ITEM DEVELOPMENT GUIDE CONTENTS

Item Writing Guide. . . . . . . . . . . . . . . . . . 2- 3 ABCGN Writing Style . . . . . . . . . . . . . . . . . .3 Item Stem Samples I . . . . . . . . . . . . . . . . .4-6 Item Stem Samples II . .. . . . . . . . . . . . . 7-10 Question Sample Suggestions. . . . . . . . . .11 Cognitive Codes . . . . . . . . . . . . . . . . . . 12-15 Selected Pharmacological Agents. . . . 16-18 Selected Acronyms. . . . . . . . . . . . . . . . . . . 19

1

Item Writing Guidelines

Basic Rules: 

Use an important concept, such as a common clinical issue or question



Items should involve situations commonly occurring in the gastroenterology setting



Focus on the importance of the item: what does the examinee need to know



The examinee should be able to answer the question without looking at the options. The stem should pose a clear question.



Avoid trivial, tricky, or unnecessarily complex items.



Write options that are homogenous, with all options falling into the same category, such as diagnoses, treatments, associated conditions.



All options should be viable or plausible, grammatically consistent, and approximately the same length.



Do not write items that ask “Which of the following are true?” or Each of the following is true EXCEPT.



Avoid all negative wording



Avoid absolute terms such as always, never, none, all or only.



Avoid “all of the above”, or “none of the above”.



Avoid nonspecific terms such as may, might, can, could, commonly, frequently, usually, sometimes, rarely. By adding the word MOST (eg. most likely diagnosis) helps to focus and clarify the item.



Do not repeat words or phrases in the stem and options.



Avoid test items created from general concepts taking directly from textbooks. EXAMPLE of recall/memory item taken directly from textbook.

Original: (poor) Which of the following is a sign of hypocalcemia? a. leg cramps b. nausea c. bradycardia d. renal failure 2

KEY

Revised: (better) The nurse assesses a patient admitted with acute pancreatitis whose chief complaints are numbness and tingling of the extremities and leg cramps. Which of the following would be the best intervention to assist the patient? (S&F 1259) a. magnesium replacement b. intravenous calcium DISTRACTORS c. antibiotic therapy d. albumin administration 

Do not use gender, ethnic, cultural, racial or religious stereotypes.



Do not use language that fosters stereotypes



Avoid personal pronouns



Phrase stem in the active voice not passive

STEM

Distractors:  Affect the difficulty of the item  Consist of the correct answer and three distractors or incorrect answers  Must be homogenous  Must be plausible  Must be similar to the correct answer in length and construction

ABCGN Writing Style 

All acronyms in the exam are to be followed with the full name of organization



All procedure acronyms are to be followed with the full name



All medications are to be listed by trade name and corresponding generic chemical name in parenthesis



Use the word “patient” instead of “client”



Vital signs – eg. Temperature 98.6 (Fahrenheit) Pulse 82, Respiration 20, Blood Pressure 120/80

*Selected pharmacological agents – page 12-14 *Selected acronyms – page 1

3

I.

Sample Item Stems for Phases of the Nursing Process

Assessment Phase: 

The nurse is performing a (an) . . . . . .on a patient with . . . . . .Which of the following findings should the nurse anticipate?



The nurse is admitting a patient for a (procedure/treatment) . . . . . . Which of the following actions should the nurse take initially? (Correct answer is to initially assess)



The nursing assistant reports to the nurse that a patient is displaying (some type of behavior/symptom) . . . . . . for (length of time . . . . . . To assess for . . . . . ., the nurse should_____________.



The nurse is caring for a patient who has (disease condition) . . . . . .The client exhibits (symptoms) . . . . . .To monitor the client, the nurse should_____________.



A patient has just had (procedure/surgery) . . . . . . and is receiving (medication/therapy . . . . . .. Which of the following should the nurse assess first? All options are correct, the key is first.

Analysis Phase 

The nurse is caring for a patient with . . . . . .Which of the following statements by the client would alert the nurse to a (complication of condition) . . . . . . ?



The nurse is caring for a patient with (disease condition) . . . . . .. Which of the following assessment findings requires the nurse’s immediate action?



