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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Document preview page 1

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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022)

Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) provides everything you need to pass your certification test.

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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 3 preview imageYOU’VE JUST PURCHASEDMORE THANA TEXTBOOK!REGISTER TODAY!PlaceStickerHereYou can now purchase Elsevier products on Evolve!Go to evolve.elsevier.com/shop to search and browse for products.2019v1.0Enhance your learning with Evolve Student Resources.These online study tools and exercises can help deepen yourunderstanding of textbook content so you can be moreprepared for class, perform better on exams, and succeedin your course.Activate the complete learning experience that comes with eachhttp://evolve.elsevier.com/Silvestri/NGN/If your school uses its own Learning Management System, your resources may bedelivered on that platform. Consult with your instructor.has already been revealed, the code may have been used and cannotbe re-used for registration. To purchase a new code to access thesevaluable study resources, simply follow the link above.
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 4 preview imageStrategies for Student Success on theNEXT GENERATIONNCLEX®(NGN)TEST ITEMS
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 6 preview imageLinda Anne Silvestri,PhD, RN, FAANNursing InstructorUniversity of Nevada, Las VegasLas Vegas, Nevada;PresidentNursing Reviews, Inc. and Professional Nursing Seminars, Inc.Henderson, Nevada;Next Generation NCLEX® (NGN) Consultant and Subject Matter ExpertElsevier Inc.Angela Elizabeth Silvestri,PhD, APRN, FNP-BC, CNEAssociate Professor and BSN Program DirectorUniversity of Nevada, Las VegasLas Vegas, Nevada;PresidentNurse Prep, LLCHenderson, Nevada;Next Generation NCLEX® (NGN) Subject Matter ExpertElsevier Inc.Donna D. Ignatavicius,MS, RN, CNE, CNEcl, ANEF, FAADNSpeaker and Curriculum Consultant for Academic Nursing ProgramsFounderBoot Camp for Nurse Educators;PresidentDI Associates, Inc.Littleton, Colorado;Next Generation NCLEX® (NGN) Consultant and Subject Matter ExpertElsevier Inc.Strategies for Student Success on theNEXT GENERATIONNCLEX®(NGN)TEST ITEMS
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 7 preview imageElsevier3251 Riverport LaneSt. Louis, Missouri 63043STRATEGIES FOR STUDENT SUCCESS ON THE NEXT GENERATIONNCLEX® (NGN) TEST ITEMSISBN: 978-0-323-87229-4Copyright © 2023 by Elsevier Inc. All rights reserved.No part of this publication may be reproduced or transmitted in any form or by any means, electronic ormechanical, including photocopying, recording, or any information storage and retrieval system, withoutpermission in writing from the publisher. Details on how to seek permission, further information about thePublisher’s permissions policies and our arrangements with organizations such as the Copyright ClearanceCenter and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissionsThis book and the individual contributions contained in it are protected under copyright by the Publisher(other than as may be noted herein).NoticePractitioners and researchers must always rely on their own experience and knowledge in evaluating andusing any information, methods, compounds or experiments described herein. Because of rapid advancesin the medical sciences, in particular, independent verication of diagnoses and drug dosages should bemade. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors orcontributors for any injury and/or damage to persons or property as a matter of products liability,negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideascontained in the material herein.International Standard Book Number: 978-0-323-87229-4Content Strategist:Heather D. Bays-PetrovicContent Development Manager:Ellen M. Wurm-CutterContent Development Specialist:Laura Klein; Meredith MadeiraPublishing Services Manager:Julie EddySenior Project Manager:Jodi WillardDesign Direction:Amy BuxtonPrinted in IndiaLast digit is the print number:987654321
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 8 preview imageIn loving memory of my parents and Angela’s grandparents,Arnold Lawrence and Frances Mary, who opened my door of opportunityto this amazing profession of nursing. My memories of their love, support,and words of encouragement will remain in my heart forever!And, to my husband, Larry, for being my rock of supportthrough all of my life’s journeys.Linda Anne SilvestriTo my husband, Brent, who has supported my work since the day we met.I will always remember how he anticipated what I would needto be successful in this journey.To nursing students, you have chosen a wonderful profession that willgive back to you what you are putting in now. You can do this!Angela Elizabeth SilvestriTo my family, who has supported my work as an author and consultantfor many decades.To nursing students, who have chosen the caring profession that canchange the lives of so many, and to nurse educators, whose passion androle modeling continues to shape the future of the nursing profession.Donna D. Ignatavicius
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 9 preview imageviLinda Anne Silvestri,PhD, RN, FAANLinda is a well-known nurseeducator,entrepreneur,andphilanthropist whose profes-sionalaspirationsfocusonassisting nursing students tobecomesuccessful.Shehasbeenteachingnursingstu-dents at all levels of nursing education for many years.Dr. Silvestri is currently a nursing instructor at the Uni-versity of Nevada, Las Vegas (UNLV). She earned herPhD in Nursing from UNLV and conducted research onself-ecacy and the predictors of NCLEX® success. Herresearch ndings are published in theJournal of NursingEducation and Practice.Dr. Silvestri has received severalawards and honors. In 2019 she was inducted as a Fellowin the American Academy of Nursing. In 2012 she receivedthe UNLV School of Nursing Alumna of the Year Award.In 2010 she received the School of Nursing Certicate ofRecognition for the Outstanding PhD Student. Dr. Silves-tri is a member of several national nursing organizations,some of which include the Honor Society of Nursing, Sigmaeta Tau International, the National League for Nursing,the American Nurses Association, and the American Acad-emy of Nursing. Dr. Silvestri is a successful Elsevier authorof numerous best-selling NCLEX® preparation resourceson national and international levels. She also serves as anElsevier Consultant and Subject Matter Expert for the NextGeneration NCLEX® (NGN) and has presented numerouswebinars on NCLEX® preparation and success. Dr. Silvestriis the President and Owner of Nursing Reviews, Inc. andProfessional Nursing Seminars, Inc. Both companies arededicated to helping nursing graduates achieve their goalsof becoming licensed nurses.Angela E. Silvestri,PhD, APRN, FNP-BC, CNEAngela Silvestri is a well-knownnurseeducator,researcher,andauthor. She has been teaching andworking in university administra-tive roles for the last 10 years at alllevels of nursing education. Shehas experience teaching across theprogram and in both classroomand clinical settings and workingwith graduate students on theirculminating projects and research dissertations. She is cur-rently serving in a leadership role as the Program Director forthe undergraduate BSN program at the University of Nevada,Las Vegas (UNLV). Angela earned a bachelor’s in Nursingand in Sociology from Salve Regina University in Newport,RI, and her master’s—with a focus in nursing education—andPhD from the University of Nevada, Las Vegas. She also has apost-master’s graduate certicate in Advanced Practice and isa board-certied Family Nurse Practitioner. She is a Scholarin Sigma eta Tau’s New Academic Leadership Academy.Angela is passionate about college student success. She worksas a Family Nurse Practitioner with faculty, sta, and stu-dents on managing primary and episodic health care needsat UNLV’s Student Wellness Center and Faculty and StaTreatment Center. Dr. Silvestri is a successful Elsevier authorof numerous best-selling NCLEX® preparation resources onnational and international levels. She also serves as an Else-vier Subject Matter Expert for the Next Generation NCLEX®(NGN). is passion also comes through in her work at theSchool of Nursing teaching leadership and licensure exampreparation, as well as in publishing research and best-sellinglicensure exam review resources on national and internationallevels.Donna D. Ignatavicius,MS, RN, CNE, CNEcl,ANEF, FAADNNationally recognized as anexpert in nursing educationand medical-surgical nurs-ing, Donna, better known as“Iggy,” has a wealth of expe-rience in education, clinicalnursing,andadministra-tion. rough her company, DI Associates, Inc., Iggy speaksat national and state conferences and provides consultationon such topics as curriculum transformation and NGN prep-aration. In addition, she is the author of a number of articles,chapters, and books, including the tenth edition of her lead-ing textbook,Medical-Surgical Nursing: Concepts for Interpro-fessional Collaborative Care. In 2007 Iggy was inducted as afellow into the very prestigious Academy of Nursing Educa-tion for her national contributions to nursing education. In2021 she was also inducted as a fellow into the Academy ofAssociate Degree Nursing for her national inuence and con-tributions to programs preparing students for nursing prac-tice. Iggy obtained her Certied Nurse Educator® credentialin 2016 and her Certied Academic Clinical Educator® cre-dential in 2020.About the Authors
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 10 preview imageviiWe want to acknowledge the many people from Elsevier whowere such a signicant part of our journey as we preparedthis resource for nursing students. First and foremost, weextend our deepest appreciation to Heather Bays-Petrovic,Content Strategist, for accepting our proposal and promot-ing our vision for this project and for supporting us everystep of the way from start to nish. ank you, Heather! JodiWillard, Senior Project Manager, has been instrumental inmoving this publication forward. Jodi’s work and attentionto detail has been signicant in the design and nal prod-uct. ank you, Jodi! We also extend our sincere gratitudeto Laura Klein, Senior Content Development Specialist; AmyBuxton, Senior Book Designer; and Julie Eddy, PublishingServices Manager. We thank all of you for your willingnessand exibility to design this resource ensuring that our ideasand vision were executed and for your consistent attentionto the many details in our manuscript. Finally, we want tothank Bruce Seibert, Senior Digital Media Producer, andBala Cherukumilli, Digital Media Producer, for all of yourpatience and assistance in implementing our requests for theelectronic platform that accompanies this resource. A verygrateful and appreciative “ank You” from us to all of you—we could not have achieved our aspirations for this resourcewithout you!Acknowledgments
