2011 NCLEX PN Detailed Test Plan - Educator

NCLEX-PN DETAILED TEST PLAN
2011 NCLEX-PN Detailed Test Plan
Effective | April 2011
Item Writer/Item Reviewer/Nurse Educator Version
Mission Statement The National Council of State Boards of Nursing (NCSBN ) provides education, service and research through collaborative leadership to promote regulatory excellence for patient safety and public protection.
Purpose and Functions The purpose of NCSBN is to provide an organization through which boards of nursing act and counsel together on matters of common interest and concern affecting the public health, safety and welfare, including the development of licensing examinations in nursing. The major functions of NCSBN include developing the NCLEX-RN and NCLEX-PN Examinations, performing policy analysis and promoting uniformity in relationship to the regulation of nursing practice, disseminating data related to NCSBNs purpose and serving as a forum for information exchange for NCSBN members.

Copyright 2011 National Council of State Boards of Nursing, Inc. (NCSBN) All rights reserved. The NCSBN logo, NCLEX , NCLEX-RN and NCLEX-PN , TERCAP , Nursys , NNAAP and MACE are registered trademarks of NCSBN and this document may not be used, reproduced or disseminated to any third party without written permission from NCSBN.

Permission is granted to boards of nursing to use or reproduce all or parts of this document for licensure-related purposes only. Nonprofit education programs have permission to use or reproduce all or parts of this document for educational purposes only. Use or reproduction of this document for commercial or for-profit use is strictly prohibited. Any authorized reproduction of this document shall display the notice: Copyright by the National Council of State Boards of Nursing, Inc. All rights reserved. Or, if a portion of the document is reproduced or incorporated in other materials, such written materials shall include the following credit: Portions copyright by the National Council of State Boards of Nursing, Inc. All rights reserved. Address inquiries in writing to NCSBN Permissions, 111 E. Wacker Drive, Suite 2900, Chicago, IL 60601-4277. Printed in the United States of America
National Council of State Boards of Nursing 2011 NCLEX-PN Detailed Test Plan
Item Writer/Item Reviewer/Nurse Educator Version
Approved by National Council of State Boards of Nursing (NCSBN ) NCLEX Examination Committee

Effective Date April 2011
2011 NCLEX-PN Detailed Test Plan Item Writer/Item Reviewer/Nurse Educator Version
Table of Contents
I. II. Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 2011 NCLEX-PN Test Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Beliefs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Classification of Cognitive Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Test Plan Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Client Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Integrated Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Distribution of Content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Overview of Content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 III. 2011 NCLEX-PN Detailed Test Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Safe and Effective Care Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Coordinated Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Safety and Infection Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Health Promotion and Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Psychosocial Integrity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Physiological Integrity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Basic Care and Comfort . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Pharmacological Therapies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Reduction of Risk Potential . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Physiological Adaptation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 IV. Administration of the NCLEX-PN Examination. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38
Examination Length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 The Passing Standard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Similar Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Reviewing Answers and Guessing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Scoring the NCLEX Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Computerized Adaptive Testing (CAT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Pretest Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Additional Constraints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Passing and Failing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Scoring Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Types of Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 NCLEX Examination Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Confidentiality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Tutorial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 V. Item Writing Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50 Steps to Item Writing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Example Using the Above Steps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
ii
Coordinated Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Safety and Infection Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Health Promotion and Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Psychosocial Integrity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Basic Care and Comfort . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Pharmacological Therapies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Reduction of Risk Potential . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Physiological Adaptation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 VI. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54 APPENDIX A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55 Case Scenario Answers/Examples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Coordinated Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Safety and Infection Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Health Maintenance and Promotion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Psychosocial Integrity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Basic Care and Comfort . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Pharmacological Therapies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Reduction of Risk Potential . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Physiological Adaptation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
I.
Background
The Item Writer/Item Reviewer/Nurse Educator Detailed Test Plan for the National Council Licensure Examination for Practical/Vocational Nurses (NCLEX-PN ) was developed by the National Council of State Boards of Nursing, Inc. (NCSBN ). The purpose of this document is to provide more detailed information about the content areas tested in the NCLEX-PN Examination than is provided in the basic NCLEX-PN Test Plan.

This booklet contains the: 2011 NCLEX-PN Test Plan; Information on testing requirements and sample examination questions (items); Item writing exercises; and References.
About the 2011 NCLEX-PN Test Plan (Section II)
The test plan is reviewed and approved by the NCLEX Examination Committee (NEC) every three years. Multiple resources are used, including the recent practice analysis of licensed practical/vocational nurses (LPN/VN), and expert opinions of the NEC, NCSBN content staff and boards of nursing (NCSBNs member boards) to ensure that the test plan is consistent with state nurse practice acts. Following the endorsement of proposed revisions by the NEC, the test plan document is presented for approval to the Delegate Assembly, which is the decisionmaking body of NCSBN.
About the 2011 NCLEX-PN Detailed Test Plan (Section III)
The detailed test plan serves a variety of purposes. It is used to guide candidates preparing for the examination, to direct item writers in the development of items and to facilitate the classification of examination items. Two versions of the detailed test plan have been created: Item Writer/Item Reviewer/Nurse Educator Version and Candidate Version. The Item Writer/Item Reviewer/Nurse Educator Version that is provided in this document offers a more thorough and comprehensive listing of content for each client needs category and subcategory outlined in the test plan. Sample items are provided at the end of each category, which are specific to the client needs category being reviewed in that section. There is an item writing guide along with sample case scenarios that provide nurse educators with hands-on experience in writing NCLEX -style test questions. The Candidate Version of the detailed test plan provides the same comprehensive listing of content and sample items for each client needs category and subcategory outlined in the test plan; however, it does not offer an item writing guide or section with case scenarios.
For up-to-date information on the NCLEX-PN Examination, visit the NCSBN website at http://www.ncsbn.org.
II.
2011 NCLEX-PN Test Plan
Introduction
Entry into the practice of nursing is regulated by the licensing authorities within each NCSBN member board jurisdictions (state, commonwealth and territorial boards of nursing). To ensure public protection, each jurisdiction requires candidates for licensure to meet set requirements that include passing an examination that measures the competencies needed to perform safely and effectively as a newly licensed, entry-level practical/vocational nurse. NCSBN develops a licensure examination, the National Council Licensure Examination for Practical/ Vocational Nurses (NCLEX-PN Examination), which is used by member board jurisdictions to assist in making licensure decisions.
Several steps occur in the development of the NCLEX-PN Test Plan. The first step is conducting a practice analysis that is used to collect data on the current practice of entry-level practical/vocational nurses (Report of Findings from the 2009 LPN/VN Practice Analysis: Linking the NCLEX-PN Examination to Practice [NCSBN, 2009]). Newly licensed practical/vocational nurses (LPN/VNs) are asked about the frequency and priority of performing 150 nursing care activities. Nursing care activities are then analyzed in relation to the frequency of performance, impact on maintaining client safety and client care settings where the activities are performed. This analysis guides the development of a framework for entry-level nursing practice that incorporates specific client needs as well as processes that are fundamental to the practice of nursing. The next step is the development of the NCLEX-PN Test Plan, which guides the selection of content and behaviors to be tested. Variations in jurisdiction laws and regulations are considered in the development of the test plan.

The NCLEX-PN Test Plan provides a concise summary of the content and scope of the licensing examination. It serves as a guide for examination development, as well as candidate preparation. Each examination assesses the knowledge, skills and abilities that are essential for the entry-level practical/vocational nurse to use in order to meet the needs of clients requiring the promotion, maintenance or restoration of health. The following sections describe beliefs about people and nursing that are integral to the examination, cognitive abilities that will be tested in the examination and specific components of the NCLEX-PN Test Plan.

Beliefs
Beliefs about people and nursing influence the NCLEX-PN Test Plan. People are finite beings with varying capacities to function in society. They are unique individuals who have defined systems of daily living that reflect their values, cultures, motives and lifestyles. Additionally, people have the right to make decisions regarding their health care needs and to participate in meeting those needs. The profession of nursing makes a unique contribution in helping clients (individual, family or group) achieve an optimal level of health in a variety of settings.
Nursing is both an art and a science, founded on a professional body of knowledge that integrates concepts from the liberal arts and the biological, physical, psychological and social sciences. It is a learned profession based on an understanding of the human condition across the life span and the relationships of an individual with others and within the environment. Nursing is a dynamic, continually evolving discipline that employs critical thinking to integrate increasingly complex knowledge, skills, technologies and client care activities into evidence-based nursing practice. The goal of nursing for client care is preventing illness; promoting comfort; protecting, promoting, and restoring health; and promoting dignity in dying.
The LPN/VN uses specialized knowledge and skills which meet the health needs of people in a variety of settings under the direction of qualified health professionals (NFLPN, 2003). The LPN/VN uses a clinical problemsolving process (the nursing process) to collect and organize relevant health care data, assist in the identification of the health needs/problems throughout the clients life span and contribute to the interdisciplinary team in a variety of settings. The entry-level LPN/VN demonstrates the essential competencies needed to care for clients with commonly occurring health problems that have predictable outcomes. Professional behaviors, within the scope of nursing practice for a practical/vocational nurse, are characterized by adherence to standards of care, accountability of ones own actions and behaviors, and use of legal and ethical principles in nursing practice (NAPNES, 2007).
Classification of Cognitive Levels

Blooms taxonomy for the cognitive domain is used as a basis for writing and coding items for the examination (Bloom et al., 1956; Anderson & Krathwohl, 2001). The practice of practical/vocational nursing requires application of knowledge, skills and abilities; therefore, the majority of items are written at the application or higher levels of cognitive ability.
Test Plan Structure

The framework of Client Needs was selected because it provides a universal structure for defining nursing actions and competencies for a variety of clients across all settings and is congruent with state laws/rules.
Client Needs
The content of the 2011 NCLEX-PN Test Plan is organized into four major Client Needs categories. Two of the four categories are divided into subcategories:
Safe and Effective Care Environment

Coordinated Care Safety and Infection Control
Health Promotion and Maintenance Psychosocial Integrity Physiological Integrity

Basic Care and Comfort Pharmacological Therapies Reduction of Risk Potential Physiological Adaptation
Integrated Processes
The following processes are fundamental to the practice of practical/vocational nursing and are integrated throughout the Client Needs categories and subcategories:
Clinical Problem-Solving Process (Nursing Process) a scientific approach to client care that in-
cludes data collection, planning, implementation and evaluation.

