In late 2017, The NCSBN made three changes to their frequently asked questions (FAQs) site on the “What the exam looks like” section.

  1. What information do you have about the Special Research Section?
  2. Does the NCLEX bold key words in items?
  3. What is an alternate item format?

Special Research Section

The special research section requires about thirty minutes from the testing candidate and becomes available after the regular exam is complete. Because test items must have statistical data (reliability and validity stats) before being used on the NCLEX, research items are necessary.

In this way, each question is tested for flaws, updated as needed, and evaluated for placement on the exam. The special section does not affect your score on the NCLEX and does not reduce your time to finish the test.

Bold key words

Originally, the NCSBN simply stated that, yes, key words will be bold. Now they have updated this statement to reflect that words that might be bold include:  best, most, essential, first, priority, immediately, highest, initial, next, refute, increased, decreased, and support. Though this should help, it remains important that you read each question with great attention to what is being asked. 

The newer negative item types such as “Which client statement indicates to the nurse that further teaching is required?” will continue to trip up anyone not reading carefully. Even if you miss it the first time, if it seems like three of the answers are “right”, it may be that you have misread the question. Slow down and look again.

SATA

Ah. The dreaded SATA question, AKA the multiple response item. One of the alternate item format questions that is most used on nursing school exams and perhaps on the NCLEX. Striking dread and fear into the hearts and minds of nursing students everywhere. Once upon a time, the NCSBN reassured nursing candidates that at least two answers would be correct and nursing educators were reassured that at least one answer should be wrong. Though this reassuring “fact” is no longer true, the way to approach a select-all-that-apply test question does not change!

“Multiple response items may require a candidate to select a single correct response, have more than one correct response, or require all responses to be correct regardless of the number of possible responses.” – NCSBN 2017

NCLEX Mastery reflects this change, and will continue to add similar items in the future.

Nursing graduates report that the National Council Licensure Examination (NCLEX) is full of these item types (20-50% by some tester’s memories!) Why on earth would the National Council of State Boards of Nursing choose to put future nurses through this torture? The answer is pretty straightforward: It is a sure way to ensure that the nurse’s thinking is complex enough to be competent and safe.

Select every choice that applies to that question.

Treat every choice as though it is true or false.

Example 1: 

A client with a recent cerebrovascular accident (CVA) is on a dysphagia diet. What does the nurse do to ensure client safety while eating?

  • True– Monitor the client while eating.
  • False- Feed the client.
  • True– Place the head of bed at 90 degrees.
  • True– Check for pocketing of food.
  • False- Offer thinned liquids.

Example 2: 

A client with a recent cerebrovascular accident (CVA) is on a dysphagia diet. What does the nurse do to ensure client safety while eating?

  • False- Have family assist the client while eating.
  • False- Place the head of bed in semi-Fowlers.
  • False- Feed the client.
  • False- Offer thinned liquids.
  • True–  Offer thickened liquids.

 Example 3: 

 

A client with a recent cerebrovascular accident (CVA) is on a dysphagia diet. What does the nurse do to ensure client safety while eating?

  • True– Ensure speech pathologist consult.
  • True– Monitor the client while eating.
  • True– Place the head of bed at 90 degrees.
  • True– Check for pocketing of food.
  • True– Offer thickened liquids.

Rationales to the above questions, if you like!

Example 1: 

A client with a recent cerebrovascular accident (CVA) is on a dysphagia diet. What does the nurse do to ensure client safety while eating?

Monitor the client while eating.True, the nurse doesn’t have to assist or watch the entire meal, but should watch the first few bites and sips and then check in often to assess for difficulties.

A client with a recent cerebrovascular accident (CVA) is on a dysphagia diet. What does the nurse do to ensure client safety while eating?

Feed the client. False, having a CVA or dysphagia doesn’t necessarily mean the nurse has to feed the client. If monitoring indicates feeding is required then the nurse ensures that the client is fed, whether that is by the nurse, speech and language pathologist, or the nursing assistive personnel. A CVA can have various effects and different levels of impairment.

A client with a recent cerebrovascular accident (CVA) is on a dysphagia diet. What does the nurse do to ensure client safety while eating?

Place the head of bed at 90 degrees. True, unless contraindicated for some other reason, the client should sit as straight up as possible while eating. This would not be a good long term position for a client with a brain injury of any kind, but sitting the client up while eating helps the altered swallowing process, opening the esophagus more than the trachea.

A client with a recent cerebrovascular accident (CVA) is on a dysphagia diet. What does the nurse do to ensure client safety while eating?

Check for pocketing of food. True, clients with a recent CVA may not completely remember how to swallow and may be holding food in their cheeks or toward the back of the mouth. This is a safety hazard that can lead to aspirating the food.

A client with a recent cerebrovascular accident (CVA) is on a dysphagia diet. What does the nurse do to ensure client safety while eating?

Offer thinned liquids. False, the client with a recent CVA should have thickened liquids until cleared by the speech and language pathologist. Thick liquids are easier for the swallowing muscles to manage.

Example 2: 

A client with a recent cerebrovascular accident (CVA) is on a dysphagia diet. What does the nurse do to ensure client safety while eating?

Have family assist the client while eating. False, family members are not skilled in determining if a client is having silent difficulties with swallowing or in feeding at a correct pace. Teaching and observation would be required first.

A client with a recent cerebrovascular accident (CVA) is on a dysphagia diet. What does the nurse do to ensure client safety while eating?

Place the head of bed in semi-Fowlers. False, semi-Fowler’s is less than 45 degrees and is not a good position for anyone to eat well. Standard Fowler’s may be acceptable depending on other clinical factors. 

A client with a recent cerebrovascular accident (CVA) is on a dysphagia diet. What does the nurse do to ensure client safety while eating?