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 11 preview imageviiiWelcome to theStrategies for Student Success on the Next Gen-eration NCLEX® (NGN) Test Items!is book is focused on providing you with informationabout the Next Generation NCLEX® (NGN) and practicequestions to prepare you to successfully answer the new testitem types expected on the NGN.ais book highlights gen-eral NGN Tips and unique test-taking strategies. Chapter 1introduces the clinical judgment (CJ) cognitive skills uponwhich the new test items will be based. Chapter 2 presentsexamples of the new NGN test item types. Chapters 3 through8 describe the CJ cognitive skills and present unique test-taking strategies on how to answer practice items that measureeach skill. Chapter 9 demonstrates how Stand-alone items andUnfolding Case Studies will be presented on the NGN, andChapterprovides an NGN Practice Test to apply what waslearned throughout the book. e answers, rationales, test-taking strategies, content area, and CJ cognitive skill(s) foreach practice question throughout the book are presented atthe end of the book. In addition, the priority concept is identi-ed. e specic focus of each chapter is summarized below.Organization of the BooknChapter 1,Introduction to the Cognitive Skills of ClinicalJudgment, describes how clinical judgment builds onthe nursing process and introduces you to the six essen-tial cognitive skills of the NCSBN Clinical JudgmentMeasurement Model (NCJMM). These cognitive skills arethe basis for the new NGN test item types.nChapter 2,Introduction to the NGN and the New NGN ItemTypes, explains the purpose and design of the NGN andpresents the new test item types. An example of each itemtype is presented, and the correct responses are providedwith brief rationales.nChapter 3,Strategies for Answering NGN Questions:Recognize Cues, describes the CJ cognitive skill,RecognizeCues, which requires you to identify relevant clinical find-ings and decide which findings are ofimmediatecon-cern andmostimportant based on the clinical scenario.This chapter also identifies test items and enhanced test-taking strategies that you can use when answering itemsthat measure this skill. Examples of these test items allowyou the opportunity to practice applying these strategieswithin the chapter and in the practice test at the end of thechapter.aPlease note:The NGN content provided in this book and on the Evolve sitereects the information available at the time of production of this resource.The NCSBN research about NGN is ongoing, and changes in the items tomeasure each cognitive skill may be forthcoming. The NCSBN website atwww.ncsbn.org provides you with the latest updates.nChapter 4,Strategies for Answering NGN Questions:Analyze Cues, describes the CJ cognitive skill,AnalyzeCues, which requires you to connect or link relevant cuesto the clinical scenario, interpret these cues, and establishtheir significance. This chapter also identifies test itemsand enhanced test-taking strategies that you can use whenanswering items that measure this skill. Examples of thesetest items allow you the opportunity to practice applyingthese strategies within the chapter and in the practice testat the end of the chapter.nChapter 5,Strategies for Answering NGN Questions:Prioritize Hypotheses, describes the CJ cognitive skill,Prioritize Hypotheses, which requires you to establishand rank client needs or hypotheses in order of priority.This chapter also identifies test items and enhanced test-taking strategies that you can use when answering itemsthat measure this skill. Examples of these test items allowyou the opportunity to practice applying these strategieswithin the chapter and in the practice test at the end of thechapter.nChapter 6,Strategies for Answering NGN Questions:Generate Solutions, describes the CJ cognitive skill,Generate Solutions, which requires you to use knowledgeof evidence-based solutions about treatments and inter-ventions that would address identified client needs andmodify them to meet priorities of care. This chapter alsoidentifies test items and enhanced test-taking strategiesthat you can use when answering items that measure thisskill. Examples of these test items allow you the opportu-nity to practice applying these strategies within the chapterand in the practice test at the end of the chapter.nChapter 7,Strategies for Answering NGN Questions: TakeAction, describes the CJ cognitive skill,Take Action, whichrequires that you perform appropriate and necessary inter-ventions based on the client’s situation and generated solu-tions. This chapter also identifies test items and enhancedtest-taking strategies that you can use when answeringitems that measure this skill. Examples of these test itemsallow you the opportunity to practice applying these strat-egies within the chapter and in the practice test at the endof the chapter.nChapter 8,Strategies for Answering NGN Questions:Evaluate Outcomes, describes the CJ cognitive skill,Evaluate Outcomes, which requires that you examine out-comes and measure client progress towards meeting thoseoutcomes in the plan of care. This chapter also identifiestest items and enhanced test-taking strategies that youcan use when answering items that measure this skill.Examples of these test items allow you the opportunity topractice applying these strategies within the chapter and inthe practice test at the end of the chapter.Preface
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 12 preview imagePrefaceixnChapter 9,Strategies for Answering NGN Stand-aloneItems and Unfolding Case Studies, describes the differencesbetween Stand-alone items and Unfolding Case Studies.Samples of Stand-alone items (including the bow-tie andtrend) are illustrated, as well as Unfolding Case Studies.This chapter also identifies test items and enhanced test-taking strategies that you can use when answering ques-tions accompanying each type of case study. Examplesof these test items allow you the opportunity to practiceapplying these strategies within the chapter. This chapteralso points out external factors to consider in NGN cases,such as the environmental and individual factors.nChapter,NGN Practice Test: Putting It All Together, pro-vides you with the opportunity to practice all of the newtypes of test items expected on the NGN, starting withUnfolding Cases Studies and ending with Stand-aloneBow-tie and Trend items.Special Features of the BooknNGN tips within each chapter.These unique tips providethe student with key points to remember, such as the NGNitem type or cognitive skill (CS) features.nIn-chapter sample questionsare presented within Chapters3 through 9 to provide examples of the new NGN testitem types that best measure the clinical judgment cogni-tive skill presented in the chapter. Each question withinthe chapter specifies the priority concept and content areabeing tested. The answer, rationale, enhanced test-takingstrategy, and references are also presented to help studentslearn the thinking process needed to select the correct testitem response.nEnd-of-chapter practicequestions are presented at the endof Chapters 3 through 8 to provide the opportunity for stu-dents to apply what they learned in each chapter and expe-rience answering selected test items that measure each ofthe NCSBN’s clinical judgment cognitive skills. Chapter 9presents Stand-alone items, both Bow-tie and Trend items,and Unfolding Case Studies.nA comprehensive practice testis presented in Chapter 10 toallow students to apply what they learned in Chapters 1through 9. Students have the opportunity to answer mul-tiple Unfolding Case Studies and Stand-alone items rep-resenting all clinical specialty areas. The priority concept,content area, answer, rationale, enhanced test-taking strat-egy, and reference for each test item are provided at theend of the book.nEnhanced test-taking strategies for the NGN.This uniquefeature walks students through the thinking processneeded to navigate complex NGN cases. Each strategyexplains how to apply the cognitive skill when consideringthe information presented in the clinical scenario. Eachquestion is accompanied by test-taking strategies that arepresented both narratively and in a table format to guidethe student through a logical thinking process and to suitmultiple learning styles. This thinking process with test-taking strategies will also help on current NCLEX-style(Stand-alone) items and nursing course exams.nThinking Space.The Thinking Spaces located in the marginsof the book is a place for personal note-taking. The studentcan use these spaces to write down new and importantinformation they want to remember. To become most famil-iar with the cognitive skills and to build clinical judgmentskills, using the Thinking Space to make important linkagesbetween clinical scenario information and the cognitive skillwill reinforce the aspects of the NCJMM model as the stu-dent is studying and preparing for the NGN.Special Features Found on Evolvee Evolve site accompanying this resource provides the stu-dent with all of the case studies and practice test questions inthe book plus an additional 30 unfolding case studies, eachwith 6 NGN items. e book includes 60 single cases (eachwith 1 NGN item), 10 Stand-alone items (5 Bow-tie and 5Trend), and 5 Unfolding Case Studies (items with 6 NGNitems). is equals a total of 100 NGN items. en there arean additional 30 unfolding cases, each with 6 NGN items, and4 additional Stand-alone items (2 Bow-tie and 2 Trend) total-ing 184 NGN items. Altogether, there are a total of 284 NGNitems on Evolve.e Evolve site lists various category selections. You canselect by type of question—either single case, Stand-aloneitems (either bow-tie or trend), or Unfolding Case Study. Youcan also select by the specic cognitive skill, content area, orpriority concept. e table below illustrates the various cat-egories for selection.TypeCognitive SkillContent AreaPriorityConceptSingleStand-aloneUnfoldingRecognize CuesAnalyze CuesPrioritizeHypothesesGenerateSolutionsTake ActionEvaluateOutcomesFoundationsof NursingMaternal-NewbornNursingMedical-SurgicalNursingMental HealthNursingPediatricNursingPharmacologyClottingCognitionEliminationFluid andElectrolyteBalanceGasExchangeGlucoseRegulationImmunityMobilityMood andAectPerfusionStress andCopingTissueIntegrityHow to Use This BookFor StudentsAs implied in the title, this book was written to help you besuccessful when taking the new test item types that will be