Caring interaction of the LPN/VN and client in an atmosphere of mutual respect and trust. In this
collaborative environment, the LPN/VN provides support and compassion to help achieve desired therapeutic outcomes.
Communication and Documentation verbal and nonverbal interactions between the LPN/VN
and the client, as well as other members of the health care team. Events and activities associated with client care are validated in written and/or electronic records that reflect standards of practice and accountability in the provision of care.
Teaching/Learning facilitation of the acquisition of knowledge, skills and attitudes to assist in pro-
moting a change in behavior.
Distribution of Content
The percentage of test items assigned to each Client Needs category and subcategory of the 2011 NCLEXPN Test Plan is based on the results of the study Report of Findings from the 2009 LPN/VN Practice Analysis: Linking the NCLEX-PN Examination to Practice (NCSBN, 2009) and expert judgment provided by members of the NCLEX Examination Committee.

Client Needs Safe and Effective Care Environment

Coordinated Care Safety and Infection Control
Percentage of Items from Each Category/Subcategory
13-19% 11-17% 7-13% 7-13%
Heath Promotion and Maintenance Psychosocial Integrity Physiological Integrity

Basic Care and Comfort Pharmacological Therapies Reduction of Risk Potential Physiological Adaptation
9-15% 11-17% 9-15% 9-15%
Distribution of Content for the NCLEX-PN Test Plan

Client Needs Categories Safe & Effective Care Environment
Coordinated Care 13-19 % Safety & Infection Control 11-17%
Integrated Processes Clinical Problem-Solving Process (Nursing Process)
Health Promotion & Maintenance
Health Promotion & Maintenance 7-13%
Caring
Psychosocial Integrity
Psychosocial Integrity 7-13%
Communication & Documentation
Basic Care & Comfort 9-15% Pharmacological Therapies 11-17% Reduction of Risk Potential 9-15% Physiological Adaptation 9-15%
Physiological Integrity
Teaching & Learning
10
12
14
16
18
20
Percentage of Items on NCLEX-PN Examination
Overview of Content
All content categories and subcategories reflect client needs across the life span in a variety of settings.

The LPN/VN provides nursing care that contributes to the enhancement of the health care delivery setting and protects clients and health care personnel.
Coordinated Care The LPN/VN collaborates with health care team members to facilitate effective
client care. Related content includes, but is not limited to:

Advance Directives Advocacy Client Care Assignment Client Rights Collaboration with Interdisciplinary Team Concepts of Management and Supervision Confidentiality/Information Security Continuity of Care Establishing Priorities Ethical Practice Informed Consent Information Technology Legal Responsibilities Performance Improvement (Quality
Improvement) Referral Process Resource Management
Safety and Infection Control The LPN/VN contributes to the protection of clients and health care
personnel from health and environmental hazards. Related content includes, but is not limited to:
Accident/Error/Injury Prevention Emergency Response Plan Ergonomic Principles Handling Hazardous and Reporting of Incident/Event/Irregular
Infectious Materials
Home Safety
Occurrence/Variance Restraints and Safety Devices Safe Use of Equipment Security Plan Standard Precautions/Transmission-Based Precautions/Surgical Asepsis
Health Promotion and Maintenance

The LPN/VN provides nursing care for clients that incorporate knowledge of expected stages of growth and development and prevention and/or early detection of health problems. Related content includes, but is not limited to:
Aging Process Ante/Intra/Postpartum and Newborn Care Data Collection Techniques Developmental Stages and Transitions Health Promotion/Disease
Prevention
High Risk Behaviors Lifestyle Choices Self-Care
The LPN/VN provides care that assists with promotion and support of the emotional, mental and social wellbeing of clients. Related content includes, but is not limited to:
Abuse/Neglect Behavioral Management Chemical and Other Dependencies Coping Mechanisms Crisis Intervention Cultural Awareness End of Life Concepts Grief and Loss Mental Health Concepts Religious and Spiritual Influences on Health Sensory/Perceptual Alterations Stress Management Support Systems Therapeutic Communication Therapeutic Environment
The LPN/VN assists in the promotion of physical health and well-being by providing care and comfort, reducing risk potential for clients and assisting them with the management of health alterations.
Basic Care and Comfort The LPN/VN provides comfort to clients and assistance in the
performance of their activities of daily living. Related content includes, but is not limited to:
Assistive Devices Elimination Mobility/Immobility Non-Pharmacological Comfort Interventions Pharmacological Therapies The LPN/VN provides care related to the administration of Nutrition and Oral Hydration Personal Hygiene Rest and Sleep
medications and monitors clients who are receiving parenteral therapies. Related content includes, but is not limited to:
Adverse Effects/Contraindications /Side Medication Administration Pharmacological Pain Management
Effects/Interactions Dosage Calculations Expected Actions/Outcomes
Reduction of Risk Potential The LPN/VN reduces the potential for clients to develop complica-
tions or health problems related to treatments, procedures or existing conditions. Related content includes, but is not limited to:
Changes/Abnormalities in Vital Signs Diagnostic Tests Laboratory Values Potential for Alterations in Body Systems Potential for Complications of Diagnostic Potential for Complications from Surgical
Procedures and Health Alterations

Therapeutic Procedures
Tests/Treatments/Procedures
Physiological Adaptation The LPN/VN participates in providing care for clients with acute, chron-
ic or life-threatening physical health conditions. Related content includes, but is not limited to:
Alterations in Body Systems Basic Pathophysiology Fluid and Electrolyte Imbalances Medical Emergencies Radiation Therapy Unexpected Response to Therapies
III. 2011 NCLEX-PN Detailed Test Plan
The 2011 NCLEX-PN Test Plan in the previous section provides a general outline of the categories and subcategories of the examination. The 2011 NCLEX-PN Detailed Test Plan (Item Writer/Item Reviewer/Nurse Educator Version) is used to guide the direction of examination content, which is to be followed by NCLEX item writers, item reviewers and nurse educators.

The activity statements used in the Report of Findings from the 2009 LPN/VN Practice Analysis: Linking the NCLEX-PN Examination to Practice (NCSBN, 2009) preface each of the eight content categories and are identified throughout the detailed test plan by an asterisk (*). NCSBN performs an analysis of those activities used frequently and identified as important by entry-level nurses to ensure client safety. This is called a practice analysis; it provides data to support the NCLEX examination as a reliable, valid measure of competent, entry-level LPN/ VN practice. The practice analysis is conducted at least every three years.
All task statements in the 2011 NCLEX-PN Detailed Test Plan require the nurse to apply the fundamental principles of clinical decision making and critical thinking to nursing practice. The detailed test plan also makes the assumption that the nurse integrates concepts from the following bodies of knowledge: Social Sciences (psychology and sociology) Biological Sciences (anatomy, physiology, biology and microbiology)
In addition, the following concepts are utilized throughout the four major client needs categories and subcategories of the test plan: Clinical Problem Solving (Nursing Process) Caring Communication and Documentation Teaching and Learning. Note: There are certain inconsistencies throughout this document related to word usage and punctuation. Sentences or phrases marked by an asterisk are activity statements taken directly from the Report of Findings from the 2009 LPN/VN Practice Analysis: Linking the NCLEX-PN Examination to Practice (NCSBN, 2009). In order to provide proper attribution to the original survey these statements have not been altered to fit the overall grammatical style of this document. In addition, the term client refers to an individual, family or group. Clients are the same as residents or patients.
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Coordinated Care
Coordinated Care The LPN/VN collaborates with health care team members to facilitate effective
client care. COORDINATED CARE Related Activity Statements from the Report of Findings from the 2009 LPN/VN Practice Analysis: Linking the NCLEX-PN Examination to Practice
Provide information about advance directives Advocate for client rights and needs Promote client self-advocacy Assign client care and/or related tasks (e.g., assistive personnel or LPN/VN) Involve client in care decision making Contribute to the development and/or update of the client plan of care Participate as a member of an interdisciplinary team Recognize and report staff conflict Participate in staff education Use data from various sources in making clinical decisions Supervise/evaluate activities of assistive personnel Maintain client confidentiality Provide for privacy needs Follow up with client after discharge Participate in client discharge or transfer Provide and receive report Organize and prioritize care for assigned group of clients Participate in client consent process Use information technology in client care Receive and process health care provider orders Recognize task/assignment you are not prepared to perform and seek assistance Respond to the unsafe practice of a health care provider (e.g., intervene or report) Follow regulation/policy for reporting specific issues (e.g., abuse, neglect, gunshot wound
or communicable disease)
Participate in quality improvement (QI) activity (e.g., collecting data or serving on QI
committee)
Apply evidence-based practice when providing care Participate in client data collection and referral Participate in providing cost effective care
*Activity Statements used in the 2008 RN Practice Analysis
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Related content includes, but is not limited to:
Advance Directives
Provide information about advance directives* Review client understanding of advance directives (e.g., living will, health care proxy, Durable Power
of Attorney for Health Care [DPAHC])

Verify the client advance directives status
Advocacy
Advocate for client rights or needs* Discuss identified treatment options with client and respect the decisions made Promote client self-advocacy* Use interpreters to assist in achieving client understanding
Client Care Assignments

Assign client care and/or related tasks (e.g., assistive personnel or LPN/VN)* Compare needs of client to knowledge, skills and abilities of assistive personnel prior to making
client care assignments Organize information for client assignments Provide information to supervisor when client care assignments need to be changed (e.g., change in client status)
Client Rights
Inform client of individual rights (e.g., confidentiality, informed consent) Involve client in care decision making* Intervene if client rights are violated Recognize client right to refuse treatment/procedure
Collaboration with Interdisciplinary Team

Identify roles/responsibilities of health care team members Identify need for nursing or interdisciplinary client care conference Contribute to the development and/or update of the client plan of care* Contribute to planning interdisciplinary client care conferences Participate as a member of an interdisciplinary team*
Concepts of Management and Supervision

