Running head: TEST CREATION

Test Creation
NCLEX Questions
Sarah Scobie
SUNY Delhi
NURS 603 CRN 11373, Measurement and Evaluation in Nursing
Kirsty Digger
November 1, 2016

TEST CREATION

2
Test Creation

Test Questions

Blooms Taxonomy & NCLEX Category

A nurse is caring for a client with anemia and an order is

received for a transfusion of two units of packed red
blood cells. Distinguish all of the key assessments the
nurse performs prior to picking up the initial unit of
packed red blood cells:
1) Consent for blood administration signed by client.
2) Consent for blood administration signed by the
physician.
3) Nurse explains the procedure to the client for
consent.
4) Type and crossmatch is completed.
5) Client identified and verified by two licensed
nurses.
6) The physician explains the procedure to the client
for consent.
7) Intravenous access obtained/ integrity assessment.
8) Assessment of vital signs per facility specific
policy.

The student will compare and

contrast the key assessments that
apply before the blood unit is
obtained. In regards to Blooms
taxonomy, this question promotes
analysis and categorization of the
assessments performed before and
after the unit of blood is obtained
(Huitt, 2011). This question fits
within analysis because the student
is required to distinguish the
assessments to be completed before
obtaining the blood product.
Delineation of which assessments
occur prior to obtaining the blood
product and which are important at
the bedside occurs within this
question. The NCLEX category
includes physiological integrity:
Pharmacological and parenteral
therapies. Subcategories include
blood and blood products and
informed consent.

An order is received for Ancef 1gram to be administered

via peripherally inserted central catheter (PICC) line.
Drag and drop the appropriate supplies required for the
nurse to safely administer this medication onto the PICC
picture.

The student will apply knowledge of

safe PICC line and antibiotic
administration. The drag and drop
promotes critical thinking and
application of appropriate pictures
in which the medication would be
administered. Another
consideration would be for the drag
and drop pictures to be applied in
priority order. This question fits
within Blooms taxonomy in level of
application (Huitt, 2011). The
NCLEX category includes

TEST CREATION

3
physiological integrity:
Pharmacological and parenteral
therapies. The sub categories
include central venous access
devices, medication administration
safety, and includes monitoring for
allergic/adverse reaction. Safety
and infection control is a
consideration for this question as
inclusion of the alcohol to clean the
PICC tip should be included.

10ML Normal Saline

Yes

Heparin 10
units/mL
Yes

TEST CREATION

No

Yes

3mL Saline Syringe

No

Yes

TEST CREATION

Yes

No

Yes

TEST CREATION

Identify the infection control concern contained within

this picture. (Answer both hands should be gloved).
The emergency department nurse is caring for a client
who has been identified as a victim of physical abuse. In
planning care for the client, which is the priority nursing
action?
(a) Adhering to the mandatory abuse-reporting laws.
(b) Notifying the case worker of the family situation.
(c) Removing the client from any immediate danger.
(d) Obtaining treatment for the abusing family
member.
(Silvestri, 2014).
A nurse is teaching a group of healthy adults about the
benefits of flu immunizations. Which purpose of patient
education is the nurse fulfilling?
a. Restoration of health.
b. Coping with impaired functions.
c. Promotion of health and illness prevention.
d. Health analogies.
(Quizlet, 2016).

A 68-year-old woman is diagnosed with

thrombocytopenia due to acute lymphocytic leukemia.
She is admitted to the hospital for treatment. The nurse
should assign the patient:
(a) to a private room so she will not infect other patients
and health care workers.

6
This hot spot picture fits within
NCLEX safe and effective care
environment with sub-category of
safety and infection control. This
picture identification encourages
complete the task based on
knowledge of infection control
principles. This question would fit
within application as the student will
solve the inappropriate infection
control principle within the picture
(Huitt, 2011).
This question fits within NCLEX
section of psychosocial integrity
under abuse/neglect subcategories.
This question encourages the
student to contrast the correct
answers with the priority answer.
When the student compares the
answers to determine the priority,
this question fits within analysis of
Blooms taxonomy (Huitt, 2011).
This question fits within the
NCLEX category of health
promotion and maintenance. The
sub-category included health
promotion and disease prevention.
The level of Blooms taxonomy
includes application of knowledge
of vaccination in health promotion.
The student must solve which
purpose the nurse is fulfilling with
this education session.
This question fits within NCLEX
category of safe and effective care
environment. Subcategories include
assignment, delegation, and ethical
practice. This question promotes
application within Blooms
taxonomy with incorporation of

TEST CREATION

(b) to a private room so she will not be infected by other

patients and health care workers.
(c) to a semiprivate room so she will have stimulation
during her hospitalization.
(d) to a semiprivate room so she will have the opportunity
to express concerns regarding her illness.
Kaplan (2016)

7
direction. The nurse is required to
advocate for this client to have a
private room.