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 13 preview imagePrefacexpart of the Next Generation NCLEX® (NGN). e rst twobook chapters present a review of clinical judgment and theNGN item types. All new item types are based on the six cog-nitive (thinking) skills needed for safe, appropriate clinicaljudgment. Be sure that you are very familiar with this infor-mation before beginning to practice answering the test ques-tions later in the book.Chapters 3 through 8 describe each clinical judgment cog-nitive skill and provide general NGN Tips on how to answertest items that measure each skill. Sample NGN test items arethen presented with the Rationale and Test-Taking Strategyfor the correct and incorrect responses, followed by six end-of-chapter practice questions for you to answer. e practicequestions in each chapter represent all content specialties. erationale and test-taking strategy that you can use for eachquestion to determine the correct answers are described indetail, with tables to help organize the information in eachquestion. In addition, each test item is labeled by prioritynursing concept and content specialty. References are alsoprovided to help you review the content associated with eachtest item if needed.When working through Chapters 3 through 8, start withChapters 3 and 4 early in your program so that you can learnhow to determine the most important client ndings in aclinical scenario and what they mean (Recognize Cues andAnalyze Cues). When you feel you have mastered these cogni-tive skills, work through Chapter 5, which will help you learnto prioritize client needs and the care required to meet them.Chapters 6 and 7 are focused on helping you learn to plan andimplement nursing actions to meet the client’s needs. Finally,Chapter 8 will assist you in determining whether the client’scondition has improved aer care has been implemented.Aer working through Chapters 3 through 8 and when youfeel ready to put all the cognitive skills together, Chapter 9 pro-vides examples for NGN Unfolding Case Studies and Stand-alone items. Chapter 10 presents a comprehensive practice testthat simulates what you can expect on the NGN. e rationaleand test-taking strategy for each practice test item in thesechapters are described in detail. Many additional practice NGNtest items are available on the Evolve site with rationale, test-taking strategy, content specialty, priority nursing concept, andreference for each Unfolding Case Study or Stand-alone item.For Facultyis book is designed for you to use as it is organized, begin-ning with helping students learn what CJ is and gain anunderstanding of each of the essential CJ cognitive skills asdescribed in Chapter 1. Students in their rst nursing courseshould learn how to use these skills to make safe, appropri-ate clinical judgments to ensure client safety. If students arealready making clinical judgments using these skills, Chap-ter 1 could be used for review. en students should becomefamiliar with the NGN test design and new item types as pre-sented in Chapter 2. Finally, by the end of the rst semester(or other term), students should learn how to Recognize Cuesand Analyze Cues (Chapters 3 and 4). ese cognitive skillsfocus on assessing the client, discerning how to determinewhich client ndings are the most important, and decidingwhat those ndings mean. End-of-chapter practice ques-tions can be used during class, online, simulation pre- orpost-brieng, or clinical post-conference. e test items canbe assigned to students as individuals or in groups to answer.Regardless of where or how practice test items are used, suchas in the classroom, online, lab sessions, or clinical setting,be sure to review the answers, rationales, and strategies forarriving at the correct response(s) to identify and improvestudents’ thinking process as needed.As students progress to the next course, they should beginto learn how to prioritize care to determine what nursingactions they would plan and implement. Part of this thinkingprocess includes an assessment to decide if the actions wereeective and the client’s condition has improved. ereforestudents in this semester would focus on Chapters 5 through8. Again, you can assign the practice items to students as indi-viduals or in groups and review the items to help studentsimprove their thinking as needed.Chapters 9 andputs together all the cognitive skill stepsand new NGN test item types—both Stand-alone items andUnfolding Case Studies. ese chapters can be used when-ever students are applying the individual CJ cognitive skillsto successfully answer the new test items in preparation forthe NGN. Assign these practice Unfolding Case Studies andStand-alone items as individual student practice to determineany skill areas where improvement is needed. Students need-ing improvement can then review any of the six earlier chap-ters (Chapters 3 through 8) to hone their thinking skills.Faculty Tool Kite Faculty Tool Kit was created to guide faculty in using thisbook with their students at any stage in the program to pre-pare them for the NGN.e Tool Kit:■Furnishes a guide for how to use this book,Strategies forStudent Success on the Next Generation NCLEX® (NGN)Test Items,to prepare students for the NGN■Provides chapter-to-chapter strategic points to empha-size to students and ways to prepare students for an-swering NGN items■Provides suggestions for using the Evolve site accompa-nying this book■Presents step-by-step guides for writing Stand-aloneitems and Unfolding Case Studies■Presents step-by-step guides for writing NGN items■Species NCSBN resources that focus on NGN for stu-dents and faculty■Provides Elsevier resources and references for prepar-ing students for the NGNAdditional Resources for StudentsnIgnatavicius, D.D. (2021).Developing Clinical Judgment forProfessional Nursing and the Next-Generation NCLEX-RN®Examination.St. Louis: Elsevier.
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 14 preview imagePrefacexiisworkbookhelpsstudentspreparingtobecomeRNs learn how to develop NCSBN’s six clinical judg-ment cognitive skills through practice in answeringnew NGN test item types embedded in unfolding andsingle-episode cases throughout the entire curriculum.Clinical scenarios are presented from more basic careto complex, multisystem care of clients in multiple spe-cialty areas.nIgnatavicius, D.D. (2022).Developing Clinical Judgmentfor Practical-Vocational Nursing and the Next-GenerationNCLEX-PN® Examination.St. Louis: Elsevier.is workbook helps students preparing to become LPNsor LVNs learn how to develop NCSBN’s six clinical judg-ment cognitive skills through practice in answering newNGN test item types embedded in unfolding and single-episode cases. Clinical scenarios in multiple specialtyareas are included, with a primary emphasis on the careof older adults in a variety of health care settings, andcan be used throughout the entire curriculum.nSilvestri, L., & Silvestri, A. (2023).Saunders ComprehensiveReview for the NCLEX-RN® Examination(9th ed.). St.Louis: Elsevier.is is an excellent resource to use both while you arein nursing school and in preparation for the NCLEX®examination. is book contains 20 units with 70 chap-ters, and each chapter is designed to identify speciccomponents of nursing content. e book and accom-panying soware contain more than 5200 practice ques-tions and include alternate item format questions. esoware also contains a 75-question preassessment testthat generates an individualized study calendar. A pos-tassessment test is included, as well as case studies andaccompanying NGN item type practice questions.nSilvestri, L., & Silvestri, A. (2021).Saunders Q&A Reviewfor the NCLEX-RN® Examination(8th ed.). St. Louis:Elsevier.is book and accompanying Evolve site provide youwith more than 6000 practice questions based on theNCLEX-RN® test plan. Each practice question includesa priority nursing tip that provides you with a piece ofimportant information to remember that will help youanswer questions on nursing exams and on the NCLEX®examination. e chapters in this book are uniquelydesigned and are based on the NCLEX-RN® examina-tion test plan framework, including Client Needs andIntegrated Processes. Alternate item format questionsand accompanying NGN item type practice questionsare included. With practice questions focused on theClient Needs, Integrated Processes, and Clinical Judg-ment/Cognitive Skills, you can assess your level ofcompetence.nSilvestri, L., & Silvestri, A. (2020).HESI/Saunders OnlineReview Course for the NCLEX-RN® Examination.(3rd ed.)St. Louis: Elsevier.e online NCLEX-RN® review course provides a sys-tematic and individualized approach and addresses allareas of the test plan identied by the National Councilof State Boards of Nursing, Inc. is self-paced onlinereview contains 10 interactive, multimedia-rich mod-ules featuring animations and videos, practice ques-tions, end-of-lesson case studies, and much more! Adiagnostic pretest generates a study calendar to guideyour review. NCLEX®-style questions—including everytype of alternate item format question—are provided,concluding with a comprehensive examination thatwill sharpen your test-taking skills. In addition, casestudies and accompanying NGN practice questionsare included. Unique videos that simulate a live reviewcourse focus on dicult subjects such as dysrhythmiasand make them easier to understand.nSilvestri, L., & Silvestri, A. (2021).Saunders 2022-2023Clinical Judgment and Test-Taking Strategies(7th ed.) St.Louis: Elsevier.is book is designed for both RN and PN nursing stu-dents and provides a foundation for understanding andunpacking the complexities of NCLEX® exam ques-tions, including alternate item formats.Saunders 2022-2023 Clinical Judgment and Test-Taking Strategiestakesa detailed look at all the test-taking strategies you willneed to know in order to pass any nursing examination,including the NCLEX® examination. Special nursingcontent tips are integrated along with other tips, suchas clinical preparation tips and life-planning tips. ereare 1200 practice questions included so you can applythe testing strategies. NGN items and practice test ques-tions are also included on the Evolve site accompanyingthis resource.nSilvestri, L., & Silvestri, A. (2022).Saunders ComprehensiveReview for the NCLEX-PN® Examination(8th ed.). St.Louis: Elsevier.is is an excellent resource to use both while you are innursing school and in preparation for the NCLEX® exam-ination. is book contains 19 units and 65 chapters, andeach chapter is designed to identify specic componentsof nursing content. e book and accompanying Evolvesite contain more than 4500 practice questions andinclude alternate item format questions. e soware alsocontains a 75-question preassessment test that generatesan individualized study calendar. A post-assessment testis also included, as well as case studies and accompanyingNGN item type practice questions.nSilvestri, L., & Silvestri, A. (2020).Saunders Q&A Reviewfor the NCLEX-PN® Examination(6th ed.). St. Louis:Elsevier.is book and accompanying Evolve site provide youwith more than 5900 practice questions based on theNCLEX-PN test plan. Each practice question includesa priority nursing tip that provides you with a piece ofimportant information to remember that will help youanswer questions on nursing exams and on the NCLEX®examination. e chapters in this book are uniquelydesigned and are based on the NCLEX-PN® examina-tion test plan framework, including Client Needs andIntegrated Processes. Alternate item format questions
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 15 preview imagePrefacexiiand accompanying NGN item type practice questionsare included. With practice questions focused on theClient Needs, Integrated Processes, and Clinical Judg-ment/Cognitive Skills, you can assess your level ofcompetence.nSilvestri, L., & Silvestri, A. (2020).HESI/Saunders OnlineReview Course for the NCLEX-PN® Examination.(3rd ed.)St. Louis: Elsevier.is online NCLEX-PN® review course provides a sys-tematic and individualized approach and addresses allareas of the test plan identied by the National Councilof State Boards of Nursing, Inc. is self-paced onlinereview contains 10 interactive, multimedia-rich mod-ules featuring animations and videos, practice ques-tions, end-of-lesson case studies, and much more! Adiagnostic pretest generates a study calendar to guideyour review. NCLEX®-style questions—including everytype of alternate item format question—are provided,concluding with a comprehensive examination thatwill sharpen your test-taking skills. In addition, casestudies and accompanying NGN practice questionsare included. Unique videos that simulate a live reviewcourse focus on dicult subjects such as dysrhythmiasand make them easier to understand.