Recognize and report staff conflict* Verify abilities of staff members to perform assigned tasks (e.g., job description, scope of practice,
training, experience)
Provide input for performance evaluation of other staff Participate in staff education* Use data from various sources in making clinical decisions* Serve as resource person to other staff Supervise/evaluate activities of assistive personnel*
*Activity Statements used in the 2009 PN Practice Analysis
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Confidentiality/Information Security
Identify staff actions that impact client confidentiality and intervene as needed (e.g., access to
medical records, discussions at nurses' station, change-of-shift reports) Recognize staff member and client understanding of confidentiality requirements Apply knowledge of facility regulations when accessing client records Maintain client confidentiality* Provide for privacy needs*
Continuity of Care
Follow-up with client after discharge* Participate in client discharge or transfer* Provide follow-up for unresolved client care issues Provide and receive report* Record client information (e.g., medical record, referral/transfer form) Use agency guidelines to guide client care (e.g., clinical pathways, care maps, care plans)
Establishing Priorities
Organize and prioritize care for assigned group of clients* Participate in planning client care based upon client needs (e.g., diagnosis, abilities, prescribed
treatment) Use effective time management skills
Ethical Practice
Identify ethical issues affecting staff or client Inform client of ethical issues affecting client care Intervene to promote ethical practice Review client and staff member knowledge of ethical issues affecting client care
Informed Consent
Identify appropriate person to provide informed consent for client (e.g., client, parent, legal
guardian) Participate in client consent process* Describe informed consent requirements (e.g., purpose for procedure, risks of procedure) Recognize that informed consent was obtained (e.g., completed consent form, client understanding of procedure)
Information Technology
Use information technology in client care* Access data for client or staff through online databases and journals Enter computer documentation accurately, completely and in a timely manner
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Legal Responsibilities
Identify legal issues affecting staff and client (e.g., refusing treatment) Receive and process health care provider orders* Recognize task/assignment you are not prepared to perform and seek assistance* Respond to the unsafe practice of a health care provider (e.g., intervene or report)* Follow regulation/policy for reporting specific issues (e.g., abuse, neglect, gunshot wound, or
communicable disease)* Document client care
Performance Improvement (Quality Improvement)

Identify impact of performance improvement/quality improvement activities on client care
outcomes
Participate in quality improvement (QI) activity (e.g., collecting data or serving on QI committee)* Document performance improvement/quality improvement activities Report identified performance improvement/quality improvement concerns to appropriate
personnel (e.g., nurse manager, risk manager)

Apply evidence-based practice when providing care*
Referral Process
Identify community resources for client (e.g., respite care, social services, shelters) Recognize need for client referral for actual or potential problem (e.g., physical therapy, speech
therapy) Use appropriate documents to contribute information needed for client referral (medical record, referral form) Participate in client data collection and referral*
Resource Management
Recognize client need for materials and equipment (e.g., oxygen, suction machine, wound care supplies) Review effective use of client care materials by assistive personnel (e.g., supplies) Participate in providing cost effective care*
Sample Item The nurse has contributed to a staff education program about client confidentiality. Which of the following statements by a staff member would indicate a correct understanding of the teaching? a. The nurse can share client information with housekeeping staff who work on the unit. b. Clients should be instructed to provide a unique password for family members to use to access medical information. (key) c. Staff may provide updates to a clients family members on the clients condition if the family members are on hospital premises. d. Family members are permitted to see the clients medical record if the client provides verbal consent. (Key) is used throughout this document to denote the correct answer(s) for the exam item.
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Safety and Infection Control

Safety and Infection Control The LPN/VN contributes to the protection of clients and health care
personnel from health and environmental hazards.
SAFETY AND INFECTION CONTROL Related Activity Statements from the Report of Findings from the 2009 LPN/VN Practice Analysis: Linking the NCLEX-PN Examination to Practice
Identify client allergies and intervene as appropriate Verify the identity of client Assist in or reinforce education to client about safety precautions Evaluate the appropriateness of health care provider order for client Participate in preparation for internal and external disasters (e.g., fire or natural disaster) Use safe client handling (e.g. body mechanics) Identify and address hazardous conditions in health care environment (e.g., chemical,
smoking or biohazard)
Acknowledge and document practice error (e.g. incident report) Follow protocol for timed client monitoring (e.g., restraint, safety checks) Implement least restrictive restraints or seclusion Assure availability and safe functioning of client care equipment Initiate and participate in security alert (e.g., infant abduction or flight risk) Identify the need for and implement appropriate isolation techniques Use standard/universal precautions Use aseptic and sterile techniques
Accident/Error/Injury Prevention
Identify client allergies and intervene as appropriate* Identify and facilitate correct use of infant and child car seats by client Identify client factors that influence accident/error/injury prevention (e.g., age, developmental
stage, lifestyle)
Recognize what factors related to mental status may contribute to the client potential for accident
or injury (e.g., confusion, altered thought processes, diagnosis)

Determine client/staff member knowledge of safety procedures Verify the identity of client* Utilize facility client identification procedures (e.g., client name band, allergy bands) Monitor client care environment for safety hazard and report problems to appropriate personnel
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Assist in or reinforce education to client about safety precautions* Remove fire hazards from client care areas Protect client from accident/error/injury (e.g., protect from another individual, falls, environmental
hazards, burns)
Provide client with appropriate method to signal staff members Evaluate the appropriateness of health care provider order for client*
Emergency Response Plan

Identify nursing and assistive personnel roles during internal and external disasters Participate in preparation for internal and external disasters (e.g. fire or natural disaster)* Contribute to selection of client to recommend for discharge in disaster situation
Ergonomic Principles
Use safe client handling (e.g. body mechanics)* Provide instruction and information to client about body positions that prevent stress injuries
Handling Hazardous and Infectious Materials

Identify and employ methods to control the spread of infectious agents (e.g., cleaning with
appropriate solutions)
Identify and address hazardous conditions in health care environment (e.g., chemical, smoking or
biohazard)*
Demonstrate knowledge of facility protocols for handling hazardous and infectious materials
Home Safety
Identify fire/environmental hazards (e.g., frayed electrical cords, small area rugs, inadequate
footwear)
Determine client understanding of home safety needs Provide client with information on home safety Reinforce client education on home safety precautions (e.g., home disposal of syringes, lighting,
handrails, kitchen safety)
Reporting of Incident/Event/Irregular Occurrence/Variance

Identify situations requiring completion of incident/event/irregular occurrence/variance report
(e.g., medication administration error, client fall)

Acknowledge and document practice error (e.g., incident report)* Monitor client response to error/event/occurrence
Restraints and Safety Devices

Demonstrate knowledge of appropriate application of restraints/safety devices Follow protocol for timed client monitoring (e.g., restraint, safety checks)* Implement least restrictive restraints or seclusion* Document use of restraints/safety devices and client response Check for proper functioning of restraints/safety devices
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Safe Use of Equipment

Assure availability and safe functioning of client care equipment* Follow facility protocols/procedures for safe use of equipment Provide safe equipment use for client care (e.g., continuous passive motion [CPM] device, oxygen,
mobility aids)
Security Plan
Initiate and participate in security alert (e.g., infant abduction or flight risk)* Use principles of triage and evacuation protocols/procedures Monitor effectiveness of security plan
Standard Precautions/Transmission-Based Precautions/Surgical Asepsis

Identify communicable diseases and modes of transmission (e.g., airborne, droplet, contact) Identify client knowledge of infection control procedures Identify the need for and implement appropriate isolation techniques* Use standard/universal precautions* Use aseptic and sterile techniques* Use appropriate supplies to maintain asepsis (e.g., gloves, mask, sterile supplies) Use correct techniques to apply and remove gloves, mask, gown and protective eye wear Use correct hand hygiene techniques Prevent environmental spread of infectious disease through correct use of equipment Protect immunocompromised client from exposure to infectious diseases/organisms Monitor client care area for sources of infection Set up a sterile field Reinforce appropriate infection control procedures with client and staff members
Sample Item The nurse is assisting to plan a community bicycle safety program. Which of the following information should the nurse recommend including? a. Demonstrating the correct way to wear a bicycle helmet to parents of preschoolers. (key) b. Asking school-aged children who have been involved in bicycle accidents to speak to a group of peers. c. Informing parents that it is necessary for all children to have a complete physical examination prior to initiating bike riding. d. Telling parents that it is safest for children to ride bikes on the weekends.
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Health Promotion and Maintenance The LPN/VN provides nursing care for clients that incorpo-
rate knowledge of expected stages of growth and development and prevention and/or early detection of health problems. HEALTH PROMOTION AND MAINTENANCE Related Activity Statements from the Report of Findings from the 2009 LPN/VN Practice Analysis: Linking the NCLEX-PN Examination to Practice
Provide care that meets the special needs of the newborn - less than 1 month old Provide care that meets the special needs of infants or children aged 1 month to 12 years Provide care that meets the special needs of adolescents aged 13 to 18 years Provide care that meets the special needs of young adults aged 19 to 30 years Provide care that meets the special needs of adults aged 31 to 64 years Provide care that meets the special needs of adults aged 65 to 85 years of age Provide care that meets the special needs of adults aged greater than 85 years of age Assist with fetal heart monitoring for the antepartum client Assist with monitoring a client in labor Monitor recovery of stable postpartum client Collect data for health history Collect baseline physical data (e.g., skin integrity, or height and weight) Recognize barriers to communication or learning Compare client development to norms Assist client with expected life transition (e.g., attachment to newborn, parenting or
retirement)
Provide care and resources for beginning of life and/or end of life issues and choices Identify and educate clients in need of immunizations (required and voluntary) Participate in health screening or health promotion programs Provide information for prevention of high risk behaviors
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Aging Process
Identify client knowledge on aging process and assist in reinforcing teaching on expected changes
related to aging Provide care that meets the special needs of the newborn less than 1 month old* Provide care that meets the special needs of infants or children aged 1 month to 12 years* Provide care that meets the special needs of adolescents aged 13 to 18 years* Provide care that meets the special needs of young adults aged 19 to 30 years* Provide care that meets the special needs of adults aged 31 to 64 years* Provide care that meets the special needs of clients aged 65 to 85 years of age* Provide care that meets the special needs of clients aged greater than 85 years of age*
Ante/Intra/Postpartum and Newborn Care

Identify client emotional preparedness for pregnancy (e.g., support systems, perception of
pregnancy) Assist in performing client non-stress test Assist with fetal heart monitoring for the antepartum client* Assist with monitoring a client in labor* Perform care of postpartum client (e.g., perineal care, assistance with infant feeding) Contribute to newborn plan of care Reinforce client teaching on infant care skills (e.g., feeding, bathing, positioning) Monitor recovery of stable postpartum client* Monitor client ability to care for infant
Data Collection Techniques

