interventions/tasks to avoid a lot of replication. See Appendix D

Safety and Infection Control

Create a Crossword

In small groups students come up with a list of clues/words that demonstrate the effects of sensory deficits on client safety. Clients can be in the home, hospital, long-t it tti term care, or even community settings. Then the groups create a crossword puzzle and share with the other teams.http://www.puzzle-maker.com/CW/The faculty chooses a couple of clue term combos to 'include' on the next exam.

Health Promotion and Maintenance

Post-Op Pain Concept Map

Given your assigned developmental group, create a concept map for that client based on them experiencing severe post operative abdominal pain not well controlled with medication. Focus on the impact the pain could have on their normal functioning and what non pharmacological interventions may be utilized.Develop the concept map with the online Concept Map Generator.

http://davisplus.fadavis.com/wilkinson/Concept_Map_Generator.cfm

Upload the Concept Map PDF to the Developmental Discussion forum. Then comment on two other maps.

Psychosocial Integrity

Explore NAMI Discussions

Sign up for free access to the parents' section of NAMI.

http://www.nami.org/Template.cfm?Section=Child_and_Teen_Support&template=/Security/Login.cfm

Do not participate in the NAMI discussions. Do not reply or post Do not reply or post. Review some of the discussions. Report back to the class what you have discovered. Would you send a client's family here? Why or why not?

Tim J. Bristol, RN, PhD, CNE 2

Basic Care and ComfortChat Challenge

Your reading for today included changing the colostomy wafer and pouch. This includes specific assessments to ensure the client is not at risk for infection/breakdown/embarrassmentIn your groups ( assign them in groups of 5) go into y g p ( g g p ) gthe chat area in Blackboard and list the steps in changing the wafer of a colostomy. One person lists one step, then one person the next and so on. Each step must be posted from a different person.Once you feel your group has completed this, raise your hand. I will check the list. The first team with a complete list wins a trip to Tim's treasure chest.

Pharmacological and Parenteral Therapies

Sharing ExperiencesInvite 3 individuals (friends, family, former patients) to share their experiences with medication therapeutic/side effects. Can be a recorded video or live in class.HTN medication;Anti-Depressants/Psychotics;Hormone Replacement In 5 minutes, please introduce yourself and then answer these

tiquestions:What prompted you to begin this medication?What were the most significant 3 effects this medication has had on you?How has your life changed with this medication.Student activity: Create a Power Point Patient Education Piece on managing the medication discussed. Each student/group is assigned one of the meds from that person. Be sure to get a signed release for Audio/Video capture/ distribution from those who share.

Reduction of Risk Potential

At Risk Rescue - Wiki

Student Groups are assigned an At Risk SituationAt risk for aspirationAt risk for skin breakdownAt risk for infectionAt risk for altered perfusionAt risk for impaired oxygenation

The Wiki will include a description for 3 different clients that would fit into that category. For each client they must describe:Key risk factorsKey symptoms or changes that help identify manifestations of that riskKey nursing actions to prevent this riskKey nursing actions to reverse injury related to their scenarioBecause this is a Wiki, students can be as creative as they like. They can add images, video, power point, text, color, etc. If a Wiki is not available. They can create a free Blog or facebook group.

Physiological Adaptation

Living Lecture

Today we will be working on the Respiratory system. Follow along online as I lecture.http://www.nursinged.com/Lesson/10-RespPNEd9/10-RespPNEd9.swfp // g / / p / p

Note the interactions and audio. Please turn the audio off so you hear me live. You can listen to the recordings later.

TECH TOOLS

Concept Map Creator

Free with Text BookFree and Open/Available:

FA Davis: http://davisplus.fadavis.com/wilkinson/Concept_Map_Generator.cfmIHMC http://cmap.ihmc.us/conceptmap.html

Tim J. Bristol, RN, PhD, CNE 3

Musical Map Collaboration

1. Each Poster Has a Concept at the top. Your group moves to one of the posters.

2. Music starts, your group writes concepts on postits. Post on the posterboard – no links yet. Try not to duplicate Concepts/ Subconcepts.

3. Music stops you stop writing and move to next poster.

4. Music Starts. Start writing. 5. After group gets to 4th board. Create

links/crosslinks.

facebook ® and Video

Keep groups secretDon’t ‘friend’ studentsKeep your profiles privateHIPAA is still HIPAA

Twitter®

Can keep Tweets privateCan block followers

Chat in Blackboard®

Login see Appendix CTry to keep chats to 10 people if possible

Knowledge Management

Practice in classCollaborate

KM+C=Real Life

Tim J. Bristol, RN, PhD, CNE 4

QSEN-Reduce Reliance on Memory

Search your textbook or entire

libraryHighlights

search

Connect & Collaborate

Make notes and share them with

youryour colleagues

and students

AACN – Essentials: ‘telecommunication for effective communication”

Connect & Collaborate

Notes appear in textbook

Connect & Collaborate

Highlighting is easy

Use messages, notes, and file uploads to

collaborate

Connect & Collaborate

Define multiple groups to organize

your efforts

Integrated quizzes are graded and add

accountability

Connect & Collaborate

y

Tim J. Bristol, RN, PhD, CNE 5

Questions?

Higher Order Thinking Learning Activity Form A tool for developing Higher Order Thinking Learning Activities based on the NCLEX® Test Plan 

Circle one in Each Area Client Needs*  Integrated Processes*  Clinical Reasoning/Complex Relationships CR2 1.Safe and Effective Care Environment  a.Management of Care  b.Safety and Infection Control 2.Health Promotion and Maintenance 3.Psychosocial Integrity 4.Physiological Integrity  a.Basic Care and Comfort  b.Pharmacological and Parenteral Therapies  c.Reduction of Risk Potential  d.Physiological Adaptation 

1.Nursing Process 2.Caring 3.Communication and 

Documentation 4.Teaching/Learning 

*Varied sources of data *Similar options *Prioritization *Teaching Notes: ______________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________  

 Environment   

Purpose    

Summary    

Tools    

Budget/Concerns    

**R‐VARK / Realistic, Visual, Aural, Read/Write, Kinesthetic Input  Process  Output      

Reflection on Learning/Thinking 

*NCSBN.org ;  2010 NCLEX‐RN® Detailed Test Plan  /  ** VARK – Adapted from Neil Fleming  www.vark‐learn.com Copyright © 2010,  NurseTim, Inc.  All Rights Reserved  

Higher Order Thinking Learning Activity Form A tool for developing Higher Order Thinking Learning Activities based on the NCLEX® Test Plan 

Circle one in Each Area Client Needs*  Integrated Processes*  Clinical Reasoning/Complex Relationships CR2 1.Safe and Effective Care Environment  a.Management of Care  b.Safety and Infection Control 2.Health Promotion and Maintenance 3.Psychosocial Integrity 4.Physiological Integrity  a.Basic Care and Comfort  b.Pharmacological and Parenteral Therapies  c.Reduction of Risk Potential  d.Physiological Adaptation 

1.Nursing Process 2.Caring 3.Communication and 

Documentation 4.Teaching/Learning 

*Varied sources of data *Similar options *Prioritization *Teaching Notes: ______________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________  

 Environment   

Purpose    

Summary    

Tools    

Budget/Concerns    

**R‐VARK / Realistic, Visual, Aural, Read/Write, Kinesthetic Input  Process  Output      

Reflection on Learning/Thinking 

*NCSBN.org ;  2010 NCLEX‐RN® Detailed Test Plan  /  ** VARK – Adapted from Neil Fleming  www.vark‐learn.com Copyright © 2010,  NurseTim, Inc.  All Rights Reserved