The Construction of Test Items for Nursing Assessment Using the Test Blueprint.

Posted: December 13th, 2022

The Construction of Test Items for Nursing Assessment Using the Test Blueprint.


The Construction of Test Items for Nursing Assessment Using the Test Blueprint
The blueprint is a tabular roadmap that serves to assist the nurse instructor in formulation of test items that reflect the course content and is fair in grading the student. It explicitly lays down the areas to be tested or gives an idea of the same, whichever is convenient for the instructor. Its main function therefore is to guide test item development and save time in doing so (McDonald, 2018).The Construction of Test Items for Nursing Assessment Using the Test Blueprint.


There is no one representative blueprint for use by everyone. The teacher or instructor can modify it as they please to suit their needs and that of their students (Oermann & Gaberson, 2014). This means that details like taxonomy and objectives of the test areas may or may not be included depending on the instructor.
The following is an example of a blueprint developed to assist in the designing of test items for assessing knowledge in nursing as a whole, incorporating points to be awarded and the nursing process phases.
Table 1: Test blueprint for a test in nursing as a whole
Test item type Number of test items Question number Phase of the nursing process Nature of test item Percentage points out of 100%
True-false 2 1 Nursing diagnosis Recall 5
2 Assessment Recall 5
Matching 1 1 Assessment, diagnosis, and evaluation Understanding, recall. 5
Multiple Choice (MCQ) 5 1 Assessment Clinical practice 5
2 Planning and implementation Clinical practice 5
3 Implementation and evaluation Clinical practice 5
4 Assessment and diagnosis Clinical practice 5
5 Assessment Clinical practice 5
Multiple Response 2 1 Assessment, diagnosis, and evaluation Recall 5
2 Diagnosis and evaluation Recall and application of knowledge 5
Completion 1 1 Assessment and diagnosis Recall, assessment, diagnosis 15
Essay 1 1 Assessment/ evaluation, and diagnosis Recall 20
Context Dependent 2 1 Assessment, diagnosis, planning, and implementation. Application of knowledge and critical thinking item 5
2 Planning and implementation Ethics and application of knowledge 5
Hot Spot 1 1 Assessment Recall 5

True-False Test Items
For question 1 and 2 below, underline T if the statement is true and F if it is false.
1. James Osmond is a 49 year old male diagnosed with type II diabetes mellitus seven years ago. He currently has a body mass index or BMI of 40 and attends follow-up clinic without fail on top of taking his medication as required. He is on glucovance for his blood sugar control. Recently during a routine laboratory check, James was discovered to be having an estimated glomerular filtration rate (eGFR) of 75ml/minute per 1.73m2. You know that James may soon need dialysis. In which stage of renal failure is he according to this information?
T F Stage one of end-stage renal disease
T F Stage three of end-stage renal disease
T F Stage two of end-stage renal disease
T F Stage four of end-stage renal disease
T F He hasn’t entered renal failure yet
2. With reference to question 1 above, an eGFR of below 90ml/minute per 1.73m2 is indicative of:
T F Diabetes mellitus in renal failure
T F An elevated body mass index
T F Renal failure regardless of comorbidity
T F Ineffectiveness of glucovance
T F Declining glomerular function
Matching Test Items
For each statement in column A, choose the correct corresponding answer in column B. Give your answer as Note that each 1a, 2d, et cetera. Note that each response can only be used once.The Construction of Test Items for Nursing Assessment Using the Test Blueprint.
Premises Responses
1. Extensively drug resistant TB (XDR-TB)
2. HIV infection
3. Multi-drug resistant TB (MDR-TB)
4. Pulmonary TB
5. Spinal TB a. Associated with tubercles
b. Likely to develop in an immunocompromised TB patient
c. Non-responsive to isoniazid, ethambutol, pyrazinamide, and rifampicin
d. Non-responsive to first line drugs and fluoroquinolones
e. Potentiates the progression of TB