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 16 preview imagexiiiCHAPTER1Introduction to the Cognitive Skills of Clinical Judgment,1What Are the Purpose and Design of the CurrentNCLEX®?, 1Why Is There a Need for NCLEX®Change?, 2What Is the NCSBN’S Denition and Model of ClinicalJudgment?, 3What Are the Six NCSBN Clinical Judgment MeasurementModel Cognitive Skills?, 3How Will the Six Clinical Judgment Skills Be Measured onthe NGN?, 8How Can You Prepare for the NGN?, 8CHAPTER2Introduction to the NGN and the New NGN Item Types,Test Item Types Used for Unfolding Case Studies, 10Test Item Types Used for Stand-alone Items, 20CHAPTER3Strategies for Answering NGN Questions: Recognize Cues,23What Are Cues?, 23How Are Client Findings (Cues) Presented in an NGNClinical Scenario?, 23Which Client Findings Are Relevant?, 24Which Relevant Client Findings Are of Immediate Concernto the Nurse?, 25What Types of Clinical Scenarios May Be Included on theNGN?, 25What NGN Item Types Optimally MeasureRecognizeCues?,25Practice Questions, 32CHAPTER4Strategies for Answering NGN Questions: Analyze Cues,36How Do You Analyze Cues?, 36How Does Analyzing Cues Help You Guide Client Care?, 36How Do You Analyze Cues in an NGN Clinical Situation?,37What Will You Think About to Analyze Cues in ThisClinical Scenario?, 38Which Client Findings Are Most Important WhenAnalyzing Cues?, 39When Might You Need to Analyze Cues in a ClinicalSituation?, 39What NGN Item Types Optimally MeasureAnalyze Cues?,39Practice Questions, 48CHAPTER5Strategies for Answering NGN Questions: PrioritizeHypotheses,53What Do Hypotheses Mean?, 53What Does Prioritizing Mean?, 53What to Consider When Prioritizing Hypotheses, 53External Factors and Prioritizing Hypotheses, 54How Do You Know That You Need to Prioritize?, 56What Three Strategies Can You Use to PrioritizeHypotheses?, 57How Do You Prioritize Hypotheses in an NGN ClinicalSituation?, 58What Will You Think About to Prioritize Hypotheses in ThisClinical Scenario?, 59What NGN Item Types Optimally MeasurePrioritizeHypotheses?,59Practice Questions, CHAPTER6Strategies for Answering NGN Questions: GenerateSolutions,73What to Consider When Generating Solutions, 73The Plan of Care and Generating Solutions, 73How Do You Know That You Need to Generate Solutions?,73How Do You Generate Solutions in an NGN ClinicalSituation?, 74What Will You Think About to Generate Solutions in ThisClinical Scenario?, 75What NGN Item Types Optimally MeasureGenerateSolutions?,75Practice Questions, 82CHAPTER7Strategies for Answering NGN Questions: Take Action,85How Do You Know What Actions to Take?, 85How Will Nursing Actions Be Tested?, 85What NGN Item Types Optimally MeasureTake Action?,Practice Questions, 92CHAPTER8Strategies for Answering NGN Questions: EvaluateOutcomes,96How Do You Evaluate Outcomes?, 96How WillEvaluate OutcomesBe Tested?, 97NGN Question Stems AddressingEvaluate Outcomes,97What NGN Item Types Optimally MeasureEvaluateOutcomes?,98Practice Questions, 105Contents
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 17 preview imageContentsxivCHAPTER9Strategies for Answering NGN Stand-alone Items andUnfolding Case Studies,111What Are Stand-alone Items?, 111What Are Unfolding Case Studies?, 125How Are Stand-alone Items and Unfolding Case StudiesDierent?, 125CHAPTER10NGN Practice Test: Putting It All Together,134Unfolding Case Studies, 134Stand-alone Items, 157Answers to Practice Questions,163References and Bibliography,289
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 18 preview image1is chapter will help yu understand the need fr change in the NCLEX® and the sixclinical judgment cgnitive (thinking) skills that serve as the basis fr new test itemtypes n the NGN. Aer a brief review f thecurrentNCLEX® design, thinking skillsneeded t make safe, evidence-based clinical judgment are intrduced. General NGNTips are prvided t help yu relate each thinking skill with the new exam.e new NGN item types will be included n the NCLEX® n sner than 2023 andare described in Chapter 2 f this bk. Specic Test-Taking Strategies that will helpyu crrectly answer these new items are prvided thrughut ther chapters f thisbk and accmpany all practice questins in the bk and n the Evlve site. Be suret review this chapterbeforereading the rest f this bk r practicing NGN questins!What Are the Purpose and Design of the Current NCLEX®?As yu knw, prelicensure nursing educatin prgrams like the ne yu’re currently inprepare students fr eligibility t take either the NCLEX-RN® r the NCLEX-PN® aergraduatin. ese natinal licensure examinatins are develped and updated underthe directin f the NCSBN. is rganizatin als versees the administratin f theNCLEX® in the United States, Canada, and a number f ther cuntries.e primary purpse f the NCSBN is tprotect the publicby prviding cmpe-tency assessments, such as the NCLEX®, that are sund and secure. e NCLEX® is cm-prehensive and reects current nursing practice. T ensure examinatin currency, theNCSBN cllects and analyzes nursing practice data every 3 years frm thusands fgraduates t determine what knwledge and activities are required in their jbs as newnurses. is infrmatin is used t develp the cntent f the NCLEX® and is rganizedin a new licensure test plan every 3 years (https://www.ncsbn.rg/testplans.htm). etest plan is rganized by fur majr Client Needs Categries, sme f which have sub-categries. In additin, ve Integrated Prcesses are dened and included thrughutthe NCLEX® Test Plan as shwn in Bx 1.1e NCLEX® currently measures the new graduate’s minimum cmpetence in safetyt ensure public prtectin thrugh a variety f test items. Mst f the test items (abut95%) are either Multiple Chice r Multiple Respnse, als knwn as Select All atApply (SATA) questins. Fr each f these item types, client infrmatin is presentedin a shrt clinical scenari fllwed by a questin abut the nurse’s rle in client care.Examples f these test item types are presented in Bx 1.2As yu’ll ntice in the afrementined test items, each questin fcuses n what thenurse wuld d r say in respnse t specic client data. Only the client infrmatinthat is the mst imprtant, relevant, r, in sme cases, f immediate cncern t thenurse is presented in the clinical situatin. e answer is then selected frm a list fchices prvided. e narrw fcus f these test items des nt represent the scpe factual nursing practice and des nt allw measurement f clinical judgment. Rather,these types f items reect whether the candidate can distinguish between right andwrng. At this pint in yur educatin, yu likely are very familiar with these item typesn yur curse exams.Introduction to the CognitiveSkills of Clinical JudgmentC H A P T E R1THINKING SPACE
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 19 preview imageStrategies for Student Success on the Next Generation NCLEX®(NGN) Test Items2Why Is There a Need for NCLEX®Change?Althugh natinal NCLEX® rst-time pass rates fr bth RN and PN graduates havebeen abve 80% fr many years, health care emplyers cntinue t reprt increasingerrrs in client care and lack f apprpriate clinical judgment skills amng new nursinggraduates. A recent literature review cnducted by the NCSBN fund that 50% f allnurses have been invlved in at least ne client errr. Sixty percent f thse errrs werethe result f pr clinical judgment. Over 80% f nursing emplyers arenotsatisedwith the ability f new nursing graduates t make accurate r apprpriate clinical deci-sins regarding client care. In respnse t these data, the NCSBN began t questin ifthe NCLEX® was measuring “the best thing” t prtect the public.e 2013–2014 Strategic Practice Analysis f activities perfrmed by practicing RNsand RN rle experts cnrmed the imprtance f sund clinical judgment skills frIntegrated ProcessesClient Needs Categories/SubcategoriesNursing ProcessaTeaching and LearningCommunication and DocumentationCaringCulture and SpiritualitySafe and Eective Care EnvironmentManagement of CarebSafety and Infection ControlHealth Promotion and MaintenancePsychosocial IntegrityPhysiological IntegrityBasic Care and ComfortPharmacological and ParenteralTherapiescReduction of Risk PotentialPhysiological AdaptationBOX 1.1NCLEX-RN®Test Plan Organizing ConceptsaThis Integrated Process on the NCLEX-PN®Test Plan is the Problem-Solving Process.bThis Client Needs subcategory on the NCLEX-PN®Test Plan is Coordinated Care.cThis Client Needs subcategory on the NCLEX-PN®Test Plan is Pharmacological Therapies.Example : Multiple Choice Single ResponseThe nurse is planning care for a client admitted to the hospital with a diagnosis of acutepancreatitis and controlled hypertension. What is the nurse’spriorityfor the client’s careat this time?☐Administer an antiemetic medication.☐Manage the client’s acute pain.☐Monitor the client’s blood pressure.☐Administer supplemental oxygen.Example : Multiple Response (Select All That Apply)The nurse is assessing an adolescent who was taken to the ED for threatening to commitsuicide. What is (are) themost appropriatequestion(s) for the nurse to ask the client atthis time?Select all that apply.☐“What made you want to kill yourself?”☐“Do you have a plan for killing yourself?”☐“Do you plan to kill yourself with anyone else?”☐“Is this the ųrst time you’ve threatened to kill yourself?”☐“Did you write a suicide note to explain why you are doing this?”BOX 1.2Examples of Current Multiple Choice and Multiple ResponseNCLEX®Test ItemsNote:Indicates correct response(s).THINKING SPACE