Feed the client. False, having a CVA or dysphagia doesn’t necessarily mean the nurse has to feed the client. If monitoring indicates feeding is required then the nurse ensures that the client is fed, whether that is by the nurse, speech and language pathologist, or the nursing assistive personnel. A CVA can have various effects and different levels of impairment. 

A client with a recent cerebrovascular accident (CVA) is on a dysphagia diet. What does the nurse do to ensure client safety while eating?

Offer thinned liquids. False, the client with a recent CVA should have thickened liquids until cleared by the speech and language pathologist. Thick liquids are easier for the swallowing muscles to manage.

A client with a recent cerebrovascular accident (CVA) is on a dysphagia diet. What does the nurse do to ensure client safety while eating?

Offer thickened liquids. True, Thick liquids are easier for the swallowing muscles to manage.

Example 3: 

A client with a recent cerebrovascular accident (CVA) is on a dysphagia diet. What does the nurse do to ensure client safety while eating?

Ensure speech pathologist consult. True, many stroke protocols will dictate that the speech and language pathologist evaluates the client first and recommends the diet. If the client is prescribed any kind of diet, the nurse will at least want to ensure that speech therapy is on board with the client’s case.

A client with a recent cerebrovascular accident (CVA) is on a dysphagia diet. What does the nurse do to ensure client safety while eating?

Monitor the client while eating. True, the nurse doesn’t have to assist or watch the entire meal, but should watch the first few bites and sips and then check in often to assess for difficulties.

A client with a recent cerebrovascular accident (CVA) is on a dysphagia diet. What does the nurse do to ensure client safety while eating?

Place the head of bed at 90 degrees. True, unless contraindicated for some other reason, the client should sit as straight up as possible while eating. This would not be a good long term position for a client with a brain injury of any kind, but sitting the client up while eating helps the altered swallowing process, opening the esophagus more than the trachea.

A client with a recent cerebrovascular accident (CVA) is on a dysphagia diet. What does the nurse do to ensure client safety while eating?

Check for pocketing of food. True, clients with a recent CVA may not completely remember how to swallow and may be holding food in their cheeks or toward the back of the mouth. This is a safety hazard that can lead to aspirating the food.

A client with a recent cerebrovascular accident (CVA) is on a dysphagia diet. What does the nurse do to ensure client safety while eating?

Offer thickened liquids. True, Thick liquids are easier for the swallowing muscles to manage.

 

Study On!

 

Posted by Catherine MSN RN

Catherine is a nursing subject matter expert at Higher Learning Technologies, the developers of awesome Mastery products. Catherine worked in oncology, pulmonary, progressive care, intensive care, med-surg, step-down, and hospice. Catherine taught/teaches clinical, classroom, and simulation. Spare time fillers include craft festivals, camping, and raising 5 boys in TN. #BoyMomma #ICanStudyAnywhere #IsItMayYet #NursesRock <<Never be afraid to do something new. Remember amateurs built the ark; professionals built the Titanic. - Anonymous<<

18 Comments

  1. Cidoline Mbanwi January 12, 2018 at 9:14 pm

    Thanks very much I appreciate the update literature and also sample questions on my Nclex mastery app as I prepare for my exams.

    Reply

    1. Catherine MSN RN January 17, 2018 at 6:31 pm

      You are so welcome!Study on!

      Reply

  2. Have the changes already been made to NCLEX?

    Reply

    1. Catherine MSN RN January 18, 2018 at 9:21 pm

      Yes, Stephanie. The changes went into effect in December.

      Reply

  3. I feel so defeated passed rn nursing scho of april 2013 faile rn nclex 9 times came near passing on everything 5 times im feeling like really giving up. Im currently an lpn. I have kaplan, ati and have been studying with rn mastery, im just not understanding what im doing wrong……

    Reply

    1. Catherine MSN RN January 18, 2018 at 9:25 pm

      Neika, it is perfectly natural to feel defeated after 4 years of effort! Have you considered taking an RN refresher course? This might help clarify some concepts that you are missing. These courses usually meet once weekly over a period of weeks and review, in class, advanced nursing concepts. We wish you the best of luck. Reach out to us at nursing@hltcorp.com if we can assist further!

      Reply

  4. You can’t imagine how much that helps to know. I’ve struggled in passing my test and those “select-all that apply” really are stressful. I really don’t understand the point of the torture..
    Thank you again!

    Reply

    1. Catherine MSN RN January 18, 2018 at 9:26 pm

      You are most welcome, Renee. Good luck!!!

      Reply

  5. Khristine calica January 19, 2018 at 6:28 pm

    I will have my 1st lpn exam this coming March.thanks for the update

    Reply

    1. Catherine MSN RN January 19, 2018 at 7:58 pm

      You are welcome, Khristine!

      Reply

  6. Thank you very much for the update

    Reply

    1. Catherine MSN RN January 29, 2018 at 4:59 pm

      You are so welcome! Thank you for following us!

      Reply

  7. I appreciate for update… thanks a lot

    Reply

    1. Catherine MSN RN February 8, 2018 at 2:12 am

      You are so welcome, Harpreet!

      Reply

  8. I do want to say thanks for this update.

    Reply

    1. Catherine MSN RN February 20, 2018 at 7:12 pm

      Thank you, Angela. We are glad you found it useful!

      Reply

  9. Can you please point me to a NCSBN document which published the change to SATA questions? Thanks.

    Reply

    1. Catherine MSN RN April 19, 2018 at 3:02 pm

      Sure! Glad to help. Here is the link – https://www.ncsbn.org/9010.htm Look under “What the exam looks like” > “What is an alternate item format? > Multiple response items paragraph.

      Reply

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