Running head: OBJECTIVE TESTS: DESIGNS AND CONSIDERATIONS 1

Assignment 1: Objective Tests: Design and Considerations

Marjorie Reilly

SUNY Delhi

NURS 603, CRN 11373, Measurement and Evaluation in Nursing Education

Kirsty Digger

November 6, 2016
OBJECTIVE TESTS: DESIGNS AND CONSIDERATIONS 2

Assignment 1: Objective Tests: Design and Considerations: Cardiovascular Problems

The content area that will be highlighted for this assignment is cardiovascular problems. This is a

content area that is covered in nursing pre-licensure programs. In addition, this is a content area I

am responsible for covering in my work at Columbia Greene Community College. Thus, I was

interested in looking at this area for this assignment in order to investigate objective test design

and considerations for this content area.

OBJECTIVE TESTS: DESIGNS AND CONSIDERATIONS 3

Cardiovascular Problems: NCLEX Style Questions

The correct answer(s) for each of the following questions will be bolded.

Question 1

NCLEX Category: Safe and Effective Care Environment

Sub-category: Safe Use of Equipment

The nurse is preparing to initiate an intravenous line containing a high dose of potassium
chloride for a patient who has critically low serum potassium with ECG changes. The nurse
plans to use an intravenous infusion pump. The nurse brings the pump to the bedside, prepares to
plug the pump cord into the wall, and notes that there is no receptacle available in the wall
socket. The nurse should take which action?

a. Initiate the intravenous infusion without the pump

b. Contact the electrical maintenance department for assistance
c. Plug in the pump cord in the available plug above the room sink
d. Use an extension cord from the nurses lounge for the pump plug

Answer Rationales

Correct:
b. The nurse should know and use hospital resources for assistance.
Incorrect:
a. Potassium chloride is a high alert medication, and should be administered using a pump for
medication safety.
c. Use of electrical appliances near water/sink presents a hazard.
d. A regular extension should not be use because it poses a risk for fire.

(Silvestri, 2014)

Blooms Taxonomy Cognitive Level: Application

This question requires the cognitive level of application because it requires the use of knowledge
in a new situation in which concepts have to be applied in order to respond correctly (Oermann
& Gaberson, 2014). In this case the student must know that potassium is a high-alert medication
that must be on a pump, needs to be aware of resources available in the hospital setting, must
understand that using electrical appliances near water is a hazard, and must also know that
extension cords pose a risk for fire in order to maintain patient safety in this situation.
OBJECTIVE TESTS: DESIGNS AND CONSIDERATIONS 4

Question 2

NCLEX Category: Psychosocial Integrity

Sub-category: Cultural Awareness/Cultural influences

A Chinese American client with a new diagnosis of congestive heart failure is being provided
discharge instructions regarding disease management (diet, medications, daily weights, etc.).
During the teaching session, the client continuously turns away from the nurse. The nurse should
implement which best action?

a. Continue with the instructions, verifying client understanding

b. Walk around the client so the nurse constantly faces the client
c. Give the client an instruction booklet on CHF management and return later to continue
with instructions
d. Tell the client the importance of instructions for the maintenance of health

Answer Rationales

Correct:
a. It is common for Chinese Americans to maintain a formal distance with other people as a form
of respect. Many Chinese Americans are also uncomfortable with face-to-face communication
and direct eye contact. The best course of action is to continue the teaching and verify client
understanding.
Incorrect:
b. Walking around the client conflicts with this cultural practice, and lacks cultural awareness.
c. The client may consider it rude if the nurse returns later to complete the teaching.
d. Telling the client about the importance of the instructions may be seen as patronizing or
degrading.