Collect data for health history* Collect baseline physical data (e.g., skin integrity, or height and weight)* Prepare client for physical examination (e.g., reinforce explanation of procedure, provide privacy
and comfort) Document findings according to agency/facility policies/procedures Report client physical examination results to health care provider
Developmental Stages and Transitions

Identify and report client deviations from expected growth and development Identify occurrence of expected body image changes Recognize barriers to communication or learning* Compare client development to norms* Assist client with expected life transition (e.g., attachment to newborn, parenting or retirement)* Assist client to select age-appropriate activities Modify approaches to care in accordance with client development stage Provide care and resources for beginning of life and/or end of life issues and choices* Determine client acceptance of expected body image change (e.g., aging, pregnancy, menopause) Determine impact of expected body image changes on client (e.g., temperament)
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Health Promotion/Disease Prevention

Identify risk factors for disease/illness (e.g., age, gender, ethnicity, lifestyle) Identify and educate clients in need of immunizations (required and voluntary)* Identify precautions and contraindications to immunizations Identify client health seeking behaviors (e.g., breast and testicular self-examinations) Gather data on client health history and risk for disease (e.g., lifestyle, family and genetic history) Check results of client health screening tests (e.g., Papanicolaou [Pap] test or smear, stool occult
blood test)
Provide assistance for screening examinations (e.g., scoliosis, breast and testicular
self-examinations, blood pressure check)

Participate in a health screening or health promotion programs* Assist client in disease prevention activities Monitor client actions to maintain health and prevent disease (e.g., smoking cessation, exercise,
diet, stress management)

Monitor incorporation of healthy behaviors into lifestyle by client (e.g., screening examinations,
immunizations, limiting risk taking behaviors)

Reinforce teaching with client about health risks and health promotion Recognize client unexpected response to immunizations
High Risk Behaviors

Assist client to identify high risk behaviors Provide information for prevention of high risk behaviors* Monitor client lifestyle practice risks that may impact health (e.g., excessive sun exposure, lack of
regular exercise)
Reinforce client teaching related to client high risk behavior (e.g., unprotected sexual relations,
needle sharing)
Lifestyle Choices
Identify client lifestyle practices that may have an impact on health Identify contraindications to chosen contraceptive method (e.g., smoking, compliance, medical
conditions)
Identify client attitudes/perceptions on sexuality Recognize client need/desire for contraception Recognize expected outcomes for client family planning methods Recognize client need to discuss sensitive issues related to sexuality Support client in family planning Respect client sexual identity and personal choices (e.g., sexual orientation) Respect client lifestyle choices (e.g., child-free, home schooling, rural or urban living) Reinforce teaching with client on healthy lifestyle choices (e.g., exercise regimen, smoking
cessation)
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Self Care
Determine client ability and support for performing self-care (e.g., feeding, dressing, hygiene) Consider client self care needs before contributing to changes in plan of care Monitor client ability to perform instrumental activities of daily living (e.g., using telephone,
shopping, preparing meals) Sample Item The nurse has reinforced teaching with a client about prevention of coronary artery disease (CAD). Which of the following statements by the client would indicate a correct understanding of the teaching? a. I should enroll in a smoking cessation program. (key) b. I will increase my daily intake of foods high in potassium. c. I will avoid performing isometric exercises more than 3 times per week. d. I can decrease my high density lipoprotein level (HDL) if I stop drinking alcohol.
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Psychosocial Integrity The LPN/VN provides care that assists with promotion and support of the
emotional, mental and social well-being of clients.
PSYCHOSOCIAL INTEGRITY Related Activity Statements from the Report of Findings from the 2009 LPN/VN Practice Analysis: Linking the NCLEX-PN Examination to Practice
Assist in or reinforce education to caregivers/family on ways to manage client with
behavioral disorders
Participate in behavior management program by recognizing environmental stressors and/
or providing a therapeutic environment

Participate in reminiscence therapy, validation therapy or reality orientation Participate in client group session Identify signs and symptoms of substance abuse/chemical dependency, withdrawal or
toxicity
Collect data regarding client psychosocial functioning Identify client use of effective and ineffective coping mechanisms Identify significant body or lifestyle changes and other stressors that may affect recovery/
health maintenance
Assist client to cope/adapt to stressful events and changes in health status (e.g., end of life,
grief and loss, life changes or physical changes)

Collect data on client potential for violence Assist in managing the care of angry/agitated client Make adjustment to care with consideration of client spiritual or cultural beliefs Explore why client is refusing or not following treatment plan Assist in the care of the cognitively impaired client Promote positive self-esteem of client Provide emotional support to client and family Use therapeutic communication techniques with client
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Abuse/Neglect
Identify client risk factors for abusing or neglecting others Identify signs and symptoms of physical, psychological or financial abuse in client (e.g., family
involvement, inadequate weight gain, poor hygiene)

Recognize risk factors for domestic, child and/or elder abuse/neglect and sexual abuse Provide safe environment for abused/neglected client Provide emotional support to client who experienced abuse or neglect Reinforce client teaching on coping strategies to prevent abuse or neglect Evaluate client response to interventions
Behavioral Management
Monitor client appearance, mood and psychomotor behavior and observe for changes Explore cause of client behavior Assist client with achieving self-control of behavior (e.g., contract, behavior modification) Assist client in using behavioral strategies to decrease anxiety Assist in or reinforce education of caregivers/family on ways to manage client with behavioral
disorders*
Participate in behavior management program by recognizing environmental stressors and/or
providing therapeutic environment*

Participate in reminiscence therapy, validation therapy or reality orientation* Participate in client group session* Reinforce client participation in therapy Use behavioral management techniques when caring for a client (e.g., positive reinforcement,
setting limits) Evaluate client response to behavioral management interventions
Chemical and Other Dependencies

Identify signs and symptoms of substance abuse/chemical dependency, withdrawal or toxicity* Plan and provide care to client experiencing substance-related withdrawal or toxicity (e.g., nicotine,
opioid, sedative) Provide care and support for client with impulse-control disorders (e.g., gambling, sexual addiction, pornography) Reinforce provided information on substance abuse diagnosis and treatment plan to client Encourage client participation in support groups (e.g., Alcoholics Anonymous, Narcotics Anonymous) Monitor client response to treatment plan and contribute to revision of plan as needed
Coping Mechanisms
Collect data regarding client psychosocial functioning* Identify client support systems and available resources Identify client use of effective and ineffective coping mechanisms*
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Identify significant body or lifestyle changes and other stressors that may affect recovery/health
maintenance*
Recognize abilities of client to adapt to temporary/permanent role changes Recognize client response to illness (e.g., rationalization, hopelessness, anger) Provide support to the client with unexpected altered body image (e.g., alopecia) Use therapeutic techniques to assist client with coping ability Assist client to cope/adapt to stressful events and changes in health status (e.g., end of life, grief
and loss, life changes or physical changes)*

Assist client in maintaining level of independence after unexpected body image changes
(e.g., amputation, paralysis)

Monitor client progress toward achieving improved body image (e.g., mastectomy, colostomy)
Crisis Intervention
Identify client in crisis Identify client risk for self injury and/or violence (e.g., suicide or violence precaution) Collect data on client potential for violence* Assist in managing the care of angry/agitated client* Use crisis intervention techniques to assist client in coping Provide opportunities for client to understand why the crisis occurred Guide client to resources for recovery from crisis (e.g., social supports) Reinforce client teaching on suicide/violence prevention Report changes in client behavior (indicating a developing crisis) to supervisor
Cultural Awareness
Identify importance of client culture/ethnicity when planning/providing/monitoring care Recognize client cultural practices that may affect interventions for procedures/surgery
(e.g., direct eye contact)

Recognize cultural issues that may impact client understanding/acceptance of psychiatric diagnosis Make adjustment to care with consideration of client spiritual or cultural beliefs* Respect cultural background/practices of client (does not include dietary preferences) Document how client language needs are met
End of Life Concepts

Identify client end of life needs (e.g., financial concerns, fear, loss of control, role changes) Identify client ability to cope with end of life interventions Provide care or support for client/family at end of life Assist client in resolution of end of life issues
Grief and Loss

Identify client reaction to loss (e.g., denial, fear) Support the client in anticipatory grieving Reinforce client teaching on expected client reactions to grief and loss (e.g., denial, fear) Provide client with resources to adjust to loss/bereavement (e.g., individual counseling,
support groups)
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Mental Health Concepts

Identify expected behaviors of client with independent or dependent personality Identify client symptoms of acute or chronic mental illness (e.g., schizophrenia, depression,
bipolar disorder)
Recognize client use of defense mechanisms Recognize change in client mental status Recognize client symptoms of relapse Explore why client is refusing or not following treatment plan* Assist in the care of the cognitively impaired client* Assist in promoting client independence Establish trusting nurse-client relationship Promote positive self-esteem of client*
Religious and Spiritual Influences on Health

Identify client emotional problems related to religious/spiritual beliefs (e.g., spiritual distress,
conflict between recommended treatment and beliefs)

Recognize effect of client religious/spiritual beliefs on plan of care Assist client to meet religious/spiritual needs (e.g., referral to pastoral care) Assist in evaluation of client religious/spiritual needs related to necessary nursing interventions Respect client religious/spiritual beliefs
Sensory/Perceptual Alterations
Identify needs of client with altered sensory perception (e.g., hallucinations, delirium) Verify client ability to effectively communicate needs
Stress Management
Identify actual/potential stressors for client (e.g., fear, lack of information) Implement measures to reduce environmental stressors (e.g., noise, temperature, pollution) Monitor client effective use of stress management techniques
Support Systems
Determine client abilities to provide client support Identify client support systems/resources Identify family response to client illness (e.g., acute episodes, chronic disorder, terminal illness)
Therapeutic Communication
Provide emotional support to client and family* Assist client in communicating needs to health care staff Develop and maintain therapeutic relationships with client Respect client personal values and beliefs Establish a trusting nurse-client relationship Use therapeutic communication techniques with client* Encourage client appropriate use of verbal and non-verbal communication Monitor effectiveness of communications with client
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Therapeutic Environment
Identify external factors that may interfere with client recovery (e.g., stressors, noise) Participate in community meetings Contribute to maintaining a safe and supportive environment for client Monitor client response to environmental factors
Sample Item The nurse is contributing to a staff education program about anorexia nervosa (AN). Which of the following information should the nurse recommend including? a. Clients with AN often perform poorly in school. b. There are several underlying physiologic causes for AN. c. The average age of onset for AN is 22 years old. d. Amenorrhea is a common symptom associated with AN. (key)
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Basic Care and Comfort
Basic Care and Comfort The LPN/VN provides comfort to clients and assistance in the perfor-
mance of their activities of daily living.
BASIC CARE AND COMFORT Related Activity Statements from the Report of Findings from the 2009 LPN/VN Practice Analysis: Linking the NCLEX-PN Examination to Practice
Use transfer assistive devices (e.g., t-belt, slide board or mechanical lift) Institute bowel or bladder management Discontinue or remove peripheral intravenous (IV) line, nasogastric (NG) tube or urinary
catheter
Perform an irrigation of urinary catheter, bladder, wound, ear, nose or eye Provide for mobility needs (e.g., ambulation, range of motion, transfer to chair,
repositioning or the use of adaptive equipment)