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 20 preview imageCHAPTER1Introduction to the Cognitive Skills of Clinical Judgment3many tasks and activities perfrmed by entry-level nurses. is analysis als highlightedthat nurses tday make mre cmplex decisins t prvide safe care fr clients withhigher acuity and advanced age.e NCSBN literature review als fund that the nurse’s primary practice activity isthe ability t prblem slve and critically think—thinking prcesses needed fr mak-ing apprpriate clinical judgments.Problem solvingis the prcess f develping andevaluating nursing slutins r appraches t client prblems.Critical thinkingcan bedescribed as a prcess requiring the use f lgic and clinical reasning t identify thestrengths and weaknesses f nursing slutins r appraches t client prblems. eNCBSN built n these prcess descriptins t create a denitin and mdel f clinicaljudgment t be used as a basis fr develping new NCLEX® test item types.What Is the NCSBN’S Definition and Model of ClinicalJudgment?As a result f the literature review, Strategic Practice Analysis, and input frm a vari-ety f nurse clinicians and educatrs, the NCSBN develped this denitin f clinicaljudgment:Clinical judgment is dened as the observed outcome of critical thinking and decisionmaking. It is an iterative process that uses nursing knowledge to observe and assess present-ing situations, identify a prioritized client concern, and generate the best possible evidence-based solutions in order to deliver safe client care.S, what des this denitin mean fr yu as a nursing student and future prfes-sinal nurse? ink abut each f these key pints in the clinical judgment denitin:■Recgnize that clinical judgment is the result routcome of thinkingt make deci-sins abut client care when ptential r actual health prblems ccur. The sameprcess f thinking t make clinical decisins ccurs repeatedly as yu manage clientprblems(iterative process).■Acquire and recallnursing knowledget make apprpriate clinical judgments.(Hwever, having knwledge des nt guarantee that an accurate r apprpriateclinical judgment will be made.)■Learn hw tprioritizea client’s need fr care based n the data presented abut aclinical situatin.■Be familiar with thebest current evidenceregarding a presented client situatin syu can cme up with pssible slutins r appraches fr care t keep the clientsafe.Yu will want t acquire these skills and a strng knwledge base during yur nurs-ing prgram t be ready fr a dynamic, cmplex health care system and the NGN.Aer the NCSBN develped its denitin f clinical judgment, the rganizatin cre-ated a mdel f clinical judgment, called the NCSBN Clinical Judgment MeasurementMdel (NCJMM). As the name implies, this mdel was created t measure the nursinggraduate’s ability t make clinical judgments. Althugh it is nt imprtant fr yu t befamiliar with the entire mdel, it is essential that yu master the thinking skills assci-ated with clinical judgment. e NCJMM identies six cgnitive (thinking) skills thatare needed fr eective prfessinal nursing practice and serve as the basis fr the newNGN test item types. ese skills are smetimes referred t as Layer 3 f the NCJMMand are intrduced in the next sectin f this chapter.e NCJMM als identies factrs that inuence the ability f nurses t make appr-priate clinical judgments. Examples f these Envirnmental and Individual factrs,smetimes referred t as Layer 4 f the NCJMM, are listed in Table 1.1. Individual fac-trs are thse related t the nursing graduate candidate taking the NGN.What Are the Six NCSBN Clinical Judgment MeasurementModel Cognitive Skills?e NGN includes new test item types that measure the six cgnitive skills f clinicaljudgment. Each f these thinking skills, smetimes referred t as cgnitive prcesses,THINKING SPACE
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 21 preview imageStrategies for Student Success on the Next Generation NCLEX®(NGN) Test Items4is intrduced in this chapter. Chapters 3 thrugh 8 in this bk describe these skills inmre detail and present examples f NGN test items that are designed t measure eachskill. e six cgnitive skills essential fr clinical judgment are listed in Bx 1.3 with keyquestins that explain the fcus f each skill.Recognize CuesFr clients in any health care setting, the nurse cllects client data frm a number fsurces.Cuesare client ndings r assessment data that prvide infrmatin fr nursesas a basis fr decisin making t make apprpriate clinical judgments and can be dividedint fur majr types as listed belw. Chapter 3 describes these surces f cues in mredetail.■Envirnmental cues; e.g., presence f family member■Client bservatin cues; e.g., signs and symptms■Medical recrd cues; e.g., lab values r vital signs■Time pressure cues; e.g., rapid clinical declineIn actual clinical practice, the nurse reviews all client ndings t determine whichdata are mst imprtant, relevant, and, in sme cases, f immediate cncern. T helpyuRecognize Cues,ask yurself which client data are mst imprtant in the presentedclinical scenari. Carefully review the client’s presenting data, such as vital signs andmedical diagnsis, t determine their relevance. Fr example, a heart rate f 140 bpmwuld be f immediate cncern fr a middle-aged adult, but is within the typical rangefr a newbrn.In sme clinical scenaris the client has a histry f ne r mre acute and/r chrnichealth prblems. Fr example, an lder adult with a lng histry f COPD may have aPao2f 65 mm Hg. is arterial xygen level is abnrmal because it is belw the usualrange f 80 t 100 mm Hg. Hwever, frthisclient, the lw arterial xygen level islikely nt imprtant r f immediate cncern because it is expected. Many clients withadvanced COPD have chrnically lw arterial xygen, but they cmpensate by usingbreathing techniques cmbined with lw-w supplemental xygen.Analyze CuesAer relevant cues have been identied in a clinical scenari, the nurse rganizes andlinks them t the client’s presenting clinical situatin. Ask yurself: “What d the rel-evant client data mean r indicate at this time?” Fr example, cnsider a middle-agedRecognize Cues:What matters most?Analyze Cues:What could it mean?Prioritize Hypotheses:Where do I start?Generate Solutions:What can I do?Take Action:What will I do?Evaluate Outcomes:Did it help?BOX 1.3Clinical Judgment Cognitive Skills With Key QuestionsRemember:ToRecognize Cues,carefully review the client’s as-sessment data like developmentalage and history to help determineif ndings are relevant or of im-mediate concern to the nurse.NGN TIPTABLE 1.1Example of Environmental and Individual Factors ThatInuence Clinical JudgmentExamples of Environmental FactorsExamples of Individual FactorsEnvironmentMedical recordsTime pressureTask complexityResourcesCultural considerationsClient observationConsequences and risksKnowledgeSkillsSpecialtyPrior experienceLevel of experienceCandidate characteristics
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 22 preview imageCHAPTER1Introduction to the Cognitive Skills of Clinical Judgment5client wh had a small bwel resectin 2 days ag and begins having increasing abdm-inal pain, distentin, vmiting, and absent bwel sunds. ese data, when grupedtgether, are cnsistent with a pstperative paralytic ileus. T link these assessmentndings with an ileus, yu need knwledge f pathphysilgy, especially signs andsymptms.In sme clinical scenaris, the client may havemultiplerelevant cues that are assci-ated with several dierent client cnditins. e example in Bx 1.4 illustrates this typef scenari fr an lder adult hspitalized fr a urinary tract infectin and sepsis. Inthis inking Activity, yu wuld need t review each client nding t determine if it iscnsistent with ne r mre f the specied client cnditins.In this example, ne nding may be linked with tw r three client cnditins, suchas generalized weakness and acute cnfusin. Hwever, dyspnea n exertin is assci-ated with nly ne f the listed prblems—anemia. e crrect respnses t the ink-ing Activity are fund in Bx 1.5In ther clinical scenaris, the client may nt be experiencing an actual health prb-lem, but is at risk fr ne r mre ptential cmplicatins. Fr example, the wman whrecently had a spntaneus vaginal delivery is at risk fr pstpartum hemrrhage withinthe rst 24 hurs, particularly if the uterus becmes bggy (a client bservatin cue). Insme clinical situatins then, part f the thinking prcess tAnalyze Cuesis t identifyif cues are linked t r assciated with ptential cmplicatins.Prioritize HypothesesAer rganizing, gruping, and linking relevant client ndings with actual r ptentialclient cnditins, the next cgnitive skill requires yu t narrw dwn what the datamean and priritize the client’s prblems r needs. Althugh yu may have learnedabut pririty decisin-making mdels such as the ABCs r Maslw’s Hierarchy fNeeds, these mdels are en nt very useful in helping yu make clinical judgments inmre cmplex clinical situatins.TPrioritize Hypotheses,review and evaluate each f the client’s needs r health prb-lems in the clinical situatin. en rank them t decide what ismost likelythe prirityClient FindingDehydrationHypernatremiaAnemiaGeneralized weaknessAcute confusionDry mouthIncreased heart rateDyspnea on exertionBOX 1.4Example of a Thinking Activity That Requires the Ability toAnalyze CuesRemember:ToAnalyze Cues,youare not required to make a medical diagnosis but rather will beexpected to connect or link clientndings with selected client con-ditions or health problems, eitheractual or potential.NGN TIPClient Assessment FindingDehydrationHypernatremiaAnemiaGeneralized weaknessXXXAcute confusionXXXDry mouthXXIncreased heart rateXXXDyspnea on exertionXBOX 1.5Example of a Thinking Activity That Requires the Ability toAnalyze Cues