(Silvestri, 2014)

Blooms Taxonomy Cognitive Level: Application

This question requires the cognitive level of application because it requires the use of knowledge
in a new situation in which concepts have to be applied in order to respond correctly (Oermann
& Gaberson, 2014). Answering this question correctly requires the student to have knowledge of
the cultural considerations of some Chinese Americans, identify that these observed behaviors
are consistent with these cultural considerations, and to then plan the proper course of action
accordingly.
OBJECTIVE TESTS: DESIGNS AND CONSIDERATIONS 5

Question 3

NCLEX Category: Safe and Effective Care Environment

Sub-category: Continuity of Care

The nurse in preparing to discharge a patient home after a new diagnosis of congestive heart
failure (CHF). The client will be managed in outpatient setting by a Tele-Health CHF program.
The coordination of health care services for patients when they move from one health care
setting to another is called:

a. Continuity of care
b. Discharge planning
c. Consultation
d. Integrated health care system

Answer Rationales

Correct:
a. Continuity of care ensures uninterrupted care when patient moves from one health care setting
to another.
Incorrect:
b. Discharge planning is a type of continuity of care in which comprehensive planning is done
before a patient leaves a health care facility.
c. Consultation is a way to obtain information about a patient.
d. An integrated health system is a community-based framework that helps to facilitate care
across various health settings.

(Monahan, 2008)

Blooms Taxonomy Cognitive Level: Knowledge

This question merely asks that the student is familiar with the definition of continuity of care
which is a recall/memorization question. Although the question includes information regarding
the type of care the patient will receive upon discharge, the root of the question only requires that
the student have the knowledge cognitive level of understanding by knowing the definition of a
phrase.
OBJECTIVE TESTS: DESIGNS AND CONSIDERATIONS 6

Question 4

NCLEX Category: Psychosocial Integrity

Sub-category: Cultural Awareness/Cultural influences

In order to ensure safety and culturally competent care in a patient who will be receiving
Warfarin (Coumadin) therapy for a new diagnosis of atrial fibrillation, the nurse must assess the
clients health care practices. Which factors should be included in the nurses assessment? (Select
all that apply.)

a. Health-seeking behaviors
b. Responsibility for health care
c. Folklore practices
d. Barriers to health care

Answer Rationales

Correct:
All of the answers are correct in this question. Warfarin (Coumadin) is a high-alert medication
that requires that the nurse assess the patients health-seeking behaviors which are an individuals
actions to promote wellness, recovery and rehabilitation (Monahan, 2008). The patient will have
to be assessed for level of responsibility of health care, as regular laboratory draws and medical
care is warranted with Warfarin (Coumadin) therapy. It is also important to assess the existence
of any folklore or cultural practices that may impact the safety of therapy (herbal therapies, food,
beverages, etc.). Finally, any barriers to health care such as the lack of transportation to required
blood draws to monitor INR, inability to manage such things as medication therapy or dietary
restrictions must be identified.

(Monahan, 2008)

Blooms Taxonomy Cognitive Level: Analysis

This question requires the cognitive level of analysis because it requires the student to break
down information into components (risks of Warfarin therapy, patients self-care or cultural
practices), and identify relationships between them in order to identify possible areas of risk and
plan for them (Oermann & Gaberson, 2014). This question asks the student to identify all of the
areas that must be assessed, and distinguish between significant and insignificant information in
order to ensure patient safety in light of cultural and other issues affecting health behaviors.
OBJECTIVE TESTS: DESIGNS AND CONSIDERATIONS 7

Question 5

NCLEX Category: Psychosocial Integrity

Sub-category: Crisis Intervention

The patriarch and primary breadwinner of a family has recently experienced a life-altering
myocardial infarction. In the period after this event while the patient is receiving home nursing
care, the client and family cannot function normally and require interventions to regain
equilibrium. In crisis situations, the nurse should facilitate referrals to which health care
professionals? (Select all that apply.)

a. A psychiatrist
b. A psychiatric nurse specialist
c. A hospital emergency department
d. A crisis center

Answer Rationales

Correct:
All of the answers are correct in this question. In a crisis situation such as that being experienced
by this client and family as evidenced by their inability to function normally, it is appropriate for
the nurse to help to facilitate referrals to psychiatrists, psychiatric nurse specialists, hospital
emergency departments, and crisis centers in order to help ensure the well-being of both client
and family.

