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LIPPINCOTT'S Q&A REVIEW FOR NCLEX-RN 10TH EDITION BY DIANE M. BILLINGS
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1Introduction to the NCLEX-RN® Licensing Examination and Preparation for Test-Taking1PART
Billings_Part 1_Chap 1.indd 1 Billings_Part 1_Chap 1.indd 1 8/9/2010 7:31:48 PM 8/9/2010 7:31:48 PM 21The NCLEX-RN® Licensing Examination
Overview
The National Council Licensure Examination for Registered Nurses (NCLEX-RNs®) is administered to graduates of nursing schools to test the knowl-edge, abilities, and skills necessary for entry-level safe and effective nursing practice. The examina-tion is developed by the National Council of State Boards of Nursing, Inc. (NCSBN), an organization with representation from all state boards of nursing.
1 The same examination is used in all 50 states, the District of Columbia, and United States possessions. The exam is also administered at international test centers worldwide.
1 Students who have graduated from baccalaureate, diploma, and associate-degree programs in nursing must pass this examination to meet licensing requirements in the United States.
The T est Plan
The NCSBN prepares the test plan used to develop the licensing examination. The test plan is based on an analysis of current nursing practice and the skills, abilities, and processes nurses use to provide nursing care.
Practice Analysis: The Foundation of the T est Plan
The NCLEX-RN test plan is based on the results of a practice analysis conducted every 3 years of the entry-level performance of newly licensed registered nurses and on expert judgment provided by mem-bers of the National Council’s Examination Commit-tee as well as a Job Analysis Panel of Experts.
1, 2, 5 The job analysis asks newly graduated nurses to rank the nursing activities that they perform on a regular basis. The questions used on the test plan, therefore, include those activities that nurses commonly perform. For example, the 2008 RN practice analysis revealed that nursing practice commonly involved activities such as preparing and administering medications, using rights of medication administration; ensuring proper iden-tifi cation of client when providing care; applying principles of infection control (e.g., hand hygiene, room assignment, isolation, aseptic/sterile tech-
nique, universal/standard precautions); performing emergency care procedures (e.g., cardiopulmonary resuscitation, abdominal thrust maneuver, respira-tory support, automated, external defi brillator); rec-
ognizing signs and symptoms of complications and intervening appropriately when providing client care; reviewing pertinent data prior to medication administration (e.g., vital signs, lab results, allergies, potential interactions).
Less commonly performed activities included providing care and/or support for a client with non-substance related dependencies; assisting client and staff to access resources regarding genetic issues; incorporating alternative/complementary therapies into client plan of care (e.g., music therapy, relax-ation therapy), and performing post-mortem care.
The National Council of State Boards of Nursing also used the fi ndings from the Practice Analysis activity statements to generate knowledge state-ments, the knowledge needed by newly licensed nurses to provide safe care.
5 The fi ndings of this second report are used to inform item development for the NCLEX-RN examination.
T est Item Writers
Nurse clinicians and nurse educators nominated by the Council of State Boards of Nursing to serve as item writers write the test questions on the NCLEX-RN exam. Because the item writers come from a variety of geographical areas and practice settings, the test items refl ect nursing practice in all parts of the country.
T est Plan Details
Test plans, or test blueprints, are developed to indicate the components and the relative weights of the components that will be tested on an exam. Because exams test both content (knowledge) and process (critical thinking, synthesis of informa-tion, clinical decision-making), test plans usually have two or three dimensions. The test plan for the NCLEX-RN addresses two components of nursing Billings_Part 1_Chap 1.indd 2 Billings_Part 1_Chap 1.indd 2 8/9/2010 7:31:48 PM 8/9/2010 7:31:48 PM The NCLEX-RN® Licensing Examination 3
Understanding the category of client needs is key ( ) to recognizing the types of questions that are found on the licensing exam and the relative empha-sis given to the category based on the percentage of questions from that category on the exam.
Integrated Processes
The NCLEX-RN test plan also is organized accord-ing to four integrated processes. These include the nursing process, caring, communication and docu-mentation, and teaching/learning. (See Table 1.1 and Figure 1.1.)
The Nursing Process
The NCLEX-RN test plan includes questions from all steps of the nursing process. The fi ve phases of the nursing process are: (1) assessment, (2) analysis, (3) planning, (4) implementation, and (5) evaluation.
Assessment. Assessment involves establishing a database. The nurse gathers objective and subjective information about the client, and then verifi es the data and communicates information gained from the assessment.
Analysis. Analysis involves identifying actual or potential health care needs or problems based on assessment data. The nurse interprets the data, col-lects additional data as indicated, and identifi es and communicates the client’s nursing diagnoses. The nurse also determines the congruency between the client’s needs and the ability of the health care team members to meet those needs.
Planning. Planning involves setting outcomes and goals for meeting the client’s needs and design-ing strategies to attain them. The nurse determines the goals of care, develops and modifi es the plan, collaborates with other health team members for delivery of the client’s care, and formulates expected outcomes of nursing interventions.
Implementation. Implementation involves initiating and completing actions necessary to accomplish the defi ned goals. The nurse organizes and manages the client’s care; performs or assists the client in performing activities of daily living; counsels and teaches the client, signifi cant others, and health care team members; and provides care to attain the established client goals. The nurse also provides care to optimize the achievement of the client’s health care goals; supervises, coordinates, and evaluates delivery of the client’s care as pro-vided by nursing staff; and records and exchanges information.
Evaluation. Evaluation determines goal achievement. The nurse compares actual with expected outcomes of therapy, evaluates compliance with prescribed or proscribed therapy, and records and describes the client’s response to therapy or care. The nurse also modifi es the plan, as indicated, and reorders priorities.care: (1) client needs categories and (2) integrated processes, such as the nursing process, caring, communication and documentation, and teaching/learning. (See Table 1.1.) Representative items test knowledge of these components as they relate to specifi c health care situations in all of the four major areas of client needs. The questions developed for the test plan are written to test nursing knowledge and the ability to apply nursing knowledge to client situations.
Client Needs
The health needs of clients are grouped under four broad categories: (1) safe, effective care environ-ment; (2) health promotion and maintenance; (3) psychosocial integrity; and (4) physiologic integ-rity. Two of these categories include subcategories of related and specifi ed needs. (See Table 1.2.) The percentage of test items in each subcategory on the NCLEX-RN examination is shown in Figure 1.1. TABLE 1.1
Test Plan Structure
The framework of Client Needs was selected for the NCLEX-RN® examination because it provides a univer-
sal structure for defi ning nursing actions and competen-
cies across all settings for all clients.
Client Needs
Four major categories of Client Needs organize the content of the NCLEX-RN Test Plan. Two of the four categories are further divided into a total of six subcat-egories that defi ne the content contained within the two Client Needs categories. These categories and subcat-egories are:
A. Safe, Effective Care Environment
1. Management of Care2. Safety and Infection Control
B. Health Promotion and Maintenance
C. Psychosocial Integrity
D. Physiological Integrity
1. Basic Care and Comfort2. Pharmacological and Parenteral Therapies3. Reduction of Risk Potential4. Physiological Adaptation
Integrated Concepts and Processes
The following concepts and processes fundamental to the practice of nursing are integrated throughout the four major categories of Client Needs:
■ Nursing Process
■ Caring
■ Communication and Documentation
■ Teaching/Learning
Copyright by the National Council of State Boards of Nursing, Inc. All rights reserved.
Billings_Part 1_Chap 1.indd 3 Billings_Part 1_Chap 1.indd 3 8/9/2010 7:31:48 PM 8/9/2010 7:31:48 PM
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