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 23 preview imageStrategies for Student Success on the Next Generation NCLEX®(NGN) Test Items6health prblem. Evaluate factrs in the clinical situatin such as urgency, risk, diculty,and time sensitivity fr the client. Fr example, cnsider this clinical situatin:A 42-year-old postpartum client who just gave birth to a third child in 4 years reportssevere “aerbirth pains” of 9/10 on a 0 to 10 pain intensity scale. e client also reportshaving problems with getting the baby to latch for breast-feeding/chest-feeding. enurse assesses that the client has a boggy uterus and is saturating a peri-pad every 20 to30 minutes.In this example, the client has three prblems that yu wuld evaluate and rank inthis rder:1. Excessive pstpartum bleeding due t bggy uterus2. Severe abdminal pain due t uterine cntractins3. Diculty with breast-feeding/chest-feeding due t inability f baby t latche pririty fr this client at this time is t manage excessive pstpartum bleedingbecause the client culd becme hypvlemic and develp shck. In this situatin, man-aging the client’s bleeding is mreurgentthan managing severe pain r breast-feeding/chest-feeding diculty t prevent theriskf a life-threatening cmplicatin.Generate SolutionsAer identifying the client’s pririty prblem in a given clinical scenari, yu want tthink abut all the pssible actins that can be used t reslve r manage the prblem.T assist in selecting the pssible actins r apprach t care yu might include, rstdetermine what utcmes are desired r expected fr the client. Fr example, cnsiderthis scenari:e birth parent of an 11-year-old brings the child to the ED for a right forearm injuryexperienced as a result of a scooter accident. e nurse observes that the child is crying andguarding the right arm, which is swollen, deformed, and bruised. e child is le-handed.During the head-to-toe assessment, the nurse notes old bruising on the le side of the child’schest and scarring on both upper thighs. Both knees have large abrasions with small stonesand dirt embedded in them. e child denies having had any previous accidents or injuries.An x-ray conrms a right nondisplaced metaphyseal ulnar fracture.In this example, the client has an acute injury and signs f previus injuries, pssiblyfrm abuse. e desired utcmes wuld include that the client:■States that pain is n mre than a 2–3/10 n a 0 t 10 pain intensity scale■Des nt experience cmprmised neurvascular cmprmise in the right arm■Has decreased swelling f the right arm■Will experience healing f bilateral knee abrasins withut infectin■Is safe at hme (n neglect r abuse) with the birth parent r ther family/significantthere next step in this thinking prcess is t identify multiple ptential actins r nurs-ing interventins that culd achieve the desired utcmes. Als identify which actinswuld be avided r are cntraindicated. T develp a list f actins r interventinsfr this pediatric client, yu need knwledge f child develpment, fracture treatment,child abuse, and pain management.Sme nursing actins may fcus n cllecting additinal infrmatin abut the cli-ent. Fr instance, the nurse wuld likely want t interview the birth parent t btaininfrmatin abut the ld bruising and scarring bserved n the child’s chest andthighs. Other ptential actins that culd help achieve the desired utcmes in thisclinical situatin include:■States that pain is n mre than a 2–3/10 n a 0 t 10 pain intensity scale■Administer nnpiid pain medicatin; avid piids if pssible.■Prvide distractin fr the child, such as an iPad r gaming device.■Reassure the child that analgesics will be available as needed aer discharge.Remember:The urgency of a clini-cal situation and risk to the clientare important factors that willhelp youPrioritize Hypotheses.NGN TIPRemember:ToGenerate Solutionsto meet a client’s priority needs,determine the client’s desired orexpected outcomes rst.NGN TIP
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 24 preview imageCHAPTER1Introduction to the Cognitive Skills of Clinical Judgment7■Des nt experience cmprmised neurvascular cmprmise in the right arm■Assist in applying a right synthetic frearm cast.■Mnitr the child’s right arm neurvascular status aer cast applicatin.■Has decreased swelling f the right arm■Apply ice pack t arm utside cast and teach child need t use ice fr the next 24hurs.■Teach child t keep arm elevated as much as pssible.■Will experience healing f bilateral knee abrasins withut infectin■Clean bth knees t remve debris and dirt.■Apply triple antibitic cream n pen areas and cver with clean gauze.■Apply tpical lidcaine t knees t decrease pain.■Is safe at hme (n neglect r abuse) with the birth parent r ther family/significantther■Cmmunicate cncern abut child’s safety t primary health care prvider.■Cnsult with the scial wrker abut the child’s ptential safety risk, family situa-tin, and pssible change in placement f the child.■Reprt ptential child abuse t Child Prtective Services (CPS).Aer the list f ptential actins has been identied fr each desired utcme, deter-mine which actins shuld be implemented t meet the pririty needs f the client intheTake Actionprcess.Take ActionDeciding which actin t implement is the fcus f this clinical judgment thinkingskill. Aer generating a list f pssible interventins, determine the mst apprpriateinterventin r cmbinatin f interventins that will reslve r manage the client’spririty health prblems r cncerns. Als determine hw each interventin will beimplemented. Examples f methds t accmplish r implement interventins includewhat t cmmunicate, dcument, perfrm, administer, teach, r request frm a primaryhealth care prvider r ther member f the health care team.Fr example, in the pediatric clinical scenari described in the previus sectin nGenerate Solutions,yu might request a cnsultatin with the scial wrker t interviewthe birth parent abut the child’s injuries and hme situatin. Scial wrkers are expertsin interviewing and addressing family situatins, and can determine if the child’s inju-ries are ptentially cnsistent with abuse.When deciding n hw t implement interventins, avid memrized textbk meth-ds r prcedures. Instead cnsider the elements f the clinical situatin t determinewhich apprach t use. Fr example, teaching the birth parent abut the care f the childaer discharge wuld be apprpriate fr mst situatins. Hwever, in the pediatric clinicalexample, yu mightnotwant t teach the birth parent abut hme care aer dischargefrm the ED until it is determined whether the child will g hme with the birth parent. Ifabuse is suspected, the child wuld be remved frm the current family situatin.Evaluate Outcomese last clinical judgment thinking skill is t determine if the interventins imple-mented fr the client reslved r eectively managed the health prblem(s). e bestway t make that determinatin is t cmpare what the desired r expected utcmesare with current client ndings r bserved utcmes. Ask yurself, “Which assessmentndings/signs and symptms indicate that the client’s cnditin has imprved?” “Whichndings indicate that the client’s cnditin has declined?”Fr example, cnsider this clinical scenari:A 78-year-old client has been hospitalized for 6 days for exacerbation of chronic heart failure.On admission the client was placed on supplemental oxygen and IV furosemide for peripheralRemember:When deciding toTake Action,avoid memorizedtextbook methods and procedures; instead, customize youraction to meet the needs of theclient in the clinical scenario.NGN TIPTHINKING SPACE
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 25 preview imageStrategies for Student Success on the Next Generation NCLEX®(NGN) Test Items8edema and impending pulmonary edema. e primary health care provider adjusted the cli-ent’s cardiac medications and restricted salt intake (no added table salt). e nurse preparing forthe client’s discharge performs a head-to-toe assessment to determine the eectiveness of heartfailure management. e nurse documents the following client ndings:■Lungs clear with no adventitious breath sounds■No shortness of breath when walking short distances■Lost 5 lb (2.3 kg) during hospital stay■Bilateral ankle and foot edema decreased from 3+ to 1+■States planning to continue using table salt at homeIn this example, all f the client assessment data at the time f discharge demnstratethat the interventins used t manage heart failure were eective because the client isimprving. Hwever, the client plans t cntinue using table salt at hme, which culdcntribute t anther exacerbatin f heart failure. e nurse may need t reinfrceteaching abut the relatinship f sdium t uid retentin r cnsult with the regis-tered dietitian nutritinist t prvide the teaching.How Will the Six Clinical Judgment Skills Be Measured on theNGN?e new NGN exam is cmpsed f current test item types and new test item types. ettal number f test items shuld range between 85 and 150 ttal questins. e six NCJMMcgnitive skills intrduced in this chapter are measured n the NGN thrugh use f a varietyf new test item types that are embedded int tw types f case studies—the Unflding CaseStudy and the Stand-alne item. Bth types f cases present a clinical scenari and includepart f a medical recrd similar t the recrd shwn in the gure.Additinal medical recrd tabs may be included as the scenari