This question requires evaluation by

The nurse cares for a client diagnosed with a right-sided
the student to distinguish which
cerebrovascular accident (CVA) with dysphagia. Which of interventions are appropriate for this
the following actions by the nurse reflects appropriate
client. The student will apply the
care for the client?
knowledge of this disease process
Select all that apply.
through this select all question. This
[ ] The nurse assesses the clients ability to swallow.
question compares and contrast
[ ] The nurse positions the client at a 45-degree angle.
which fits within analysis of
[ ] The nurse offers the client scrambled eggs.
Blooms taxonomy. The NCLEX
[ ] The nurse instructs the client to place food on the left
category includes physiological
side of the mouth
integrity: Subcategories include
[ ] The nurse turns off the television.
physiological adaptations and
(Kaplan, 2016).
alterations in body systems.
An 18-year-old woman comes to the physician's office for This question includes that NCLEX
a routine prenatal checkup at 34 weeks gestation.
category health promotion and
Abdominal palpation reveals the fetal position as right
maintenance. The subcategory
occipital anterior (ROA). At which of the following sites
includes techniques of physical
would the nurse expect to find the fetal heart tone?
assessment. This question fits within
(a) Below the umbilicus, on the mother's left side
Blooms taxonomy of application as
(b) Below the umbilicus, on the mother's right side
the student is required to apply
(c) Above the umbilicus, on the mother's left side
knowledge of anatomy and consider
(d) Above the umbilicus, on the mother's right side
the weeks of gestation.
(Kaplan, 2016)
The nurse teaches a group of mothers of toddlers how to
This question fits within safe and
prevent accidental poisoning. Which of the following
effective care of the NCLEX
suggestions should the nurse give regarding medications? category. Subcategories include
(a) Lock all medications in a cabinet.
accident prevention and home
(b) Child proof all the caps to medication bottles.
safety. The level of Blooms
(c) Store medications on the highest shelf in a
taxonomy included comprehension
cupboard.
of the home safety principles
(d) Place medications in different containers.
discussed within this question.
(Kaplan, 2016).
A 65-year-old patient with pneumonia is receiving
This question fits within NCLEX

TEST CREATION

garamycin (Gentamicin). It would be MOST important

for the nurse to monitor which one of the following
laboratory values in this patient?
(a) Hemoglobin and hematocrit.
(b) BUN and creatine.
(c) Platelet count and clotting time.
(d) Sodium and potassium.

category physiological integrity.

The subcategories include
laboratory values and system
specific assessments. Blooms
taxonomy level analyzing which
laboratory value would be important
and knowledge of how this
medication is excreted. This
question fits within analysis.

Rationale for Answers

A nurse is caring for a client with anemia and
an order is received for a transfusion of two
units of packed red blood cells. Distinguish all
of the key assessments the nurse performs
prior to picking up the initial unit of packed
red blood cells:
1) Consent for blood administration
signed by client.
2) Consent for blood administration
signed by the physician.
3) Nurse explains the procedure to the
client for consent.
4) Type and crossmatch is completed.
5) Client identified and verified by two
licensed nurses.
6) The physician explains the procedure to
the client for consent.
7) Intravenous access obtained/ integrity
assessment.
8) Assessment of vital signs per facility
specific policy.

The correct answer to the question includes: 1,

2, 4, 6, 7. The consent for blood administration
must be reviewed with the client by the
physician and the consent must be signed by
the provider and the client prior to the nurse
picking up the initial unit of blood. This
supports the rationale for answers 1, 2, 6. Prior
to administration of packed red blood cells a
type and crossmatch must be verified and
completed prior to blood administration:
Rationale for answer 4. Assessment of existing
and/or establishment of intravenous access
needs to be obtained prior to obtaining the
blood to avoid delay in transfusion
administration: provides rationale for 7 being a
correct answer. Question 3 is incorrect due to
the provider is required to discuss transfusion
consent with the client. Question 5 and 8 are
correct in providing a transfusion however this
step should be completed after the blood unit
has been obtained.