A patient with (disease condition) is admitted. Upon assessment, the nurse finds complication/abnormal assessment. . . . . .The nurse recognizes that because of the client’s diagnosis, the findings are probably due to ___________________.



The nurses is caring for a patient with (disease condition) . . . who becomes (behavior/symptom, prior to endoscopy. The nurse should recognize that the client’s (behavior/symptom) . . . . . .is most likely related to_____________.



The nurse is caring for a patient with (disease condition). . . . . .who exhibits (behavior/symptoms). The nurse recognizes that the (behavior/symptom is due to _____________.



A patient with (disease condition) states to the nurse (quote from client). . . . . . Which of the following factors would most likely be related to the client’s statement?

4

Planning Phase 

The nurse is admitting a patient with (disease condition). . . . . .who has a history of (reaction/behavior/symptom). Which of the following interventions should be included in the client’s plan of care?



The nurse is caring in for a patient with disease condition). To assist the client in (related disability, the nurse should _____________.



The nurse is planning to . . . . . . . .for a patient with (disease condition). The best approach for the nurse to use is __________________.



The nurse is planning a patient care conference. The client is described as becoming . . . . . .The nurse should suggest that staff _________________.



The nurse is planning care for a client with (disease condition) . . . . . .The client has a nursing diagnosis of . . . . . .Which of the following interventions would be essential for the nurse to include in the client’s plan of care?



The nurse is admitting a patient with a possible diagnosis of . . . . . .When collecting data to develop a plan of care for the patient , the nurse should give priority to which of the following items? (all options are correct; key is priority)



The nurse receives report on the following four patients. Which patient should the nurse first . . . . . .? (assess/intervene/teach). . . . (All options are appropriate; the key is the priority/at greatest risk/has most life-threatening problem.

Implementation Phase 

A patient with . . . . .refuses (treatment). It would be most appropriate for the nurse to ___________________.



The nurse is caring for a patient with a history of . . . . . .Which of the following actions by the nurse would represent appropriate care of this client?



The nurse is explaining the effect of (treatment/procedure/age/etc.) to the patient. The nurse should explain that because of (these changes), it is most important for the patient to_________________.



A patient is receiving (procedure/treatment) . . . . . at (rate)/ or (for time). The nurse determines that (findings) . . . . . . Which of the following actions should the nurse take first? (All options are correct; key is first.)



The family of a patient being discharged asked the nurse where to go for assistance with . . . . . .It would be most appropriate for the nurse to _______________.

5



A patient with . . . . . .complains of . . . . . .The observes that . . . . . . The first action the nurse should take is to _________________. (All options are correct; key is first)



A patient with . . . . . .has been admitted for (treatment/procedure). Which of the following interventions would be most appropriate for the nurse to take when preparing the patient for the (treatment/procedure? (All options are correct for the situation; key is most.)

Evaluation Phase 

A patient is receiving . . . . . . Which of the following comments made by the patient requires further discussion with the nurse?



A patient with . . . . . . has developed. . . . . .Which of the following (medications/treatments/endoscopy intervention) that the patient has recently received may have been a contributing factor?



The nurse has assigned . . . . .to the new nursing assistant. Which of the following indicators would be the best for the nurse to use when evaluating the nursing assistant’s performance?



The nurse observes . . . . .performing (procedure/treatment). Which of the following actions by the staff members would require the nurse to intervene?



A patient has been instructed in . . . . . Which of the following observations indicates that the patient requires follow-up by the nurse?



A patient has been taking (medication/treatment/etc.) for . . . . . .Which of the following signs and symptoms would indicate that the patient may be experience (negative side effect)?



A patient who recently had (Procedure/surgery) has an order for (medication/treatment/etc.) as needed. (time) . . . . . .after the nurse administered the (medication treatment/etc.) . . . . . .the patient complains of . . . . . .Which of the following actions should the nurse take next?



A patient with . . . . . .is admitted for evaluation of . . . . . .Which of the following observations by the nurse would indicate that the . . . . . .is (worsening/improving)?

Reference: Basic Assessment Strategies for Nursing Educators National Council of States Boards of Nursing. Inc 2005

6

II. Sample Item Stems for Phases of the Nursing Process I. ASSESSMENT: Process of collecting, verifying, and communicating relevant patient data 

Which of these (manifestations, side effects) should a nurse investigate first when assessing a patient who has (undergone a dx test, nursing dx, medical dx, medication prescription)?