[Correct answer: 1d, 2e, 3c, 4a, 5b]
Multiple Choice Questions (MCQ)
1. You are the team leader of the critical care team on the evening shift. As a postgraduate student nurse manager you recognize the importance of statistics to the improvement of patient care standards and achievement of nursing outcomes in your unit. This evening you note that the body temperatures of the six patients in the unit are 38.5, 39.2, 37.2, 38.0, 36.9, and 40.1°C. What is the mean temperature of the patients in degrees Fahrenheit (°F)?The Construction of Test Items for Nursing Assessment Using the Test Blueprint.
a. 109.6°F
b. 106.9°F
c. 101.0°F
d. 101.96°F
e. None of the above
2. A young man of 18 years is brought to a primary health care centre in a rural neighborhood where you are the clinician treating patients. The nearest main hospital is one hundred and fifty miles away. He has been shot in the thigh and from the position of the limb you can tell that the femur is completely fractured. There is considerable bleeding and the young man is in a lot of pain. As the presiding advanced practice registered nurse (APRN), what would be the best course of action to take?The Construction of Test Items for Nursing Assessment Using the Test Blueprint.
a. Immediately admit the patient and have him prepared for theatre
b. Prescribe and start strong injectable non-opioid pain medication then perform open reduction and internal fixation of the femur
c. Start crystalloid intravenous fluids, give strong injectable non-opioid pain medication, immobilise the limb externally by splints, and refer to the hospital for specialist surgical intervention
d. Give intravenous fluids and pain medication before debriding the wound and admitting for observation
3. A patient on dialysis suddenly starts to sweat profusely and convulse. His temperature is normal but the blood pressure has gone down from the last reading of 142/90 mmHg to 90/50 mmHg. He is undergoing ultrafiltration (UF) of 3 litres of fluid and has already taken out 2.5 litres. The blood flow rate (BFR) of the machine is 400 cc/min. The patient has lately not been achieving his UF goal, always getting cramps towards the end of dialysis. However, the nephrologist has not yet reviewed and revised his dry weight. As the nephrology nurse performing dialysis for the patient, what would be the most appropriate thing to do in this situation?The Construction of Test Items for Nursing Assessment Using the Test Blueprint.
a. Immediately call the nephrologist
b. Stop the dialysis and reassure the patient
c. Reduce the BFR, stop the UF, and lower the head of the patient until the BP normalizes again.
d. Infuse the patient with saline and administer noradrenaline
4. You are a licensed certified registered nurse practitioner (CRNP) with your own autonomous private practice in one of the full practice authority (FPA) states. After triage, your secretary brings into the consultation room a 23 year old female who looks pale and has a baseline blood pressure of 100/60. After history taking and physical examination you note that her LMP was three months ago and she has a tender abdomen. She has neither spotting nor frank PV bleeding. She is feeling dizzy and tells you that the symptoms started suddenly as she was at her work place. From your knowledge, education, and experience; what could be the most likely problem with the young lady?
a. She is having a spontaneous abortion/ miscarriage
b. She wants to get a medical excuse to be away from work
c. She is having indigestion
d. She has got a ruptured ectopic pregnancy
5. Calculate the body mass index of a thirty year old diabetic and hypertensive patient weighing 115,000 grams and measuring 150 centimetres in height.
a. 50.11
b. 51.21
c. 51.11
d. None of the above
Multiple Response Test Items
1. Two of the following aptly describe stage four squamous cell non-small cell lung cancer (NSCLC). Which ones are they?
a. It is non-debilitating and easily manageable
b. It is metastatic, usually to the liver
c. It has a good prognosis with chemotherapy treatment
d. It has a poor prognosis even with treatment
e. It undergoes remission for months before relapsing again
2. The following statements are NOT TRUE about the male reproductive system EXCEPT two. Which ones are they?
a. The male sexual organs are not under autonomic innervation
b. Ejaculation is under sympathetic autonomic control
c. Sympathomimetics cause erectile dysfunction
d. Erection is not under parasympathetic innervation
Completion Test Items
1. Acetylcholine and noradrenaline are two common _________________ that transmit electrical impulse from one neurone to another. They perform this function at neural junctions that are referred to as _______________________. Most neurones originate from the spinal cord and form these junctions with neurones terminating on the viscera. In newborns, one of the defects of the spinal cord and spinal column is spina bifida.