(Monahan, 2008)

Blooms Taxonomy Cognitive Level: Analysis

This question requires the cognitive level of analysis because it requires the student to analyze
information in order to identify relationships between them, and to determine what should be the
most immediate course of action (Oermann & Gaberson, 2014). In this case, the student will
have to have knowledge of psychosocial considerations in order to identify issues within this
family system. The student will also have to have an understanding of various resources in the
community that would be appropriate in determining the best approach and course of action for
this family.
OBJECTIVE TESTS: DESIGNS AND CONSIDERATIONS 8

Question 6

NCLEX Category: Health Promotion and Maintenance

Sub-category: Health Promotion/Disease Prevention

The nurse realizes that more teaching is needed when the client on a cardiac low-cholesterol diet
makes which choice from the menu?

a. Stewed chicken, green beans and noodles

b. Liver and onions, salad with ranch dressing, and milk
c. Ham and bean soup, salad with vinaigrette dressing, and cornbread
d. Pork roast, brown rice, and beets

Answer Rationales

Correct:
b. Liver is an organ meat which the client should avoid because it is high in cholesterol.
Incorrect:
a., c., d. All of the other meal choices are appropriate for a cardiac, low-cholesterol diet. The
choices are relatively low in saturated fat, and include such heart healthy items as lean protein,
whole grains, vegetables and beans.

(Monahan, 2008)

Blooms Taxonomy Cognitive Level: Application

This question requires the cognitive level of application because it requires the use of knowledge
in a new situation in which concepts have to be applied in order to respond correctly (Oermann
& Gaberson, 2014). Answering this question correctly requires the student to have knowledge of
foods appropriate for a cardiac low-cholesterol diet, and to draw a conclusion about a patients
level of understanding accordingly in light of this knowledge.
OBJECTIVE TESTS: DESIGNS AND CONSIDERATIONS 9

Question 7

NCLEX Category: Health Promotion and Maintenance

Sub-category: Health Promotion/Disease Prevention/High Risk Behaviors

The nurse is educating a patient about risk factors for myocardial infarction (MI). Which of the
following are risk factors for myocardial infarction? (Select all that apply.)

a. Hypothyroidism
b. Cigarette smoking
c. Hyperlipidemia
d. Rheumatic fever
e. High density lipids (HDL)<40 mg
f. Using oral contraceptives

Answer Rationales

Correct:
b. Cigarette smoking increases blood pressure and inflammation, and lowers HDL which are all
risk factors for MI.
c. Hyperlipidemia causes increased risk for MI due to increased risk for atherosclerosis.
e. HDL levels greater than 40 mg are thought to lower the risk for heart disease.
f. Oral contraceptives increase the risk for thromboembolic events which can cause MI.
Incorrect:
a. Hypothyroidism is not a risk factor for MI.
d. Rheumatic fever is a risk factor for valve disease, rather than a risk factor for MI.

(Monahan, 2008)

Blooms Taxonomy Cognitive Level: Application

This question requires the cognitive level of application because it requires the use of knowledge
in a new situation asking the students to apply concepts in order to respond (Oermann &
Gaberson, 2014). In this question the student must have familiarity with the implications of a
variety of disease processes, lab values, lifestyle choices, medications and pathophysiologic
concerns in order to properly relate these items to the identification of myocardial infarction risk
factors.
OBJECTIVE TESTS: DESIGNS AND CONSIDERATIONS 10

Question 8

NCLEX Category: Physiological Integrity

Sub-category: Physiological Adaptation

The nurse in a medical unit is caring for a client with heart failure. The client suddenly develops
extreme dyspnea, tachycardia, and lung crackles, and the nurse suspects pulmonary edema. The
nurse immediately asks another nurse to contact the health care provider and prepares to
implement which priority interventions? (Select all that apply.)

a. Administering oxygen
b. Inserting an indwelling catheter
c. Administering furosemide (Lasix)
d. Administering morphine sulfate intravenously
e. Transporting the client to the coronary care unit
f. Placing the client in a low-Fowlers side-lying position

Answer Rationales

Correct:
a. Oxygen is always prescribed in pulmonary in order to increase oxygen concentration.
b. Indwelling catheters are inserted in order to measure output accurately. This is especially
important in a patient who will be treated with furosemide.
c. Furosemide is a rapidly acting diuretic which will help to eliminate excess fluid.
d. Morphine sulfate reduces preload, decreases anxiety, and helps to reduce the work associated
with breathing.
Incorrect:
e. Transporting the client to a coronary care unit is not a priority intervention, and may not be
necessary if the client responds well to treatment.
f. The patient is placed in high-Fowlers position in order to ease the work of breathing.