A nurse assesses that a client who has (dx) has (manifestations, vital signs). What additional data should the nurse collect to establish a nursing diagnosis of (. . . )?



When assess a patient who has (dx), a nurse should determine whether the patient ahs which of these (signs, symptoms, clinical manifestations, laboratory values)?



Which of these questions would be the most important for a nurse to ask a patient who has (dx, manifestations)?



To identify whether a patient is developing a (side effect of medication, complication of a procedure, progression of a disease), which of these questions should a nurse ask the patient? Which of these assessments should a nurse make?



Which of these questions would be the most appropriate for a nurse to ask a patient to assist in establishing a nursing diagnosis of . . . ?



Which of these data would be most important for a nurse to obtain when assessing a patient who has (manifestation, dx)?



A nurse assesses that a patient who has (dx) has (manifestation). What further information should the nurse obtain? Which of these questions would be the most important for the nurse to ask the patient?



A patient who has (dx) develops (manifestations, vital signs). What additional data should a nurse obtain?



A nurse assess that a patient has all these (Manifestations, vital signs). Which one is most likely related to (dx)?

II. ANALYSIS Process of interpreting assessment data to identify actual or potential patient health problems 

A nurse identifies that a patient who has (dx) demonstrates (manifestations, laboratory values). This finding would help substantiate a nursing diagnosis of . . .

7



A patient who has (dx) says to a nurse, “. . . .” A nurse should recognize this statement as indicative of . . . .



When assessing a patient who has (dx), which of these findings would indicate (complications, advanced disease progress)?



Which of these factors in a patient’s history is most likely related to the development of (dx)?



A nurse assesses that a patient who has (dx) has a (laboratory test, dx test) that reveals . . . Which of these nursing diagnoses is appropriate for this patient?



Which of these findings, if identified in a patient who (has dx, had procedure, is taking medication) should a nurse report to a physician immediately?



A nurse assesses a patient who (has dx) (is taking medication). Which of these patient findings would require immediate follow-up by the nurse?



A nurse obtains a health history from a patient who (has dx) (is taking medication). Which of these patient findings should the nurse follow up immediately?



Which of these findings, if identified in a patient who (has dx, is receiving rx), would indicate that the patient is at risk for developing (complication)?



A nurse should recognize that a patient who (has dx) (is taking medication) is at risk for developing (complication, side effect) if the client . ..



A patient who has (dx, been in an accident, sustained an injury) is admitted to the emergency department with (several manifestations). Which of the injuries should be treated first?

III. PLANNING Process of establishing desired patient outcomes and designIng strategies to achieve those outcomes 

Which of these outcomes would be most appropriate for a nurse to establish with a patient who has a (nursing dx, medical dx of . . . ?



A nurse is developing a plan of care with a patient who has (nursing dx, medical dx). Which of these outcomes should receive priority in the plan?



Which of the measures should (be included) ( receive priority) in the care plan for a patient who (has nursing dx, medical dx)?

8



When a patient (has nursing dx, medical dx, manifestation) ( is receiving medication), which of these (pieces of equipment, medications) should a nurse have available?



A nurse should include which of these teaching strategies when planning care for a patient who has (nursing dx, med. Dx, developmental level)?



Which of these measures, if included in the care plan for a patient who has (dx), would be most effective to (reduce, relieve) (clinical manifestation)?



The reaching plan for a patient who is taking (medication or class of medication) should include which of these instructions?



When planning home care for a patient who has (dx) which of these (measures) should a nurse assist the patient and family to identify as the priority? Which of these referrals should the nurse make?



Which of these outcomes would be most appropriate to establish for a patient who has (nursing dx)?



A nurse is planning staff assignments. Which of these patients would be the most appropriate for the nurse to assign to a nursing assistant?



A nurse should assign which of these staff members to care for (a patient who has . . . an elderly patient, an anxious patient ?



Which of the laboratory results would be most important for a nurse to monitor for a patient who has . . . ?



Which of these nursing measures would be most effective to assist a patient who has (nursing dx medical dx) in order to achieve the outcome of . . .?