Spina bifida occulta is a congenital defect of the spinal column in which the vertebrae do not develop completely, leaving a gap in the vertebral column that is not bony but through which the spinal cord and its covering membranes do not protrude. The other form of spina bifida is characterised by protrusion of the spinal cord and its covering membranes through this bony defect and is known as ________________________.
[Correct answer: neurotransmitters, synapses, spina bifida cystica]
Essay as a Test Item
Explain how the clinical condition referred to as cardiac asthma occurs. Include some of the clinical manifestations of the condition.
[Guidelines to the essay answer: the myocardium becomes weak for whatever reason; blood is not pumped with the necessary force from the left ventricle; there is backflow of oxygenated blood from the left ventricle back into the left atrium; from the left atrium the oxygenated blood flows back to the pulmonary vein; the pulmonary vein takes back the oxygenated blood to the lungs; as more and more blood is let back into the lungs by the insufficient myocardium, more fluid seeps into the lung interstices; pulmonary edema develops; less and less oxygen reaches the tissues; dyspnea and respiratory distress ensues; the heart enlarges as it tries to compensate for the myocardial insufficiency. Clinical manifestations include dyspnea, inability to lie flat, wheezing, and coughing.]The Construction of Test Items for Nursing Assessment Using the Test Blueprint.
Context-Dependent Test Items
1. The questions numbered (i) to (v) relate to the case situation presented below. Use the information to answer them.
John is a middle-aged immigrant laborer who has lately been having a productive cough not responding to usual conventional antibiotics. He has started having sweating episodes on most nights. John was diagnosed with the human immunodeficiency virus three years ago but refused to commence antiretroviral therapy until about a year ago. He is not very compliant to the medications. He presents at your primary health care community clinic in the suburbs and you are the advanced nurse practitioner who sees him.
i. What could be the most likely cause of the productive cough?
ii. What do you know about this cause and the HIV infection that he has?
iii. What is the biggest concern that you will have after concerning the patient and the community at large (including you)?
iv. What will you do as the clinician, knowing the implications of your concern?
v. What will you do next?
[Guide to correct answers: (i) Tuberculosis (ii) TB and HIV potentiate each other such that the TB will progress much faster given that the HIV virus weakens the host’s immune system (iii) A patient with active TB not on medication for the same is very infectious through aerosolized droplets by coughing. Hence John is currently a risk to everybody else (iv) I will immediately start John on the standard first line treatment of drug-sensitive TB based on the clinical diagnosis (v) I will send him to the laboratory to produce a sputum sample for testing for the acid-fast Mycobacterium tuberculosis].The Construction of Test Items for Nursing Assessment Using the Test Blueprint.
2. Questions (a) to (e) below are derived from the case below. Use the details from the case to answer them.
Pedro is 69 years old. He has got end-stage renal disease and has been on dialysis for five years. He has never liked dialysis and has a result received good news from his youngest daughter who wants to donate one of her kidneys to him. She is 25 years old with no child. She has no chronic illness, does not smoke or drink, and is not overweight.
a) What do you think of this situation?
b) Would you advise Pedro and his daughter to proceed with their plan? Why?The Construction of Test Items for Nursing Assessment Using the Test Blueprint.
c) Why is his daughter’s situation precarious?
d) What is the ethical dilemma here?
e) What is the best thing to do then?
[Guide to correct answers: (a) It is a delicate situation that requires a lot of tact and professionalism, given the age of the patient and that of his daughter. There is need to weigh the potential benefits from the living donation to a 69 year old against the risks to the young girl (b) No. I would not. At almost 70, Pedro is better off continuing with dialysis than risk the effects of a major operation like a transplant (c) The daughter is still young and may want to have her own children later on in life. The potential risks of having a single kidney at that age are immense (d) The ethical dilemma is that Pedro is entitled to want to have his life ‘saved,’ while his daughter is also entitled to a long and fulfilling life (e) there is need for an interdisciplinary approach to this case involving the nephrologist, the nurses, the social worker, and the clinical counsellor].
Hot Spot Test Item
There are twelve cranial nerves in total. They exit the base of the brain and the skull through small openings at the base of the skull known as foramina. The cranial nerves are numbered I-XII. From the diagram below, identify the olfactory nerve which is not only sensory but also the first cranial nerve.The Construction of Test Items for Nursing Assessment Using the Test Blueprint.

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