(Silvestri, 2014)

Blooms Taxonomy Cognitive Level: Analysis

This question requires the cognitive level of analysis because it requires the student to break
down information into components in order to identify relationships between them (Oermann &
Gaberson, 2014). In so doing the student is required to problem solve, make decisions, and
prioritize care in order to ensure the best approach for patient needs in this particular clinical
situation.
OBJECTIVE TESTS: DESIGNS AND CONSIDERATIONS 11

Question 9

NCLEX Category: Physiological Integrity

Sub-category: Physiological Adaptation
Blooms Taxonomy Cognitive Level: Application

Which of the following assessment findings are consistent with a diagnosis of venous stasis?
(Select all that apply.)

a. Absent or diminished peripheral pulses

b. Hair loss on the extremity
c. Moist ulcers around the malleolus
d. Edema of the extremity
e. Coolness of the extremity
f. Leathery quality of the extremity
g. Pallor of the extremity

Answer Rationales

Correct:
c., d., f. Moist ulcers around the malleolus, leathery skin on an extremity, and edema of an
extremity are all signs consistent with venous stasis
Incorrect:
a., b., e., g. Absent or diminished peripheral pulses, hair loss on an extremity, and extremity
coolness and pallor are all signs of arterial insufficiency and not venous stasis.

(Monahan, 2008)

Blooms Taxonomy Cognitive Level: Application

This question requires the cognitive level of application because it requires the use of knowledge
in a new situation asking the students to apply concepts in order to respond (Oermann &
Gaberson, 2014). In this question the student must have familiarity with the both the
pathophysiology and signs of venous stasis and arterial insufficiency in order to correctly
determine the patients diagnosis.
OBJECTIVE TESTS: DESIGNS AND CONSIDERATIONS 12

Question 10

NCLEX Category: Physiological Integrity

Sub-category: Physiological Adaptation

A client is admitted to the emergency department with new-onset atrial fibrillation with a
ventricular response of 110/min. The nurse would anticipate which of the following treatment
options to be ordered? (Select all that apply.)

a. Defibrillation
b. Start oxygen at 2-4 liters per minute
c. Anticoagulant therapy
d. Medicate with beta blocker
e. Start lidocaine drip

Answer Rationales

Correct:
b. Oxygen therapy helps increase the availability of oxygen to lungs and (ultimately) tissues
which may be impaired by a cardiac arrhythmia such as atrial fibrillation.
c. Anticoagulant therapy helps to prevent thromboembolic events caused by the formation of
blood clots in the atria in atrial fibrillation.
d. Beta blockers are often used to control the rapid heart rate of patients with atrial fibrillation.
Incorrect:
a. Elective cardioversion may be used to convert patients rhythm back to sinus rhythm in atrial
fibrillation. Defibrillation is not used to restore a normal heart rhythm in patients with atrial
fibrillation.
e. Lidocaine is a medication that is used to treat ventricular, rather than atrial arrhythmias.

(Monahan, 2008)

Blooms Taxonomy Cognitive Level: Analysis

This question requires the cognitive level of analysis because it requires the student to analyze
information in order to identify relationships between them, and to determine what should be the
most immediate course of information (Oermann & Gaberson, 2014). In so doing the student is
required to problem solve, make decisions, and anticipate and prioritize required care in order to
ensure the best approach the patient with new-onset atrial fibrillation and rapid ventricular rate.
OBJECTIVE TESTS: DESIGNS AND CONSIDERATIONS 13

References

Monahan, F. (2008). Review for the NCLEX-RN Examination. New York, NY: McGraw-Hill.

Oermann, M. & Gaberson, K. (2014). Evaluation and testing in nursing education (4th ed.). New

York, NY: Springer.

Silvestri, L. (2014). NCLEX-RN Examination (6th ed.). St Louis, MO: Elsevier-Saunders.