IV. IMPLEMENTATION Process of initiating and completing the nursing actions to accomplish the defined outcomes 

A nurse should instruct a patient who (has dx, is at risk for . . .) to make which of these life-style modifications?



A patient is scheduled to start taking (medication). A nurse should teach the patient to observe for side effects which include . . .



A patient who has (dx) has all these medication ordered. Which one would the nurse administer when the patient reports. .. ?



Before administering (medication, treatment) to a patient, which of these (laboratory values, vital signs, should a nurse check? 9



When a patient who has (dx) develops (manifestation, laboratory value), which of these actions should a nurse take (first, initially)



Which of these assessments of a patient who ahs (dx) requires immediate nursing intervention?



A patient (states, acts, experiences an unusual event) or a nurse (performs a procedure, witnesses an accident. Which of these statements would be the most appropriate for the nurse to record in the patient’s medial record?



A patient is scheduled for (surgery, dx procedure, treatment) says to a nurse, “ . . . “ Which of these responses would be most appropriate for the nurse to make?



A nurse observes a (colleague, nursing assistant) including all these measure when (performing a procedure). Which one would require the nurse to intervene? Which of these actions is most appropriate for the nurse to take?

V. EVALUATION Process of measuring the patient’s response to treatments, medications, and nursing actions and progress toward achieving defined outcomes. 

A patient has been given instructions about (treatment, procedure, medication). Which of these statements, if made by the patient (would indicate that the patient has the correction understanding of the instructions ) (would indicate that the patients need FURTHER instructions?



A patient who has (dx) is (taking medication, receiving treatment). Which of these statements, if made by the patient, would indicate that the (medication treatment) is having (an UNTOWARD, THE DESIRED) EFFECT?



A patient who has (dx) is receiving (medication, treatment). Which of these responses should a nurse expect the patient to have if the (medication, treatment) is achieving the desired therapeutic effect?



A patient is on a (diet). Which of these meals, if selected by the patient, would indicate that the patient has the correct understanding of the diet plan?



A patient who has (dx) is receiving (medication, treatment). Which of these (laboratory, assessment ) findings should a nurse recognize as indicating that the treatment is ( having the desired effect) (having an untoward effect)?



An outcome for a patient who has a (dx) of (. . . ) is ….Which of these patient (statements, behaviors, finding) would indicate that the 10

interventions to meet these outcome have been (successful, UNSUCCESSFUL) 

Which of these statements is the most accurate recording of a patient’s response to (a medication, treatment, procedure)?



Which of these (actions, statements) of a patient who has (dx) would be the best indicator of the patient’s acceptance of (dx, diet, death, body image change)? Reference: McDonald, Mary E, The Nurse Educator’s Guide to Assessing Learning Outcomes nd 2 Edition, Jones and Bartlet Publishers Inc, Page, 333-337

Additional Question Suggestions: Management/Therapy/Treatment 

Which of the following is the most appropriate next step?



Which of the following is the treatment of choice?



Which of the following is the most likely outcome?



Which of the following is the most likely the result of interaction between these drugs?



Which of the following is the most appropriate treatment?



Which of the following is the most appropriate management? (surgical, pharmacologic, observation, therapy)

Assessment/Nursing Diagnosis 

Which of the following is the most likely diagnosis?



Which of the following is the most appropriate nursing intervention?



Which of the following is most likely associated with this condition?



This patient is at increased risk for development of_______.

Science/Anatomy/Physiology/Pathophysiology 

Laboratory evaluation is most likely to show______.



Which structure is most likely to be involved?



Which of the following is the most likely mechanism of action? 11

COGNITIVE CODES – Operational Definitions (Bloom’s Taxonomy)

KNOWLEDGE: the ability to Recall specific information, such as definitions Define, identify or recognize common terms, facts, procedures, principles, laws and/or basic concepts Requires the fewest number of steps EXAMPLE identifying a normal blood value

COMPREHENSION: the ability to Recall and understand information at a basic level (information directly out of a text book – even if the statement is in quotes Know facts and advance one step further toward understanding Know what is being communicated without necessarily relating to other material or knowing full implication (s) Select or identify examples of the fact concept, principle or procedure being understood EXAMPLES: Interpreting an abnormal laboratory test Assessing for disease manifestation Determining which client symptom would indicate a specific disease/illness Identifying which statement/phrase best describes a client phenomenon, such as how to best describe a client’s pain give a specific illness/disease. Calculating a dose/intravenous drip rate (unless, situation calls for a higher level of interpretation)

