IntellistemWriter - Write Standards Aligned Nursing Exams Faster!

With many questions already developed and validated, having a process to align next generation questions to nationally recognized standards would be helpful. You may be questioning, “How should I approach writing NCLEX questions in the next generation format?”

In her recently published white paper called White Paper: Higher-Cognitive Level Test Questions: A Starting Point for Creating Next Generation NCLEX® (NGN) Test Items*, Linda Silvestri outlines some unique steps to follow that will help change current questions to next generation questions. Silvestri has developed a test blueprint that aligns the current question to new content in the Clinical Judgment Model. She suggests that you align current questions to the model and then see if they need to be modified.

It is important to remember to align each question regardless of format style: traditional multiple-choice, select all that apply or next generation format questions. These standards include cognitive levels, NCLEX-RN categories, accreditation standards such as ACEN or CCNE as well as NLN end of program competencies, and the nursing process.

Step 1:
Align Your Question to a Clinical Judgment Measurement Model Component

Begin by taking a question that has been validated and determine the standards to which it is aligned. New next generation questions should be aligned to one of the “Clinical Judgment Measurement Model” components: recognize cues, analyze cues, prioritizing hypotheses, generate solutions, take action or evaluate outcomes. Each question is usually associated with a scenario or case study. The student reads the scenario/case study that contains nurses’ notes, the client’s vital signs, lab results, demographics, history, special equipment that the client has, time considerations and client observations (both normal and abnormal findings). After reading the scenario, the question the student answers address a component in the case study/scenario. Students must analyze cues, prioritize hypotheses, generate solutions to problems or situations, take appropriate actions, or evaluate outcomes of actions to find the answer to the question.

Step 2:
Rewrite in One of the New Formats

With a question in mind, rewrite it in one of the new formats such as enhanced hot spot or highlighting an area of a case study or client story, enhanced select all that apply, enhanced drag and drop, cloze, and matrix or grids.

Step 3:
Align Your New Question to Test Blueprint Standards

Now that the question is rewritten, align the question to the standards. Each question should be aligned to each of the standards in the school’s test blueprint. Do this by selecting keywords in the question that match one of the standards in the test blueprint. An example of this includes taking action that will promote safety and align that to the NCLEX Category “Safe Use of Equipment.” The cognitive level is determined by identifying the action verb in the question. For example, taking vital signs is usually an application cognitive level question.

The alignment of each question assists in matching each question to the school’s test blueprint and proves the question and thus the exam is measuring the concepts presented in class, lab, and clinical. These standards also assist in meeting accreditation requirements by showing the standards are being measured each time an exam is being given. To expand on alignment and question development, read the full text of Ms. Silvestri’s White Paper.

*Adapted from Linda Silvestri’s Test Blueprint in Action Model. Silvestri, L. A. (2019) White Paper: Higher-Cognitive Level Test Questions: A Starting Point for Creating Next Generation NCLEX® (NGN) Test items. Elsevier Inc.