requires.eUnfolding Case Studypresents the client ver time thrugh several phases f carein the clinical scenari. It is en referred t as the NGN Case Study. e time betweenphases can be minutes, hurs, r even days. e client may initially be evaluated in anED, acute care hspital, clinic, schl, r urgent care center. As the scenari changes,r “unflds,” new NGN test items require that the candidate use the infrmatin in thecurrent phase f the client’s care t answer each questin. Nursing candidates can expectt have three NGN Case Studies with six questins each. Each f the six questins rep-resents ne f the clinical judgment cgnitive skills discussed earlier.eStand-alone itemsmetimes referred t as the Stand-alne clinical judgmentitem, presents a client at ne pint in time and includes ne f the new NGN test itemtypes. Each item measures ne r mre f the six clinical judgment cgnitive skills.Nursing candidates are expected t have varying numbers f Stand-alne items n theNGN, depending n the candidate’s ability in taking the exam. Hwever, it is expectedthat mst candidates will have abut seven Stand-alne items.How Can You Prepare for the NGN?In additin t using this bk, ther resurces such as theDeveloping Clinical Judgmentwrkbks written by ne f this bk’s authrs (D.D.I.) prvide thinking exercises tRemember:ToEvaluate Out-comes, compare desired orexpected client outcomes withcurrent observed outcomes.NGN TIPHealth HistoryNurses’ NotesVital SignsLaboratory Results
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 26 preview imageCHAPTER1Introduction to the Cognitive Skills of Clinical Judgment9help yu master the six cgnitive skills t make apprpriate clinical judgments. If yuneed help with basic NCLEX® test-taking strategies and want beginning practice withNGN test items, tw f this bk’s authrs (L.A.S. and A.E.S.) created a bk entitledClinical Judgment and Test-Taking Strategies.All f these bks are included in the NGNResurce list at the end f this bk.Anther way t prepare fr the NGN is t practice multiple test items in the Unfld-ing Case Study and Stand-alne item frmats. NGN practice questins are lcated at theend f Chapters 3 thrugh 8 f this bk. Chapter 9 illustrates Stand-alne and Unfld-ing Case Studies with apprpriate NGN test items. Chapteris a cmprehensive NGNPractice Test that includes questins in all specialty areas. Crrect answers, ratinales,test-taking strategies, specialty cntent area, selected cncepts, and references are avail-able fr all NGN practice questins in the bk.In additin t the questins in this bk, 50 Stand-alne items and Unflding CaseStudies with accmpanying questins are available fr yur practice n the ElsevierEvlve site. Categries fr selectin f questins n Evlve include Cntent Area, Prir-ity Cncept, and Clinical Judgment Cgnitive Skill.Nw that yu have been intrduced t the six cgnitive skills needed t make appr-priate clinical judgment, yu are ready t learn abut the new NGN test item types. enext chapter describes and illustrates examples f the new NGN test item types.THINKING SPACE
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 27 preview imageAs described in Chapter 1, the NGN will be composed of current test item types andnew test item types. e six NCJMM cognitive (thinking) skills introduced in Chapter1 will be measured on the NGN through use of a variety of new test item types that areembedded into two types of cases—the Unfolding Case Study and the Stand-alone item.Both types of cases present a common, realistic clinical situation that new graduates willlikely encounter.is chapter describes the 15 new item types that will likely be part of the NGN. Anexample of each item type is presented and the correct responses are provided with briefrationales. Multiple examples of all item types, each with detailed Rationales, Content Area,Priority Concept, Cognitive Skill, and References, are presented throughout this book.Unlike the current NCLEX® items, most new NGN items will be scored using partial creditrather than being completely correct or incorrect. is means that for most NGN items youwill receive credit for any correct responses but will not receive credit for incorrect responses.Test Item Types Used for Unfolding Case StudiesAs described in Chapter 1, theUnfolding Case Study,also known as the NGN Case Study,presents a client and the initial data describing the clinical situation. ese data will typi-cally be part of a client medical record. e client either will be experiencing an urgent oremergent health problem or will be at risk for experiencing an urgent or emergent healthproblem. You’ll need the information in the initial clinical scenario to answer the rstNGN test item, which will measure the clinical judgment cognitive skill ofRecognize Cues.e second NGN test item will likely measure your ability toAnalyze Cues.As the clinicalscenario continues, the client’s condition will change over time through several phases ofcare in the clinical scenario. Four additional NGN test items will measure the other clinicaljudgment cognitive skills based on what client data are provided.Twelve of the new item types on the NGN will be integrated into multiple unfoldingcase studies. e remaining two types will be used for the Stand-alone items discussedlater in this chapter. Table 2.1 organizes these item types by major category and the cog-nitive skills that they best measure. Chapter 1 describes each of the six cognitive skillsessential for making appropriate clinical judgment when caring for clients across thelifespan in a variety of health care settings.Chapter 9 provides examples of complete unfolding cases with six accompanying testitems and examples of the two types of Stand-alone items. e new item types that willbe used as part of unfolding cases are described in the following sections.Multiple Choice Test ItemsMultiple choice test items have been a large part of the NCLEX® for many years. eseitemscurrentlypresent a short clinical scenario and four choices with one correctresponse and three distractors (the wrong options) (see Box 1.2 in Chapter 1 for anexample). For the NGN, there are two variations of the multiple choice item type:Mul-tiple Choice Single ResponseandMatrix Multiple Choice.Introduction to the NGN andthe New NGN Item TypesC H A P T E R2Remember:Data presented inthe new NGN test item formatswill usually be presented as partof a medical record as shown inthe gure in Chapter 1. Many ofthe test items presented in thisbook are displayed in the medicalrecord format.NGN TIPRemember:Expect each unfold-ing case on the NGN to presentclient data that change over time(minutes, hours, days) and sixNGN test items, each measuringone of the six clinical judgmentcognitive skills.NGN TIP
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 28 preview imageC H A P T E R2Introduction to the NGN and the New NGN Item Types11Multiple Choice Single Response ItemOn the NGN, the format for the Multiple Choice Single Response test item will be similar tothe current NCLEX® format. However, the clinical scenario will be longer with more infor-mation about the client situation, usually within a portion of the medical record. In addition,the number of responses willnotbe restricted to four options, and as many as 10 optionsmay be included. Sample Question 2.1 shows an example of this type of item to measure theclinical judgment cognitive skill ofTake Actionfor an adult client with a mental health issue.TABLE 2.1NGN Item Types for Unfolding Case StudiesNGN Item Types and VariationsCognitive Skills That Can Be Optimally MeasuredMultiple ChoiceMultiple Choice Single ResponseMatrix Multiple ChoiceRecognize CuesAnalyze CuesPrioritize Hypotheses (except Matrix Multiple Choice)Generate SolutionsTake ActionEvaluate OutcomesMultiple ResponseMultiple Response Select All That ApplyMultiple Response Select NMultiple Response GroupingMatrix Multiple ResponseRecognize CuesAnalyze CuesPrioritize Hypotheses (except Matrix Multiple Choice)Generate SolutionsTake ActionEvaluate OutcomesDrop-DownDrop-Down ClozeDrop-Down RationaleDrop-Down in Table (may be replaced by aDrag-and-Drop in Table)Recognize CuesAnalyze CuesPrioritize HypothesesGenerate SolutionsTake ActionEvaluate OutcomesDrag-and-DropDrag-and-Drop ClozeDrag-and-Drop RationaleRecognize CuesAnalyze CuesPrioritize HypothesesGenerate SolutionsTake ActionEvaluate OutcomesHighlightHighlight in TextHighlight in TableRecognize CuesEvaluate OutcomesBased on the client information provided, what is the nurse’srstaction?☐Ask the client’s friends to check the client for additionalweapons.☐Reassure the client that the client is safe and secure in the ED.☐Call Security for assistance.Allow the client to vent own feelings.☐Administer an antianxiety medication.☐Distract the client and guide the client to practice copingskills.Multiple Choice Single ResponseSample Question .Health HistoryNurses’ NotesVital SignsLaboratory Results:A 28-year-old client is brought to the ED by friends,who state that the client became violent this evening ina local bar after a partner “break up.” The client accusedthe partner of “cheating” and pulled out a knife. The cli-ent’s friends were able to stop the client and take the knifebefore any harm occurred. They state that they have neverseen the client act like this and are worried that somethingmight be seriously wrong. Currently the client seems agi-tated and restless, and begins pacing in the ED demand-ing to “see my partner right now.”