Use measures to maintain or improve client skin integrity Provide care to client in traction Apply or remove immobilizing equipment (e.g., a splint or brace) Assist in the care and comfort for a client with a visual and/or hearing impairment Use alternative/complementary therapy (e.g., acupressure, music therapy or herbal
therapy) in providing client care

Provide non-pharmacological measures for pain relief (e.g., imagery, massage or
repositioning)
Evaluate pain using a rating scale Provide feeding and/or care for client with enteral tubes Monitor and provide for nutritional needs of client (e.g., labs, calorie counts/percentages
or daily weight)
Monitor client intake/output Assist with activities of daily living Assist in providing postmortem care Provide measures to promote sleep/rest
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Assistive Devices
Identify appropriate use of assistive devices (e.g., cane, walker, crutches) Use transfer assistance device (e.g., t-belt, slide board, or mechanical lift)* Contribute to care of client using assistive device (e.g., feeding devices, telecommunication
devices, touch pad, communication board) Reinforce teaching for client using assistive device Review correct use of assistive devices of client and staff members
Elimination
Identify client at risk for impaired elimination (e.g., medication, hydration status) Institute bowel or bladder management* Monitor client bowel sounds Discontinue or remove peripheral intravenous (IV) line, nasogastric (NG) tube or urinary catheter* Perform an irrigation of urinary catheter, bladder, wound, ear, nose or eye* Provide skin care to client who is incontinent (e.g., wash frequently, barrier creams/ointments)
Mobility/Immobility
Identify signs and symptoms of venous insufficiency and intervene to promote venous return (e.g.,
elastic stockings, sequential compression device)

Check client for mobility, gait, strength, motor skills Provide for mobility needs (e.g., ambulation, range of motion, transfer to chair, repositioning, or the
use of adaptive equipment)* Reinforce client teaching on methods to maintain mobility (e.g., active/passive range of motion [ROM], strengthening, isometric exercises) Use measures to maintain or improve client skin integrity* Maintain client correct body alignment Provide care to client in traction* Apply or remove immobilizing equipment (e.g., splint or brace)*
Non-Pharmacological Comfort Interventions

Identify client need for palliative/comfort care Assist in the care and comfort for a client with a visual and/or hearing impairment* Assist in planning comfort interventions for client with impaired comfort Apply therapies for comfort and treatment of inflammation/swelling (e.g., apply heat and cold
treatments, elevate limb) Use an alternative/complementary therapy (e.g., acupressure, music therapy or herbal therapy) in providing client care* Provide non-pharmacological measures for pain relief (e.g., imagery, massage or repositioning)* Provide palliative/comfort care interventions to client Respect client palliative care choices Reinforce client teaching on stress management techniques (e.g., relaxation exercises, exercise, meditation)
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Reinforce client teaching on palliative/comfort care Monitor client non-verbal signs of pain/discomfort (e.g., grimacing, restlessness) Monitor client response to non-pharmacological interventions Monitor outcome of palliative care interventions Evaluate pain using rating scale*
Nutrition and Oral Hydration

Identify client potential for aspiration (e.g., feeding tube, sedation, swallowing difficulties) Check client feeding tube placement and patency Provide feeding and/or care for client with enteral tubes* Monitor and provide for nutritional needs of client (e.g., labs, calorie counts/percentages or daily
weight)*
Monitor client ability to eat (e.g., chew, swallow) Monitor impact of disease/illness on client nutritional status Monitor client intake/output* Reinforce client teaching on special diets based on client diagnosis/nutritional needs and cultural
considerations (e.g., high protein, kosher diet, calorie restriction) Promote client independence in eating
Personal Hygiene
Determine client usual personal hygiene habits/routine Assist with activities of daily living* Assist in providing postmortem care* Reinforce teaching to client on required adaptations for performing activities of daily living
(e.g., shower chair, hand rails)
Rest and Sleep

Identify client usual rest and sleep patterns (e.g., bedtime, sleep rituals) Provide measures to promote sleep/rest* Schedule client care activities to promote adequate rest and sleep
Sample Item The nurse is reinforcing teaching about mouth care for a client who has stomatitis. Which of the following statements by the client would indicate a correct understanding of the teaching? Select all that apply. a. I should apply lubricant to my lips frequently to keep my lips moist. (key) b. I will use a soft-bristle tooth brush to brush my teeth. (key) c. I should use an alcohol-based mouth wash twice daily. d. I will remove any white or yellow patches from my tongue. e. I should drink warm liquids every two hours to decrease my discomfort.
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Pharmacological Therapies
Pharmacological Therapies The LPN/VN provides care related to the administration of
medications and monitors clients who are receiving parenteral therapies.
PHARMACOLOGICAL THERAPIES Related Activity Statements from the Report of Findings from the 2009 LPN/VN Practice Analysis: Linking the NCLEX-PN Examination to Practice
Perform calculations needed for medication administration Reinforce education to client regarding medications Evaluate client response to medication Follow the rights of medication administration Maintain medication safety practices (e.g., storage, checking for expiration dates or
compatibility)
Reconcile and maintain medication list or medication administration record Administer medication by oral route Administer intravenous piggyback (secondary) medications Administer medication by gastrointestinal tube (e.g., g-tube, nasogastric (NG) tube,
g-button or j-tube)
Administer a subcutaneous (SQ), intradermal or intramuscular (IM) medication Administer medication by ear, eye, nose, rectum, vagina or skin route Count narcotics/controlled substances Regulate client intravenous (IV) rate Monitor transfusion of blood product Monitor and maintain client intravenous (IV) site and flow rate
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Adverse Effects/Contraindications/Side Effects/Interactions

Identify potential and actual incompatibilities of client medications Identify a contraindication to the administration of a prescribed or over-the-counter medication to
the client
Identify symptoms of an allergic reaction (e.g., to medication) Implement procedures to counteract adverse effects of medications Withhold medication dose if client experiences adverse effect to medication Monitor and document client response to actions taken to counteract adverse effects of
medications Monitor client for actual and potential adverse effects of medications (e.g., prescribed, over-the-counter and/or herbal supplements) Monitor anticipated interactions among client prescribed medications and fluids (e.g., oral, IV, subcutaneous, IM, topical) Monitor and document client side effects to medications Monitor and document client response to management of medication side effects including prescribed, over-the-counter and herbal supplements Reinforce client teaching on possible effects of medications (common side effects or adverse effects, when to notify primary health care provider) Notify primary health care provider of actual/potential adverse effects of client medications
Dosage Calculation
Perform calculations needed for medication administration* Use clinical decision making when calculating doses
Expected Actions/Outcomes
Identify client expected response to medication Use resources to check on purposes and actions of pharmacological agents Apply knowledge of pathophysiology when addressing client pharmacological agents Monitor client use of medications over time (e.g., prescription, over-the-counter, home remedies) Reinforce education to client regarding medications* Reinforce client teaching on actions and therapeutic effects of medications and pharmacological
interactions Evaluate client response to medication*
Medication Administration
Identify client need for PRN medications Mix client medication from two vials as necessary (e.g., insulin) Follow the rights of medication administration* Maintain medication safety practices (e.g., storage, checking for expiration dates or compatibility)* Reconcile and maintain medication list or medication administration record* Review pertinent data prior to medication administration (e.g., vital signs, lab results, allergies)
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Assist in preparing client for insertion of central line Administer medication by oral route* Administer intravenous piggyback (secondary) medications* Administer medication by gastrointestinal tube (e.g., g-tube, nasogastric [NG] tube, g-button
or j-tube)* Administer a subcutaneous (SQ), intradermal, or intramuscular (IM) medication* Administer a medication by ear, eye, nose, rectum, vagina or skin route* Dispose of client unused medications according to facility/agency policy Count narcotics/controlled substances* Regulate client intravenous (IV) rate* Monitor transfusion of blood product* Monitor client intravenous (IV) site and flow rate* Reinforce client teaching on client self administration of medications (e.g., insulin, subcutaneous insulin pump)
Pharmacological Pain Management

Identify client need for pain medication Monitor client non-verbal signs of pain/discomfort (e.g., grimacing, restlessness) Monitor and document client response to pharmacological interventions (e.g., pain rating scale,
verbal reports) Sample Item The nurse is caring for a client who has a prescription for acetaminophen (Tylenol) 650mg, p.o., every 6 hours, p.r.n. for pain. The nurse has Tylenol 325mg tablets available. How many tablets should the nurse administer with each dose? Record your answer using a whole number. 2 (key)
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Reduction of Risk Potential

Reduction of Risk Potential The LPN/VN reduces the potential for clients to develop complica-
tions or health problems related to treatments, procedures or existing conditions.
REDUCTION OF RISK POTENTIAL Related Activity Statements from the Report of Findings from the 2009 LPN/VN Practice Analysis: Linking the NCLEX-PN Examination to Practice
Check and monitor client vital signs Perform an electrocardiogram (EKG/ECG) Perform venipuncture for blood draws Collect specimen (e.g., urine, stool, gastric contents or sputum for diagnostic testing) Monitor diagnostic or laboratory test results Identify signs or symptoms of potential prenatal complication Perform neurological checks Perform circulatory checks Check for urinary retention (e.g., bladder scan, palpation) Administer and check proper use of compression stockings/sequential compression
devices (SCD)
Perform risk monitoring and provide follow up Monitor continuous or intermittent suction of nasogastric (NG) tube Implement measures to prevent complication of client condition or procedure
(e.g., circulatory complication, seizure, aspiration or potential neurological disorder)

