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Writing Case-Based Next-Gen NCLEX Questions

By September 15, 2021June 2nd, 2023No Comments

Are you looking for a pragmatic approach to prepare your students for the Next Generation NCLEX (NGN)? 

The National Council of the State Boards of Nursing (NCSBN) will launch the Next Generation NCLEX (NGN) in April 2023 to better measure candidates’ clinical judgment ability, a proven necessity for entry-level nurses. The essence of NGN is evaluating clinical judgment using case-based scenarios and 6 questions that represent the NCSBN evaluation model of clinical judgment, in alignment with Tanner’s Model of Clinical Judgment.

You can create your own case-based scenarios and clinical reasoning questions to help your students develop clinical judgment, preparing them for both practice and NGN.

Students learn best when learning from salient, case studies which communicate a story, similar to what they will experience in practice. When writing scenarios for tests, it’s important to keep that story concise — a short paragraph of 2 to 4 sentences.

First, identify the primary objective and learning outcomes of your course to guide the emphasis of the scenario you will use for the evaluation.

Then write a case study with the following essential components:

  • Name, age, and race of the patient
  • Relevant past medical history and medications
  • The practice setting it’s taking place in
  • Recent or current symptoms
  • Current vital signs or diagnostic results
  • Psychosocial history (mental health addresses all aspects of patient care)
  • Include both relevant and irrelevant data in your scenario

Simultaneous problems are often present in patients in practice and your scenarios and questions should reflect that complexity that your students will face as graduates. Here is an example of a scenario that I wrote with a patient who presents to the ED with heart failure exacerbation:

JoAnn Smith is a 72-year-old woman who has a history of myocardial infarction (MI) four years ago and systolic heart failure secondary to ischemic cardiomyopathy with a current ejection fraction (EF) of only 15%. 

She presents to the emergency department (ED) for shortness of breath (SOB) the past three days. Her shortness of breath has progressed from SOB with activity to becoming SOB at rest. 

The last two nights she had to sleep in her recliner chair to rest comfortably upright. She is able to speak only in partial sentences and then has to take a breath when talking to the nurse. 

She has noted increased swelling in her lower legs and has gained six pounds in the last three days.

Test Item Formats

Your goal as an educator is to teach and develop the clinical reasoning processes and competencies to successfully reason through a practice-based case scenario.

Instead of trying to replicate the complex multiple select matrix type multiple choice that the NGN will use, the essence of each alternative item format is really the dreaded “select all that apply” that students hate because it requires them to discriminate and not just choose one answer.

Ask the right questions

Use the six steps of the NCSBN Action Model that align with Tanner’s Clinical Judgment Model to ask the following questions after developing the case based scenario that align with each step:

  1. (NGN-Recognize Cues) What data does the nurse need to notice that is clinically significant? Select all that apply.
  2. (NGN-Analyze Cues) Interpreting relevant clinical data in this scenario, what three problems are possible? Select all that apply.
  3. (NGN-Prioritize Hypotheses) Interpreting relevant clinical data in this scenario, which problem is most likely? (Single multiple choice)
  4. (NGN-Generate Solutions) Based on the most likely problem that was identified in the last question, what interventions are appropriate for the nurse to implement? Select all that apply.
  5. (NGN-Take Action) Based on the current problem, which orders would be anticipated by the nurse? Select all that apply.
  6. (NGN Evaluate Outcomes) After implementing the plan of care, what findings indicate the client’s condition is worsening (or improving)? Select all that apply.

Once you have the case-based scenario completed, use the six questions to develop your select all that apply by having 6 to 9 selections with plausible distractors for each item. Be aware that you will need to write a concise evaluation scenario after question five where you can simply include a set of vital signs and two or three assessment findings and decide whether you want the patient to improve or worsen and for students to select all that apply with plausible distractors.

In Closing

To be empowered to develop clinical judgment in your students, check out the Faculty Guide to Develop Clinical Judgment. You’ll learn educational best practices and practical strategies to effectively develop clinical judgment in the class, clinical, simulation, and virtual settings. 

Watch the video to learn more about writing case-based Next Gen NCLEX questions:

Keith Rischer – Ph.D., RN, CCRN, CEN

As a nurse with over 35 years of experience who remained in practice as an educator, I’ve witnessed the gap between how nursing is taught and how it is practiced, and I decided to do something about it! Read more…

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