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 29 preview imageStrategies for Student Success on the Next Generation NCLEX®(NGN) Test Items12Remember:As with any clientwho is upset, paranoid, angry,or potentially violent, you wouldrstallow the client to vent feel-ings, which may help diuse thesituation. Allowing a client tovent and keeping the client andsta safe are the initial focus ofnursing care when encounter-ing any client with an actual orpotential mental health problemor crisis.NGN TIPThe nurse provides health teaching for a 70-year-old clientwho had a TKA 3 days ago and is preparing to go home witha daughter.For each client statement, click or specify (with anX) whether thestatement indicatesunderstanding or no understandingof theteaching provided.Client StatementUnderstandingNo Understanding“I’ll call my surgeonif my incision getsred or has drainage.”☐“I can stop takingmy blood thinnerwhen I get home.”☐“I’ll have physicaltherapy for about aweek.”☐“I’m allowed to bearweight on my right leg.”☐“I can probably drivein a few months.”☐Matrix Multiple ChoiceSample Question .Rationale:e rst nursing action is to allow the client to vent feelings. is action mayhelp to de-escalate and decrease the client’s agitation and restlessness. e nurse wouldnot want to ask friends to check for weapons because they could possibly be harmed.Although calling Security may be needed later, the client may feel threatened by the pres-ence of that authority gure and become more agitated or violent at this time. Reassuringthe client that the client is safe does not address the concern. Although the client is agi-tated, distraction and practicing coping skills may be a better option at a later time aer thecurrent concern is addressed. Medication is usually the last resort unless needed to calmthe client so that communication can occur. Although the client is restless and pacing inthe ED, there is no evidence that the client would not vent feelings to the nurse.Matrix Multiple Choice Iteme Matrix Multiple Choice test item is more complex than the Multiple Choice SingleResponse item. A Matrix Multiple Choice item provides a clinical scenario and selected dataabout the client. e test item is structured in a tabular format (matrix) with at least fourrows and three columns. For this item, you would select only one response for each row.Sample Question 2.2 shows an example of this type of item to measure the clinical judgmentcognitive skill ofEvaluate Outcomesfor an adult client who has had a surgical procedure.Rationale:As indicated in the test item, the client’s statements that are not correct and showthat the client does not understand the health teaching include: “I can stop taking my bloodthinner when I get home,” and “I’ll have physical therapy for about a week.” Clients who havetotal joint arthroplasty (especially knee and hip) are at a high risk for venous thromboem-bolism—DVT or PE. To help prevent these problems, the client is prescribed an oral antico-agulant, which is typically continued for 10 days to several weeks aer surgery and should betaken aer the client is home. e client would call the surgeon if the incision becomes redand/or has drainage because these symptoms indicate possible infection.Aer surgery, most clients have 3 to 6 weeks of physical therapy depending on thetype of prothesis and the client’s overall health and tolerance. e surgical joint is oensti, painful, and swollen, which limits the client’s range of motion; however, weightbearing to tolerance helps promote ambulation and increase muscle strength. Physi-cal therapy plus exercises that clients practice every day help to improve joint functionand independence. e client will be allowed to drive when muscle strength and jointmobility improve. Driving is dicult until the surgical knee is able to ex more than 90degrees. is goal may not be achieved for 6 to 8 weeks or more aer surgery.
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 30 preview imageC H A P T E R2Introduction to the NGN and the New NGN Item Types13Multiple Response Test ItemsMultiple Response test items have been a large part of the NCLEX® for many years.ese itemscurrentlypresent a short clinical scenario with ve or six options. e cor-rect response(s) could be one, some, or all options (see Box 1.2 in Chapter 1 for anexample). For the NGN, there are four variations of the Multiple Response test item:■Multiple Response Select All That Apply Item■Multiple Response Select N Item■Multiple Response Grouping Item■Matrix Multiple Response ItemMultiple Response Select All That Apply ItemOn the NGN, the format for the Multiple Response Select All at Apply test item willbe similar to the current NCLEX® format. However, the clinical scenario will be longerwith more information about the client situation, usually within a portion of the medi-cal record. e item will have at least ve choices and no more than 10 choices. e cor-rect response could be one, some, or all options. Sample Question 2.3 shows an exampleof this type of item to measure the clinical judgment cognitive skill ofAnalyze Cuesforan older client who is residing in an assisted-living facility and who experiences acuteconfusion.Rationale:e client’s assessment ndings indicate that the client likely has a UTI (as evi-denced by multiple bacteria in the urine). Fever, acute confusion, and a low BP suggest thatthe client is dehydrated and may have urosepsis. Acute confusion is also known as delirium,a common assessment nding in older clients who have a UTI. Because the client has type 2diabetes, the client also is likely experiencing a diabetic complication called hyperglycemichyperosmolar syndrome. e client’s elevated blood glucose and dehydration are consistentwith a hyperosmolar state. A low blood pressure is also consistent with dehydration.Multiple Response Select N Iteme Multiple Response Select N test item is similar to the Multiple Response Select Allat Apply item except that the number of required correct responses is specied in thequestion. is item will also have at least ve options but no more than 10 options fromwhich to choose. Sample Question 2.4 shows an example of this type of item to measurethe clinical judgment cognitive skill ofRecognize Cuesfor an adult client who has newonset of symptoms.An 81-year-old client was admitted to an acute care unit from anassisted-living facility with a low-grade fever and acute confusion.The client’s daughter tells the admitting nurse that the client’smother had a stroke 2 years ago that resulted in left hemiparesisand urinary incontinence, and the client has been in the assisted-living facility for the past 5 months. The client has a long historyof DM type 2, which has been well controlled. Until this morning,the client’s daughter had not been allowed to visit the facility dueto the COVID-19 pandemic. During the visit today, the daughternoted that her mother was lethargic, confused, and unable to am-bulate with a walker. POC testing in the ED indicated the presenceof multiple bacteria in the client’s urine and FSBG of 331 mg/dL(18.4 mmol/L). The client’s BP is currently 96/48 mm Hg.The nurse reviews the client assessment ndings and determinesthat the client most likely has which of the following conditions?Select all that apply.UrosepsisDeliriumDehydration☐COVID-19☐DKA☐Transient ischemic attackHyperglycemic hyperosmolar syndromeMultiple Response Select All That ApplySample Question .THINKING SPACE
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Page 31 preview imageStrategies for Student Success on the Next Generation NCLEX®(NGN) Test Items14The nurse assesses a 53-year-old client whose partner broughtthe client to the ED with report of acute onset dyspnea and backpain that started about an hour ago. The client’s medical historyincludes DM type 2, obesity, hypertension, hypercholesteremia,and asthma. The client’s admission vital signs include:•Temperature = 98.8°F (37.1°C)•HR = 78 BPM and irregular•RR = 26 bpm and slightly labored•BP = 148/90 mm Hg•SpO2= 95% (on RA)The nurse reviews the client’s assessment data.Select 4 client nd-ings that are relevant and of immediate concern to the nurseDyspneaBack pain☐Temperature☐History of obesity☐History of diabetesTachypnea☐History of asthmaElevated BPMultiple Response Select NSample Question .Remember:When reviewing cli-ent ndings, rst determine whatis most relevant for that particu-lar client in the clinical scenario.Organize these ndings to deter-mine which data are consistentwith specic client conditions orhealth problems.NGN TIPThe nurse admits an 11-month-old infant who has possible bac-terial meningitis to the acute pediatric care unit.For each body system listed below, click or specify (with anX) the po-tential nursing interventions that areappropriatefor the client’s care.Each body system may support more than one potential intervention.Body SystemPotential Nursing InterventionsRespiratory☐Incentive spirometer every 2 hoursOxygen therapy via nasal cannula☐Chest x-ray now and at bedtimeContinuous pulse oximetry monitoringDroplet PrecautionsNeurologicSeizure Precautions☐Neurologic checks every dayCardiovascular☐Type and crossmatch for 2 units ofpacked red blood cells (PRBCs)Vital signs every hourContact physician if temperature above102.4°F (39.1°C)Begin IV cefotaxime infusionBlood culturesMultiple Response GroupingSample Question .Rationale:e client’s new symptoms include dyspnea and back pain, which couldindicate a possible MI and therefore are relevant in this clinical scenario. Women withan MI oen present with symptoms that dier from those in men, including having backor jaw pain. e client’s RR and BP are both elevated, but the temperature is normal. HRis within normal limits but is irregular. e medical history may help explain or predictthe current client condition, but is not relevant at this time for planning nursing care.Other examples of questions or statements that could be part of a Multiple ResponseSelect N test item with their associated cognitive skills include:■Select the three priority health problems that the client is experiencing.Analyze Cues■What are the five assessment findings that indicate the client is improving?EvaluateOutcomes■Select the four physician orders that the nurse would anticipate for this client.Take ActionMultiple Response Grouping Iteme Multiple Response Grouping test item is similar to the Multiple Response SelectAll at Apply item except that the options are presented in categories or by group ina table with a minimum of two columns and ve rows. Each category will have two tofour options per row and require that at least one response option be selected. SampleQuestion 2.5 shows an example of this type of item to measure the clinical judgmentcognitive skill ofGenerate Solutionsfor a pediatric client who has bacterial meningitis.
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Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items (2022) - Certification Guides | National Council Licensure Examination