Evaluate client respiratory status by measuring oxygen (O2) saturation Provide care for client before surgical procedure including teaching Insert urinary catheter Insert nasogastric (NG) tube Assist with the performance of a diagnostic or invasive procedure
Changes/Abnormalities in Vital Signs

Check and monitor client vital signs* Compare vital signs to client baseline vital signs Reinforce client teaching about normal and abnormal vital signs (e.g., hypertension, tachypnea,
bradycardia, fever)
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Diagnostic Tests
Perform an electrocardiogram (EKG/ECG)* Perform diagnostic testing (e.g., blood glucose, oxygen saturation, testing for occult blood) Reinforce client teaching about diagnostic test
Laboratory Values
Identify laboratory values for ABGs (pH, PO2, PCO2, SaO2, HCO3), BUN, cholesterol (total),
glucose, hematocrit, hemoglobin, glycosylated hemoglobin (HgbA1C), platelets, potassium, sodium, WBC, creatinine, PT, PTT & APTT, Compare client laboratory values to normal laboratory values Perform venipuncture for blood draws* Collect specimen (e.g., urine, stool, gastric contents or sputum for diagnostic testing)* Reinforce client teaching on purposes of laboratory tests Monitor diagnostic or laboratory test results* Notify primary health care provider about client laboratory test results
Potential for Alterations in Body Systems

Identify signs or symptoms of potential prenatal complication* Identify client with increased risk for insufficient blood circulation (e.g., immobilized limb, diabetes) Recognize change in client neurological status (level of consciousness, orientation, muscle strength) Compare current client clinical data to baseline information Perform neurological checks* Perform circulatory checks* Check for urinary retention (e.g., bladder scan, palpation)* Administer and check proper use of compression stockings/sequential compression devices (SCD)* Monitor client output for changes from baseline (e.g., nasogastric emesis, stool, urine) Reinforce client teaching on methods to prevent complications associated with activity
level/diagnosed illness/disease (e.g., foot care for client with diabetes mellitus)
Potential for Complications of Diagnostic Tests/Treatments/Procedures

Identify client response to diagnostic tests/treatments/procedures Maintain client tube patency (chest tube, tracheostomy tube) Provide care for client receiving electroconvulsive therapy (ECT) Provide appropriate follow-up after incident (e.g., fall, client elopement, or medication error) Perform risk monitoring and provide follow up* Monitor continuous or intermittent suction of nasogastric (NG) tube* Implement measures to prevent complication of client condition or procedure (e.g., circulatory
complication, seizure, aspiration or potential neurological disorder)* Reinforce teaching to prevent complications due to client diagnostic tests/treatments/procedures Notify primary health care provider if client has signs of potential complications (e.g., fever, hypotension, limb pain, thrombus formation) Evaluate client respiratory status by measuring oxygen (O2) saturation* Suggest change in interventions based on client response to diagnostic tests/treatments/ procedures
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Potential for Complications from Surgical Procedures and Health Alterations

Identify client response to surgery or health alterations Provide care for client before surgical procedure including teaching* Provide intra-operative care (e.g., positioning client for surgery, maintaining sterile field, or
providing operative observation) Reinforce teaching to prevent complications due to surgery or health alterations (e.g., cough and deep breathing, elastic stockings) Suggest change in interventions based on client response to surgery or health alterations
Therapeutic Procedures
Insert urinary catheter* Insert nasogastric (NG) tube* Assist with the performance of a diagnostic or invasive procedure * Reinforce client teaching on treatments and procedures
Sample Item The nurse is contributing to the plan of care for a client with heart failure. Which of the following interventions should the nurse recommend including in the clients plan of care? Select all that apply. a. obtaining the clients weight daily (key) b. encouraging the client to increase the daily fluid intake c. monitoring the clients serum potassium level (key) d. limiting the clients intake of fresh fruits and vegetables e. checking the client for peripheral edema (key)
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Physiological Adaptation
Physiological Adaptations The LPN/VN participates in providing care for clients with acute,
chronic or life-threatening physical health conditions.
PHYSIOLOGICAL ADAPTATION Related Activity Statements from the Report of Findings from the 2009 LPN/VN Practice Analysis: Linking the NCLEX-PN Examination to Practice
Identify/intervene to control signs of hypoglycemia or hyperglycemia Recognize and report basic abnormalities on a client cardiac monitor strip Provide care for client drainage device (e.g., wound drain or chest tube) Provide cooling/warming measures to restore normal temperature Provide care for a client with a tracheostomy Provide care to client with an ostomy (e.g., colostomy, ileostomy or urostomy) Provide care to client on ventilator Perform wound care and/or dressing change Perform check of client pacemaker Perform care for client after surgical procedure Remove wound sutures or staples Remove client wound drainage device Intervene to improve client respiratory status (e.g., breathing treatment, suctioning or
repositioning)
Reinforce education to client regarding care and condition Identify signs and symptoms related to an acute or chronic illness Respond to a client life-threatening situation (e.g., cardiopulmonary resuscitation ) Recognize complications of acute or chronic illness and intervene
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Alterations in Body Systems

Identify signs and symptoms of an infection (e.g., temperature changes, swelling, redness, mental
confusion or foul smelling urine) Identify/intervene to control signs of hypoglycemia or hyperglycemia* Recognize and report basic abnormalities on a client cardiac monitor strip* Provide care for client drainage device (e.g., wound drain or chest tube)* Provide cooling/warming measures to restore normal temperature* Provide care for a client with a tracheostomy* Provide care to a client with an ostomy (e.g., colostomy, ileostomy or urostomy)* Provide care to client on ventilator* Provide care to correct client alteration in body system Provide care to client undergoing peritoneal dialysis Provide care for client experiencing increased intracranial pressure Provide care to client who has experienced a seizure Provide care for client experiencing complications of pregnancy/labor and/or delivery (e.g., eclampsia, precipitous labor, hemorrhage) Perform wound care and/or dressing change* Perform check of client pacemaker* Perform care for client after surgical procedure* Remove wound sutures or staples* Remove client wound drainage device* Intervene to improve client respiratory status (e.g., breathing treatment, suctioning or repositioning)* Reinforce client teaching on ostomy care Reinforce education to client regarding care and condition* Notify primary health care provider of a change in client status Document client response to interventions for alteration in body systems (e.g., pacemaker, chest tube)
Basic Pathophysiology
Identify signs and symptoms related to an acute or chronic illness* Consider general principles of client disease process when providing care (e.g., injury and repair,
immunity, cellular structure)

Apply knowledge of pathophysiology to monitoring client for alterations in body systems
Fluid and Electrolyte Imbalances

Identify signs and symptoms of client fluid and/or electrolyte imbalances Provide interventions to restore client fluid and/or electrolyte balance Monitor client response to interventions to correct fluid and/or electrolyte imbalance
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Medical Emergencies
Respond to a client life-threatening situation (e.g., cardiopulmonary resuscitation)* Provide emergency care for wound disruption (e.g., evisceration, dehiscence) Notify primary health care provider about client unexpected response/emergency situation Recommend change in emergency treatment based upon client response to interventions Reinforce teaching of emergency intervention explanations to client Review and document client response to emergency interventions (e.g., restoration of
breathing, pulse)
Radiation Therapy
Provide interventions for client side effects to radiation therapy Monitor client for signs and symptoms of adverse effects of radiation therapy Reinforce client teaching for management of side/adverse effects of radiation therapy Document client response to radiation therapy (e.g., skin condition)
Unexpected Response to Therapies

Identify and treat a client intravenous (IV) line infiltration Recognize complications of acute or chronic illness and intervene* Intervene in response to client unexpected negative response to therapy (e.g., unexpected
bleeding) Document client unexpected response to therapy Promote recovery from client unexpected negative response to therapy (e.g., urinary tract infection) Sample Item The nurse is collecting data from a client who is reporting diarrhea for the past 72 hours. Which of the following findings would indicate the client is experiencing a fluid volume deficit? Select all that apply. a. orthostatic hypotension (key) b. excessive thirst (key) c. dry tongue (key) d. bradycardia e. increased urine output
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IV. Administration of the NCLEX-PN Examination
Examination Length
The NCLEX-PN Examination is a variable length adaptive test. It is not offered in paper-and-pencil or oral examination formats. The exam can range from 85 to 205 items long and of these items, 25 are pretest items that are not scored. The time limit for the exam is specified in the candidate bulletin. It is important to note that the time allotted for the examination includes the tutorial, sample items, all breaks (restroom, stretching, etc.) and the examination. All breaks are optional.
The length of the examination is determined by the candidates responses to the items. Once the minimum number of items are answered, testing stops when the candidates ability is determined to be either above or below the passing standard with 95 percent certainty. Depending upon the particular pattern of correct and incorrect responses, different candidates will take different numbers of items and therefore use varying amounts of time. The examination will stop when the maximum number of items has been taken or when the time limit has been reached. Remember, it is in the candidates best interest to maintain a reasonable pace of spending only one or two minutes on each item. The candidates should select a pace that will permit them to complete the examination within the allotted time should the maximum number of items be administered. It is important to understand that the length of an examination is not an indication of a pass or fail result. A candidate with a relatively short examination may pass or fail just as a candidate with a long examination may pass or fail. Regardless of the length of the examination, each candidate is given an examination that conforms to the NCLEX-PN Test Plan and offers ample opportunity to demonstrate his or her ability
The Passing Standard

