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Heard about the new NCLEX?

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Abstract

Here's what the buzz is about on alternative-item questions.

RECENTLY, THE NATIONAL COUNCIL of State Boards of Nursing (NCSBN) added three types of alternative-item questions to the licensing exam it administers. Here are some examples of the new types of questions in the National Council Licensure Examination for Registered Nurses (NCLEX-RN) and the National Council Licensure Examination for Practical/Vocational Nurses (NCLEX-PN).

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1. Multiple-response multiple-choice questions

These questions may have more than one correct answer and may contain more than four possible answer options. You'll be asked to select all the answers that apply, not just the best answer.

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Sample question (and answer with rationale)

While preparing a client for an upper GI endoscopy (esophagogastroduodenoscopy), the nurse should implement which of the following interventions? Select all that apply:

□ A. Administer a preparation to clean the GI tract, such as Golytely or Fleet Phospho-Soda.

□ B. Tell the client he shouldn't eat or drink for 6 to 12 hours before the procedure.

□ C. Tell the client he must be on a clear liquid diet for 24 hours before the procedure.

□ D. Inform the client that he'll receive a sedative before the procedure.

□ E. Tell the client that he may eat and drink immediately after the procedure.

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Answer

B, D

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Rationale

The client shouldn't eat or drink for 6 to 12 hours before the procedure to ensure that his upper GI tract is clear for viewing. The client will receive a sedative before the endoscope is inserted that will help him relax, but allow him to remain conscious. A GI tract cleansing and a clear liquid diet are interventions for a client having a lower GI tract procedure, such as a colonoscopy. Food and fluids must be withheld until the gag reflex returns.

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2. Fill-in-the-blank questions

These questions require you to provide the answer yourself, rather than select it from a list of options. On the computerized test, you'll type your answer in the blank space provided after the question. Keep in mind that you may need to type in a very specific response for it to be considered correct, so be sure to read the question carefully.

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Sample question (and answer with rationale)

A client is admitted with a diagnosis of diabetic ketoacidosis. An insulin drip is initiated with 50 units of insulin in 100 ml of normal saline solution. The I.V. solution is being infused via an infusion pump and the pump is currently set at 10 ml/hour. The nurse determines that the client is receiving how many units of insulin each hour?

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Answer

5 units of insulin

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Rationale

To determine the number of insulin units the client is receiving per hour, the nurse must first determine the number of units in each milliliter of fluid (50 unit/100 ml = 0.5 unit/ml). Next, she multiplies the units/ml by the rate of ml/hour (0.5 units × 10 ml/hour = 5 units).

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3. Illustrated/graphic questions

In these questions, you'll be asked to identify an area on a picture or graphic. On the computerized exam, you'll place your cursor over the correct area on an illustration.

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Sample question (and answer with rationale)

A client with severe aortic stenosis is scheduled for valve replacement. While teaching the client about his condition and upcoming surgery, the nurse shows him a heart illustration (upper right). Identify the valve that the nurse should indicate will be replaced.

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Answer
Figure. No caption a...
Image Tools

(See illustration at lower right.)

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Rationale

The aortic valve is located between the left ventricle and the aorta. It's one of the semilunar valves and normally has three cusps. A person with a bicuspid aortic valve is at risk for both aortic stenosis and aortic regurgitation.

The NCSBN hasn't yet determined how many of the new format questions each candidate may face, and most of the questions will be in the traditional format.

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Prioritizing or sequencing questions

After the book this excerpt came from went to press, a fourth new type of question was adopted. Called prioritizing or sequencing, it asks you to put the steps of a process in correct order.

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Sample question (and answer with rationale)

When teaching an antepartal client about the passage of the fetus through the birth canal during labor, the nurse describes the cardinal mechanisms of labor. Place these events into the proper sequence in which they occur.

1. Flexion

2. External rotation

3. Descent

4. Expulsion

5. Internal rotation

6. Extension

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Answer

315624

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Rationale

As the fetus moves through the birth canal, it goes through position changes to ensure that the smallest diameter of the fetal head always presents to the smallest diameter of the birth canal. Termed the cardinal mechanisms of labor, these position changes occur in the following sequence: descent, flexion, internal rotation, extension, external rotation, and finally expulsion.

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Source

NCLEX-RN 250 New-Format Questions: Preparing for the Revised NCLEX-RN, Lippincott Williams & Wilkins, 2004.

© 2004 Lippincott Williams & Wilkins, Inc.

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