1. NCLEX Test Plan
Joseph T. Catalano

2. Computerized Exam Taken at Pearson Professional Testing Sites

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

4. 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

5. Pool of Questions
Computer selects questions from pool of about 4,000 questions
Selection 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:
Trial-testing those questions
You’re having trouble in one area

6. 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%

7. Difficulty Level
Anything you know REALLY well will NOT be on the NCLEX exam
There are NOT any “happy” questions on the NCLEX—there is always something wrong, and if it’s in the question, you need to worry about it!

8. 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

9. 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!

10. 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

11. 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, computer looks at the whole exam: if majority are above the pass criterion, you pass

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

13. NCLEX Exam Procedures Sit at computer with your picture
Two chances to complete tutorial
Tight security
All sessions are taped; proctor remains in room
Be careful not to look like you’re cheating!

14. 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

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

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

17. Time Limit for NCLEX
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

18. 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

19. NCLEX Plan Type of Questions
The 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

20. 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)

21. Alternative Format Questions
New types starting in 2010:
EXHIBIT ITEMS (Type 2)
AUDIO ITEMS
GRAPHIC ITEMS

22. NCLEX Test Plan Three major components 1. Levels of cognitive ability
2. Integrated concepts and processes
3. Client health needs

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

24. NCLEX Test Plan: Levels of Cognitive Ability
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

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

26. NCLEX Test Plan: Levels of Cognitive Ability
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 (continued)

27. NCLEX Test Plan: Levels of Cognitive Ability
Level 3 (continued)
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
Used a lot by NCLEX

28. NCLEX Test Plan: Component 2 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

29. NCLEX Test Plan: Component 2 Integrated Concepts and Processes
Focus on Nursing Process
Five-step process of NCLEX
Assessment
Analysis
Planning
Intervention (implementation)
Evaluation

30. 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

31. NCLEX Test Plan: Nursing Process
Analysis
Involves developing and using nursing diagnosis
NCLEX uses NANDA nursing diagnosis system
May ask the student to prioritize nursing diagnosis
Remember Maslow and ABCs

32. NCLEX Test Plan: Nursing Process
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

33. NCLEX Test Plan: Nursing Process
Intervention/implementation
Identifies nursing actions needed to achieve goals
Includes:
medication administration; drug calculations
basic care; delegation; supervision
carrying out procedures; giving treatments
charting/record keeping
teaching; therapeutic communication
monitoring for changes, etc.

34. NCLEX Test Plan: Nursing Process
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

35. NCLEX Test Plan: Component 3 The Four Client Health Needs
Safe & Effective Care Environment
Physiological Integrity
Psychosocial Needs
Health Promotion & Maintenance

36. NCLEX Test Plan: Component 3 Client Health Needs
% of Questions 21–33% 13–19% 8–14% 6–12% 43–67% 11–17%
A. Safe & Effective Care Environment Management of Care Safety & Infection Control B. Health Promotion & Maintenance C. Psychosocial Integrity D. Physiological Integrity Basic Care & Comfort Pharmacology & Parenteral Therapies Reduction of Risk Potential Physiological Adaptation

37. NCLEX Test Plan: Component 3 Client Health Needs
Changes starting in 2010
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 % of any single type of question
Increase Pharmacology-related questions to 19%

38. NCLEX Test Plan: Component 3 Client Health Needs
Safe & Effective Care Environment

39. 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

40. NCLEX Test Plan: Component 3 Client Health Needs
Physiological Integrity

41. 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.)

42. NCLEX Test Plan: Component 3 Client Health Needs
Psychosocial Needs

43. Psychosocial Needs Coping and adaptation Psychosocial adaptation
Coping skills versus defense mechanisms
Therapeutic communication
Crisis intervention
Psychosocial adaptation
All the major psychological disorders
Anxiety disorders; depression; schizophrenia
Personality disorders; OMD
Drug abuse and treatment modes

44. NCLEX Test Plan: Component 3 Client Health Needs
Health Promotion & Maintenance

45. Health Promotion and Maintenance
Growth and development through the life span
Eriksson’s stages; Piaget
Normal G & D
Prevention and early detection of disease
Normal OB and complications
STD
Women’s health
Newborn care and complications

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

47. Pass or Fail Only on NCLEX No numerical score

48. 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

49. 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

50. Examination Study Tips
NCLEX
Contact the National Council of State Boards of Nursing Web site for information on recent changes in NCLEX, sample tutorial, and sample questions:

51. 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

52. Study Tips For NCLEX 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”

53. Study Tips For NCLEX
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

54. Night Before the Exam No Movie—Only Light Entertainment

55. Night Before the Exam Drive to the Test Site

56. Night Before the Exam
Review formulas, common medications, and information presented in tables, cards, and lists
Don’t try to study everything!

57. Night Before the Exam I Passed! Think positive!
Go to bed at a reasonable hour
Rest does not = sleep
Think positive!

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

59. Day You Take the NCLEX Exam
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!

60. Day You Take the NCLEX Exam
Do increase intake of foods with high-quality protein and complex carbohydrates
Do arrive 30 to 45 minutes early

61. Day You Take the NCLEX Exam
Don’t let security fluster you
They take:
A digital picture
A digital thumb print
A digital signature

62. Day You Take the NCLEX Exam
Wear comfortable clothes
Think positive!