The NCSBN Board of Directors (BOD) reevaluates the passing standard once every three years. The criterion that the BOD uses to set the standard is the minimum level of ability required for safe and effective entry-level nursing practice. To assist the BOD in making this decision, board members are provided with the following information: 1. 2. 3. 4. The results of a standard setting exercise performed by a panel of experts with the assistance of professional psychometricians; The historical record of the passing standard with summaries of the candidate performance associated with those standards; The results of a standard-setting survey sent to educators and employers; and Information describing the educational readiness of high school graduates who express an interest in nursing.
Once the passing standard is set, it is imposed uniformly on every test record according to the procedures laid out in the Scoring the NCLEX Examination section of this document. To pass an NCLEX examination, a candidate must perform above the passing standard. There is no fixed percentage of candidates that pass or fail each examination.
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Similar Items
Occasionally, a candidate may receive an item that seems to be very similar to an item received earlier in the examination. This could happen for a variety of reasons. For example, several items could be about similar symptoms, diseases or disorders, yet address different phases of the nursing process. Alternatively, a pretest (unscored) item could be about content similar to an operational (scored) item. It is incorrect to assume that a second item, which is similar in content to a previously administered item, is administered because the candidate answered the first item incorrectly. The candidate is instructed to always select the answer believed to be correct for each item administered. All examinations conform to their respective test plan.
Reviewing Answers and Guessing

The items are presented to the candidate one at a time on a computer screen. Each item can be viewed as long as the candidate likes, but it is not possible to go back to a previous item once the answer is selected and confirmed by pressing the <NEXT> button. Every item must be answered even if the candidate is not sure of the right answer. The computer will not allow the candidate to go on to the next item without answering the one on the screen. If the candidate is unsure of the correct answer, the best guess is made and the candidate moves on to the next item. After an answer to an item is selected, the candidate has an opportunity to think about the answer and change it if necessary. However, once the candidate confirms the answer and goes on to the next item, the candidate will not be allowed to go back to any previous item on the examination. Please note that rapid guessing can drastically lower the score. Some test preparation companies have realized that on certain paper and pencil tests, unanswered items are marked as wrong. To improve the candidates score when they are running out of time, these companies sometimes advocate rapid guessing (perhaps without even reading the item) in the hope that the candidate will get at least a few items correct. On any adaptive test, this can be disastrous. It has the effect of giving the candidate easier items which he or she will likely also get wrong. The best advice is to maintain a reasonable pace, perhaps one item every minute or two, and carefully read and consider each item before answering. It is better to run out of time than to engage in rapid guessing.
Scoring the NCLEX Examination
Computerized Adaptive Testing (CAT)

The NCLEX examination is different than a traditional paper and pencil examination. Typically, paper and pencil examinations administer the same items to every candidate, thus ensuring that the difficulty of the examination is the same across the board. Because the difficulty of the examination is constant, the percentage correct is the indicator of the candidates ability. One disadvantage of this approach is that it is inefficient. It requires the high ability candidates to answer all the easy items on the examination. Obviously asking high ability candidates easy items provides very little information about his or her ability. Another disadvantage is that guessing can artificially inflate the scores of low ability candidates. This happens because low ability candidates will be given some difficult items. In the case of multiple-choice items, candidates can answer these items correctly 25 percent of the time for reasons that have nothing to do with their ability because there are only four choices.
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Instead, the NCLEX examination uses computerized adaptive testing (CAT) to administer items. CAT is able to produce test results that are more stable using fewer items by targeting items to the candidates ability. Although everyones first item is relatively easy, subsequent items are better targeted. This is accomplished by re-estimating the candidates ability every time an item is answered. Using the candidates most current ability estimate, the computer searches the item bank for an item that has a degree of difficulty that is approximately equal to that ability estimate. As a result, the candidate should have a 50/50 chance of answering this item correctly. After the candidate answers this item, the computer reestimates the candidates ability and selects the next item using the same procedures. This process continues until it is clear (with 95 percent certainty) that the candidates ability is above or below the passing standard. Be aware that both those who pass and those who fail tend to answer approximately 50 percent of the items correctly. This is because the computer presents all candidates with items that are matched to his or her ability. The candidates ability estimate is based upon both the percentage that was answered correctly (approximately 50 percent in most cases) and the difficulty of the items that were administered. Imagine the items lined up, from easiest to most difficult. If we asked candidates the easiest items, they would answer most of them correctly. If we asked them the most difficult items, they would probably answer most of them incorrectly. Somewhere between those two extremes is a point at which each candidate goes from getting more answers right than wrong. This is the point at which each candidate answers 50 percent correctly. Items harder than that would probably be answered incorrectly; items easier than that would probably be answered correctly. CAT procedures permit that point to be found for each candidate without having to ask all the items in the extremes.
Pretest Items
For CAT to work, the difficulty of each item must be known in advance. The degree of difficulty is determined by administering the items as pretest items to a large sample of NCLEX candidates. Because the difficulty of these pretest items is not known in advance, these items are not included when estimating the candidates ability or making pass-fail decisions. When enough responses are collected, the pretest items are statistically analyzed and calibrated. If they meet the NCLEX statistical standards, they can be administered in future examinations as scored items. There are 25 pretest items on every NCLEX-PN Examination. It is impossible to distinguish operational items from pretest items, so candidates are asked to do their best on every item.
Additional Constraints
In addition to targeting items to the candidates ability, the computer implements two additional constraints. First, it prevents a candidate from receiving for a second time any item that he or she has seen within the last year (on a previous attempt). Second, it ensures that the items administered to the candidate meet the test plan specifications with regard to the proportion of items that must be drawn from the different test plan categories. Every test must meet the test plan specifications.
Passing and Failing

As mentioned earlier, to pass the NCLEX, the candidates performance on the examination must be above the passing standard. Ideally, NCSBN wants to be at least 95 percent certain of pass-fail decisions. Therefore after the minimum number of items has been answered, the computer will stop when it is 95 percent certain that the
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candidates ability is above or below the passing standard. If the ability is below the standard, the candidate fails. Candidates with very high or very low abilities tend to receive minimum length tests. However, some candidates will have a true ability that is so close to the passing standard that even 1,000 items would not be enough to arrive at a decision with 95 percent confidence. It would also be impractical to administer 1,000 items. Therefore, a maximum number of items has been established for each type of examination. When these candidates answer the maximum of items, their ability estimates are rather precise, but not enough to make a decision with 95 percent certainty. Because in these cases the precision is quite good, the 95 percent certainty requirement is waived. If a candidates ability estimate is above the passing standard, he or she passes; if it is at or below the passing standard, the candidate fails. If the examination ends because time runs out, it means that the candidate has not demonstrated with 95 percent certainty that he or she is clearly above or below the passing standard, nor has the candidate answered the maximum number of items. Because the primary mission of boards of nursing is to protect the public, it can be argued that candidates should not pass when they have not demonstrated that they are competent. However, the response patterns for some of these people have indicated that there are candidates who appeared to have a true ability that is above passing and who have been performing consistently above the passing standard. A mechanism is provided for these candidates to pass. The key word here is consistently. If a candidates performance has been consistently above the passing standard, then he or she will pass, despite having run out of time.
Scoring Items
The majority of items in the NCLEX examination are multiple-choice, but there are other formats as well. Items are scored as either right or wrong; there is no partial credit. Updated information on the administration of the examination is accessible on the NCLEX Examinations section of NCSBNs website.
Types of Items
During the administration of the NCLEX-PN Examination candidates will be required to respond to items in a variety of formats. These formats may include, but are not limited to multiple choice, multiple response, fill-inthe-blank calculation, drag and drop/ordered response, and/or hot spots. All item types may include multimedia, such as charts, tables, graphics, sound and video. For more information, please visit www.ncsbn.org to review information about alternate item formats.
NCLEX Examination Terminology
On the NCLEX examination, a prescription is defined as orders, interventions, remedies or treatments ordered or directed by an authorized health care provider. In addition, the term client refers to an individual, family or group. Clients are the same as residents or patients.
Confidentiality
Candidates should be aware and understand that the disclosure of any examination materials, including the nature or content of examination items, before, during or after the examination, is a violation of law. Violations of confidentiality and/or candidates rules can result in criminal prosecution of civil liability and/or disciplinary actions by the licensing agency, including the denial of licensure.
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Tutorial
Each NCLEX-PN candidate is provided information on how to answer examination items. A tutorial is given at the beginning of the examination explaining the various formats that candidates may see on the examination. More information on alternate item formats is available on the NCSBN website at www.ncsbn.org. The following are examples of how screens in the tutorial may appear. Examples of possible item formats include:
Multiple-Choice (one answer):
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Multiple-Response:
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Fill-in-the-Blank:
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Hot Spot:
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Exhibit:
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Drag and Drop/Ordered Response:
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Audio:
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Graphic:
To receive updated information, visit the NCSBN website at http://www.ncsbn.org.
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V.
Item Writing Exercises
The following written exercises are designed to provide nurse educators with hands-on experience in writing NCLEX style test questions. Please note, not all item types are provided in the Item Writing Exercises. Please refer to the NCSBN Website - Fast Facts About Alternative Item Formats and the NCLEX Examination at www.ncsbn.org for additional information on alternative item formats. NCSBN offers two online web courses in Assessment Strategies: Test Development and Item Writing and Assessment of Critical Thinking through NCSBN Learning Extenstion. Please utilize these Web-based courses as a means of supplementing knowledge of test writing principles and to encourage compliance with the NCLEX style of writing. The above-mentioned courses may be found at www.learningext.com.
Steps to Item Writing

A well designed multiple-choice item consists of three main components: a stem (asks a question or poses a statement which requires completion), key (the correct answers/s) and distractor(s) (incorrect option/s). The following section is designed to enhance the writers understanding of the NCLEX item writing process. Steps are provided below to assist in creating a well-designed item. Step 1. Step 2. Step 3. Step 4. Step 5. Step 6. Step 7. Step 8. Select an area of the test plan for the focus of the item. Select a subcategory from the chosen area of the test plan. Select an important concept within that subcategory. Use the selected concept and write the stem. Write a key to represent important information the entry-level nurse should know. Identify common errors, misconceptions or irrelevant information. Use the previous information and write the distractors. Complete the item using the stem, key and distractors.
Example Using the Above Steps

Here is an example of how to write an item using the above steps. 1. Select an area of the test plan for the focus of the item. *Safety and Infection Control 2. Select a subcategory from the chosen area of the test plan. *Standard Precautions/Transmission-Based Precautions/Surgical Asepsis
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3.
Select an important concept within that subcategory. *Evaluate infection control precautions implemented by staff members
4.
Use the selected concept and write the stem. *The nurse and nursing assistant are caring for a client with vancomycin-resistant enterococci (VRE). Which of the following activities by the nursing assistant would require immediate follow-up?
5.
Write a key to represent important information the entry-level nurse should know. *Contact Isolation: ~ Assisting the client to ambulate in the hallway
6.
Identify common errors, misconceptions or irrelevant information. *Lack of understanding of isolation precautions *Uncertainty related to specific diagnosis
7.
Use the previous information and write the distractors. * Leaving a blood pressure cuff in the clients room to be used by the client only *Putting on a protective gown to assist the client to sit in a chair *Taking the gloves off before leaving the clients room
8.
Complete the item using the stem, key and distractors. The nurse and nursing assistant are caring for a client with vancomycin-resistant enterococci (VRE). Which of the following actions performed by the nursing assistant would require immediate follow-up from the nurse? a. Leaving a blood pressure cuff in the clients room to be used by that client only b. Putting on a protective gown to assist the client to sit in a chair c. Taking the gloves off before leaving the clients room d. Assisting the client to ambulate in the hallway (key)
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Exercises
Case Scenarios: Using the steps listed above, create an item based on the following situations:
Coordinated Care
The charge nurse in a long term care facility is preparing client care task assignments for the on-coming shift. One of the staff members is a nursing assistant. Write an item that has one task that the nursing assistant could be assigned and three tasks that require a nurse.