12

Determining allergies, carrying out special test/procedure requirements and identifying possible risks when preparing clients for tests/procedures Simple equations, converting pounds to kilograms and vice versa

APPLICATION: the ability to Conceptualize and prioritize information, ideas, or principles, utilization of understanding in order to perform an action/ or select the key Remember and apply general ideas, rules and theories Interpret, demonstrate or predict situation, processes, phenomena and/or procedures

EXAMPLES: Making a priority decision based on nursing action for one client (most, first, initially, essential, increased) Evaluating client statements/responses involving one piece of client information (which statement would indicate a basic correct understanding) Determining which client data would require immediate action to be taken. Determining which client is at greatest risk for a given or singular medical problem (includes health promotion and wellness screening Reinforcing patient teaching Setting goals based on data collection Identifying which responses would be appropriate/most appropriate for the nurse to make, given a situation (response as a verbal statement or nursing action) Key utilized words or phrases from source (directly or indirectly) where more processing is required to sift through all 4 of the responses Therapeutic communication – evaluating client responses and selecting a therapeutic communication response Complex equations involving multiple steps (i.e. I/O items listed in ounces, totaling ounces and converting to cc’s) 13

ANALYSIS: the ability to Discriminate complex information (multiple variable) by separating and prioritizing such information into smaller segment of data such that the relationship of ideas is clearly understood and hypotheses can be stated Categorize the structure or organization of ideas, themes or patterns into smaller elements, and identify the relationship of these parts to the whole Exam cause and effect relationships Detect recurring themes EXAMPLES: Determining which client – from a list of 4 clients (with a diagnosis and complaint) should be seen/assessed/checked first Making an assignment for a staff member, given 4 clients with a diagnosis and care or a task to be completed Evaluating complex client statements/responses involving multiple pieces of information (which statement would indicate a correct understanding) Evaluating multiple client date (1 or more clients, each with multiple data or 1 patient with multiple pieces of data requiring multiple processing steps such as comparing vital signs, vitals, diagnosis, time frame, new symptoms and a scenario in the distractors and determine which action to be taking

EVALULATE: the ability to Make judgment on the basis of given criteria Use of a standard appraisal against which to judge Evaluation of material to selected or remembered criteria EXAMPLES: Judging performance of intervention-based set of criteria, standards of practice, etc. e.g. basic life support criteria, CDEC guidelines for infection control, drug side effects and contraindications, assess 14

colleagues ability to use sterile technique asses lung sounds, and select appropriate assessment technique or anatomical landmark

Create: the ability to Organize elements/ parts to form a whole Arrange steps parts/ elements provided into a pattern or correct sequence Assemble data from multiple source (stem, chart elements, etc) and combine data to form a structure EXAMPLE: Collect data from stem, lab values and prescriptions to predict potential client outcome.

Create involves putting elements together to form a coherent or functional whole. Objective classed as Create have candidates make a new product by mentally reorganizing some elements or parts into a pattern or structure not clearly present before. The processes involve in Create are generally coordinated with the candidate’s previous learning experiences’ Although Create requires creative thinking on the part of the candidate, this is not completely free expression unconstrained y the demands of a learning task o

15

Selected Pharmacological Agents Listed below by trade name and corresponding generic chemical name in parenthesis. All medications in the exam should follow this format.