An order is received for Ancef 1gram to be

administered via peripherally inserted central
catheter (PICC) line. Drag and drop the
appropriate supplies required for the nurse to
safely administer this medication onto the

The correct answers include gathering the

supplies including the (a) Ancef 1gram, (b) 12
mL normal saline syringes, (c) alcohol wipes,
(d) assessment of allergies. Completion of the
five rights at the bedside prior to administration

TEST CREATION
PICC picture.

Identify the priority infection control concern

contained within this picture.
The emergency department nurse is caring for
a client who has been identified as a victim of
physical abuse. In planning care for the client,
which is the priority nursing action?
(a) Adhering to the mandatory abusereporting laws.
(b) Notifying the case worker of the family
situation.

9
would be included as a safe patient practice.
The student must determine the appropriate
dose in this question as two doses are provided
within the drag and drop. Officer (2014)
identifies that maintaining patency of PICC
lines includes saline to assess catheter patency,
administration of medication, saline to flush
medication out of catheter, and heparin lock to
maintain patency between medications
(SASH). Always use a 10 cc syringe or large
barrel syringe for flushing as has a lower
pressure rating as a smaller has greater
pressures and may rupture the catheter
(Officer, 2014, p. 6). Iodine swabs and the
500mg dose are incorrect answers. The iodine
wipes do not have evidence to support the use
to cleanse PICC hubs therefore this is an
incorrect answer. The 500mg Cefazolin is not
the ordered dose and therefore an incorrect
answer.
This hot spot question encourages the student
to critically think about what infection control
principles are not followed. The National
Center for Biotechnology Information (NCBI)
(2010) identifies that the best practice in
phlebotomy requires that gloves are worn on
both hands. Encourages student to reflect on
knowledge of best practices. Another
identified concern within this picture is the lack
of the phlebotomist securing the needle hub
however, the priority is the second hand not
having a glove present.
This level of analysis for Blooms taxonomy
discuss planning for this client with the priority
intervention. In this question d could be easily
eliminated as the social worker could complete
a referral for the abuser, but would not be a
nursing priority. Notification of the social
worker is a correct answer but not the initial
priority. Adhering to the mandatory abuse

TEST CREATION

10

(c) Removing the client from any

immediate danger.
(d) Obtaining treatment for the abusing
family member.
(Silvestri, 2014).

reporting laws is also important but not the

priority. The removal of the client from any
danger is the top priority in this scenario
because the client and staff need to be safe
from potential abuser. Silvestri (2014)
provides further support in that evaluating the
answers in Maslows provides that safety of the
client is top priority here.
A 65-year-old patient with pneumonia is
In administration of gentamicin nephrotoxicity
receiving garamycin (Gentamicin). It would be is a potential adverse reaction of this
MOST important for the nurse to monitor
medication (Medscape, 2011). Monitoring of
which one of the following laboratory values in the BUN/CRTN would be the most important
this patient?
laboratory value to monitor. Magnesium and
(a) Hemoglobin and hematocrit.
calcium are important considerations.
(b) BUN and creatine.
Hemoglobin and hematocrit, platelet count, and
(c) Platelet count and clotting time.
sodium and potassium are not laboratory
(d) Sodium and potassium.
values that are directly affected by gentamicin.
(Kaplan, 2016)

References

TEST CREATION

11

Dolan, S. A., Arias, K. M., Felizardo, G., Barnes, S., Kraska, S., Patrick, M., & Bumsted, A.
(2016). APIC position paper: Safe injection, infusion, and medication vial practices in
health care. American Journal of Infection Control,2, 33-40. Retrieved from
http://patientsafetyauthority.org
Huitt, W. (2011). Blooms et al.s taxonomy of the cognitive domain. Educational Psychology
Interactive. Retrieved from www.edpsycinteractive.org
Kaplan. (2016). NCLEX free practice questions. Retrieved from http://kaplanquizzes.com
Medscape. (2011). New insights into the mechanism of aminoglycoside nephrotoxicity. Retrieved
from http://www.medscape.com
Officer, C. O. (2014). Care and removal of peripherally inserted central catheters (PICC) for
adults. Covenant Health, 1-25. Retrieved from http://extcontent.covenanthealth.ca
Silvestri, L. A. (2014). Saunders comprehensive review for the NCLEX-RN examination (6th
ed.). St. Louis, Missouri: Elsevier Saunders.
Quizlet. (2016). NCLEX practice questions chapter 25: Patient education. Retrieved from
www.quizlet.com