A 76-year-old client is being discharged from the hospital to their adult childs home after a certain surgery. The nurse is reinforcing the discharge instructions with the client and the adult child. Write an item indicating that correct understanding of the instructions took place.

The nurse at a local health fair is conducting a cancer screening for a specific organ. Write a multiple response item (four to six options with more than one key) indicating risk factors for cancer of that organ.
A nurse on an inpatient psychiatric unit observes a client pacing the hallway, mumbling and occasionally yelling aloud Stop it! Write an item describing the action the nurse should take in this situation.

The charge nurse is observing a newly licensed nurse care for a client with continuous tube feedings. Write an item describing an action that, if observed, would require the charge nurse to intervene immediately.
The nurse is reinforcing discharge instructions for a client who is newly prescribed a certain medication. Write a multiple response item with foods or activities that this client should avoid while on this medication. The nurse is caring for a client with a certain prescription. Write an item that names the medication, the amount and timeframe that the client would receive the medication, the amount available, the clients weight in pounds and kilograms and how much of the medication the client should receive with each administration. The concept of the item should be that the candidate needs to perform a calculation in order to achieve the correct answer.
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The nurse is caring for a client who had a procedure three hours ago. Write an item that includes observations the nurse would see in this client and which data should the nurse respond to first.
The nurse is collecting data from a client with a suspected certain disease. Write a multiple choice item of expected findings associated with this diagnosis.
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VI. References
American Educational Research Association, American Psychological Association, National Council on Measurement in Education. (2000). Standards for educational and psychological testing. Washington, DC: American Educational Research Association. Anderson, L.W., & Krathwohl, D.R. (eds). (2001). A taxonomy for learning, teaching and assessing. A revision of Blooms taxonomy of educational objectives. New York: Addison Wesley Longman, Inc . Bloom, B.S., Engelhart, M.D., Furst, E.J., Hill, W.H., & Krathwohl, D.R. (1956) Taxonomy of educational objectives: The classification of educational goals. Handbook I. Cognitive Domain. New York: David McKay. Browning A., & Bugbee A. (2000). Certification: A national organization of competency assurance handbook. Washington D.C.: National Organization of Competency Assurance. National Association for Practical Nurse Educators and Service (NAPNES). (2007). Standards of practice and educational competencies of graduates of practical/vocational nursing programs. Silver Spring, MD: Author. National Council of State Boards of Nursing, Inc. (2005). Working with others: Delegation and other health care interfaces. Chicago: Author. National Council of State Boards of Nursing, Inc. (2006). Model nursing administrative rules. Chicago: Author. National Council of State Boards of Nursing, Inc. (2006). Model nursing practice act. Chicago: Author. National Council of State Boards of Nursing, Inc. (2010). NCSBN NCLEX examination candidate bulletin. Chicago: Author.
National Council of State Boards of Nursing. (2010). Report finding from the 2009 LPN/VN practice analysis: Linking the NCLEX-PN examination to practice. Chicago: Author.
National Federation of Licensed Practical Nurses, Inc. (NFLPN). (2003). Nursing practice standards for the licensed practical/vocational nurse. Raleigh, NC: Author.
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APPENDIX A
Case Scenario Answers/Examples
Coordinated Care
The charge nurse in a long-term care facility is planning client care task assignments. Which of the following tasks would be most appropriate to assign to a nursing assistant? a. placing a fan in the room of a client who was recently diagnosed with Graves disease (key) b. assessing a client with acute pancreatitis who is reporting greenish-yellow emesis and abdominal pain c. teaching a client who was recently diagnosed with diabetes mellitus (type 2, NIDDM) how to administer insulin d. providing discharge instructions to a client with Crohns disease who experienced diarrhea, weight loss, and steatorrhea

The nurse is reinforcing teaching with the adult child of a client who had a hip replacement and is being discharged to the adult childs home. Which of the following statements by the adult child would indicate a correct understanding of the teaching? a. I will assist my parent to perform full range of motion (ROM) exercises in both legs. b. I will assist my parent to get in and out of the bathtub. c. I will install raised toilet seats on every toilet in my home. (key) d. I will keep my parent on bed-rest for the first 5 days after discharge.
Health Maintenance and Promotion

The nurse is participating in a health screening at a local health fair. Which of the following should the nurse recognize as increasing the risk for developing testicular cancer? Select all that apply. a. vasectomy b. undescended testicles (key) c. exposure to the herpes simplex virus type 2 (HSV 2) d. family history of testicular cancer (key) e. multiple sexual partners
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The nurse is caring for a client who is mumbling, pacing in the hallway, and occasionally yelling Stop it! Which of the following actions should the nurse take? a. Remove other clients from the area. b. Escort the client back to the clients room. c. Request that the client be quiet and not disrupt others. d. Use distraction to re-focus the client to reality. (key)

The nurse is observing a co-worker who is caring for a client who has prescribed continuous enteral tube feedings. Which of the following actions by the co-worker would require the nurse to intervene? a. elevating the head of the clients bed to 35 degrees b. measuring and then re-administering the residual gastric content c. changing the tube feeding container and tubing every 8 hours (key) d. replacing the formula every 4 hours with fresh formula
The nurse is caring for a client who is receiving newly prescribed tranylcypromine (Parnate). Which of the following foods should the client avoid while receiving Parnate? Select all that apply. a. chocolate (key) b. apples c. avocados (key) d. milk e. red wine (key) f. salt-substitutes The nurse is caring for a 4-year-old client who has a prescription for acetaminophen (Tylenol) 15mg/kg, p.o., every 4 hours, p.r.n. The client weighs 38 lbs. The nurse has 120mg/5 ml of Tylenol available. How many milliliters should the nurse administer with each dose? Record your answer using one decimal place. a. 10.8 ml
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The nurse is caring for a client who had a cardiac catherization 3 hours ago. Which of the following findings would be essential for the nurse to follow-up? a. blood pressure increase from 103/68 to 110/70 over the past one hour b. blood urea nitrogen (BUN), 22 mg/dL (key) c. pulse, 101 d. decrease in respiratory rate from 18 to 16 over the past one hour
The nurse is assessing a client with suspected Addisons disease. Which of the following symptoms would be consistent with Addisons disease? Select all that apply. a. muscle weakness (key) b. hypertension c. decreased serum sodium level (key) d. fatigue (key) e. decreased serum potassium level f. anorexia (key)
National Council of State Boards of Nursing 111 E. Wacker Drive, Suite 2900 Chicago, IL 60601-4277 USA 312.525.3600 | www.ncsbn.org +1.312.525.3600 International Calls 866.293.9600 Testing Services Toll-Free 312.279.1036 Testing Services Fax

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NCLEX-PN DETAILED TEST PLAN

2011 NCLEX-PN Detailed Test Plan

Effective | April 2011

Item Writer/Item Reviewer/Nurse Educator Version

Item Writer/Item Reviewer/Nurse Educator Version

Effective Date April 2011

About the 2011 NCLEX-PN Test Plan (Section II)

About the 2011 NCLEX-PN Detailed Test Plan (Section III)

2011 NCLEX-PN Test Plan

Classification of Cognitive Levels

Test Plan Structure

Safe and Effective Care Environment

Health Promotion and Maintenance Psychosocial Integrity Physiological Integrity

cludes data collection, planning, implementation and evaluation.

moting a change in behavior.

Client Needs Safe and Effective Care Environment

Percentage of Items from Each Category/Subcategory

13-19% 11-17% 7-13% 7-13%

Heath Promotion and Maintenance Psychosocial Integrity Physiological Integrity

9-15% 11-17% 9-15% 9-15%

Distribution of Content for the NCLEX-PN Test Plan

Integrated Processes Clinical Problem-Solving Process (Nursing Process)

Health Promotion & Maintenance

Health Promotion & Maintenance 7-13%

Psychosocial Integrity 7-13%

Communication & Documentation

Teaching & Learning

Percentage of Items on NCLEX-PN Examination

Safe and Effective Care Environment

client care. Related content includes, but is not limited to:

Improvement) Referral Process Resource Management

Health Promotion and Maintenance

Effects/Interactions Dosage Calculations Expected Actions/Outcomes

Procedures and Health Alterations

III. 2011 NCLEX-PN Detailed Test Plan

Safe and Effective Care Environment

*Activity Statements used in the 2008 RN Practice Analysis

Related content includes, but is not limited to:

of Attorney for Health Care [DPAHC])

Client Care Assignments

Collaboration with Interdisciplinary Team

Concepts of Management and Supervision

*Activity Statements used in the 2009 PN Practice Analysis

treatment) Use effective time management skills

*Activity Statements used in the 2009 PN Practice Analysis

communicable disease)* Document client care

Performance Improvement (Quality Improvement)

personnel (e.g., nurse manager, risk manager)

Safety and Infection Control

personnel from health and environmental hazards.

Related content includes, but is not limited to:

or injury (e.g., confusion, altered thought processes, diagnosis)

*Activity Statements used in the 2009 PN Practice Analysis

Emergency Response Plan

Handling Hazardous and Infectious Materials

handrails, kitchen safety)

Reporting of Incident/Event/Irregular Occurrence/Variance

(e.g., medication administration error, client fall)

Restraints and Safety Devices

*Activity Statements used in the 2009 PN Practice Analysis