Cardiovascular Agent – (Anti-anginal/ nitrate, inotrope)  Isordil® (isosorbide dinitrate)  Adrenaline® (epinephrine)  Cardizem® (diltiazem) Chloride Channel Activator  Amitiza® (lubiprostone) Colon-Cleansing Agents  Osmo-Prep™ , Visicol® (sodium phosphate monobasic monohydrate)  Fleet® (sodium phosphate)  Magnesium Citrate Liquid (magnesium citrate) Fiber/Bulking Agents  Citrucel® (methylcellulose)  Metamucil® (psyllilum) Histamine-2 Receptor Antagonists  Tagamet® (cimetidine hydrochloride)  Pepcid® (famotidine)  Zantac® (ranitidine hydrochloride) Hypnotic/Narcotic/Sedative Agents  Sublimaze®, Duragesic® (fentanyl citrate)  Demerol® (meperidine hydrochloride)  Versed® (midazolam hydrochloride)  Valium® (diazepam)  Diprivan® (propofol)  Aquachloral® (chloral hydrate)  Inapsine® (droperidol)  Phenergan® (promethazine) Intestinal Anti-inflammatory Agents  Colazal® (balsalazide)  Asacol®, Canasa®, Pentasa®, Rowasa® (mesalamine)  Dipentum® (olsalazine sodium)  Azulfidine® (sulfasalazine) Laxatives – Osmotic  Glycerol® , Osmoglyn®, (glycerin)  Cephulac®, Chronulac®, (lactulose)  Miralax®, Colyte®, GOlytley®, MoviPrep®, NuLYTELY® (polyethylene glycol) 16

Laxatives - Stimulant  Bisacolax®, Dacodyl®, Dulcolax®, (bisacodyl)  Natures Remedy® (cascara sagrada)  Gentlax B®, Senexon®, Senolax® (senna senosides) Gastrointestinal Agent (Anti-ulcer)  Cytotec® (misoprostol)  Carafate® (sucralfate) Gastrointestinal Agent (Prokenetic)  Reglan®, (metoclopramide) Gastrointestinal Agent (Anti-emetic)  Aloxi® (palonesetron)  Compazine® (prochlorperazine) Gastrointestinal Agent (Anticholinergic)  Levsin® (hyoscyamine) Gastrointestinal Agent (Enzymes)  Kinevac® (cholecystokinin) Gastrointestinal Agent (Antiarrthymic, anticholinergic)  Atropine® (atropine sulfate) Miscellaneous Gastrointestinal Agents  GlucaGen® (glucagon)  Tensilon® (edrophonium)  Peptavlon® (pentagastrin)  Botox® (botulinum toxin)  Urecholine® (bethanechol chloride)  Robinul® (glycopyrrolate)  Questran® (cholestyramine)  Bentyl® (dicyclomine hydrochloride) Nonsteroidal Anti-inflammatory Drugs  Voltaren® (diclofenac sodium)  Advil®, Ibuprin®, Motrin®, Nuprin®, Pamprin-IB®, Rufen® Trendar® (ibuprofen)  Indocin®, Indameth®, (indomethacin)  Mobic® (meloxicam)  Aleve®, Anaprox®, (naproxen sodium)  Feldene® (piroxicam) Proton Pump Inhibitors  Nexium® (esomeprazole magnesium/sodium)  Prevacid® (lansoprazole)  Prilosec® (omeprazole)  Protonix® (pantoprazole sodium)  Aciphex® (rabeprazole sodium) 17

Respiratory Agent  Theodor® (theophylline) Stool Softeners  Colace® (docusate) Steroidal  Solu-Medrol® (methyprednisolone)  Deltasone® (prednisone) Toxicology Agents – Antidotes – Reversal  Romazicon® (flumazenil)  Narcan® (naloxone)  Urolene Blue® (methylene blue) Tumor Necrosis Factor – Alpha Antagonistss  Humera® (adalimumab)  Remicade® (infliximab)

18

Selected Regulatory Organizations and National Boards All acronyms used in the exam are to be followed with the full name of the organization in parenthesis

CDC (Center for Disease Control and Prevention) EPA (Environmental Protection Agency) FDA (Food and Drug Administration) OSHA (Occupational Safety and Health Administration) JCAHO (Joint Commission on the Accreditation of Healthcare Organizations) SGNA (Society for Gastroenterology Nurses and Associates) ABCGN (American Board of Certification for Gastroenterology Nurses) ABNS (American Board of Nursing Specialties) NOCA (National Organization for Competency Assurance) NCQA (National Commission for Quality Assurance) AACN (American Association of Colleges of Nurses) APRN (Advanced Practice Registered Nurse) CFPC (Coalition for Professional Certification) CLEAR (Council on Licensure, Enforcement and Regulation) IOM (Institute of Medicine) IREC (Institute for Research, Education, and Consultation) NCSBN (National Council of State Boards of Nursing NCCA (National Council for Certifying Agencies)

19