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=NCLEX= The NCLEX exam is taken after an individual graduates from a school of nursing, in order to receive his or her nursing license. A nursing license gives an individual the permission to practice nursing, granted by the state he or she has met the requirements for. The exam is computerized and is known as a criterion-referenced examination. According to the chapter, “NCLEX: What You Need to Know,” in the textbook Nursing Now, a criterion-referenced examination is a “test that compares an individual’s knowledge to a predetermined standard rather than to the performance of others who take the same test.” With computerized exams such as this, the computer selects which question you are asked based on how you answered the previous question. The NCLEX covers a wide range of material. The individual will be scored by their ability to think critically about decisions involving nursing care.

Changes in the Exam
The governing body responsible in making changes to the NCLEX is the National Council of State Boards of Nursing, or the NCSBN for short. They make these changes by analyzing the current nursing practice by creating a survey. The survey asks approximately 12,000 nurses who have recently received their licenses about different nursing care activities which appear on the NCLEX. The NCSBN analyzes these nursing care activities based on how frequent the activity may occur, how it could impact the client’s safety, as well as the location of these activities. The most recent changes were made in 2010, but the NCSBN conducts these analyses every three years so more changes will be expected sometime in 2013.

NCLEX-RN
The NCLEX-RN uses the five-step nursing process. Each of the questions will fall into one of the five steps: assessment, analysis, planning, intervention and implementation, and evaluation.

Exam Content
*Basic Care and Comfort: 6-12 percent of NCLEX questions *Pharmacological and Parenteral Therapies: 13-19 percent of NCLEX questions *Reduction of Risk Potential: 13-19 percent of NCLEX questions *Physiological Adaptation: 11-17 percent of NCLEX questions *Management of Care: 13-19 percent of NCLEX questions *Safety and Infection Control: 8-14 percent of NCLEX questions *Life Span Growth and Development: 7-12 percent of NCLEX questions *Prevention and Early Detection of Disease: 5-11 percent of NCLEX questions *Coping and Adaptation: 5-11 percent of NCLEX questions *Psychosocial Adaptation: 5-11 percent of NCLEX questions
 * Physiological Integrity
 * Safe Effective Care Environment
 * Health Promotion and Maintenance
 * Psychosocial Integrity

Physiological Integrity
The Physiological Integrity category of the exam makes up the majority of the questions on the exam. With about 43-67 percent of the questions coming from this category, this portion of the NCLEX deals with adult medical and surgical care, pediatrics, and gerontology, which is the group of people who are elderly and the effects aging has on them. Some of the questions may deal with conditions that nurses deal with on a regular basis such as, diabetes, cardiovascular disorders, neurological disorders, renal diseases, and respiratory diseases. In addition, questions on traumatic injuries, immunological disorders, and skin and infectious diseases could also be asked. There are different topics on the NCLEX pertaining to the pediatric client, however. These topics may include a child’s growth and development, abnormalities formed at birth, child abuse, burn injuries, fractures and how to care for them, common infectious diseases in children, and common childhood trauma.

Safe and Effective Care Environment
This category makes up approximately 21-33 percent of total NCLEX questions. Questions in this category cover safety issues in patient care, the administration of medicine to patients, safety measures to prevent further injuries and infections, isolation precautions, safety for patients who are children, and special safety precautions for patients with psychiatric problems.

This portion of the exam may also include questions pertaining to laboratory tests, test results, and unique nursing procedures that may be associated with those test results; ethical and legal nursing problems; nursing management; and issues that deal with giving patients the best care. NCLEX questions on these topics are randomly spread throughout the exam.

Health Promotion and Maintenance
The Health Promotion and Maintenance category makes up about 12 percent of the NCLEX examination. Questions under this category deal with birth control measures, pregnancy, labor and delivery; care for a newborn infant, growth and development, and diseases that can spread easily (like sexually transmitted infections). If a patient is pregnant, it is very important that the nurse be able to act as a teacher or counselor for the patient, as well. Therefore, it is necessary to understand all components of a patient’s pregnancy. Knowledge of a proper diet, development of the fetus, signs and symptoms of complications and certain procedures that may take place during pregnancy will be helpful for this section of the exam.

Psychosocial Integrity
Like the section on Health Promotion and Maintenance, the Psychosocial Integrity category constitutes approximately 12 percent of NCLEX questions. Questions in this category of the exam pertain to patients with psychiatric problems and the issues that may affect them. In addition, this material may cover coping mechanisms for different situations. Some situations covered in this section of the exam deal with patients who do not have psychiatric disorders; however, it is still part of this category. Questions could cover information on the following disorders: depression, schizophrenia, organic mental disease, eating disorders, personality disorders, and anxiety disorders. Also included in this section may be questions about crisis intervention, substance abuse, and therapy through communication.

Question Types
Questions on the NCLEX exam are separated into three different types or levels: Level 1, Level 2, and Level 3. Level 1 questions are going to be the most basic type of question and make up less than 10 percent of the total number of questions. Level 1 questions test the individual’s knowledge and understanding. Therefore, these questions require the individual to recall specific facts and information. Level 2 questions are going to add an additional step in order to answer the question. In these types of questions, the individual will be required to know specific information and then use it to interpret or analyze the question being asked. Overall, level 2 questions are going to be analysis and application-type questions. Level 3 questions are going to be the most complex type of question on the NCLEX. These questions require the individual to judge, evaluate, and/or combine the information given. The individual will have to apply rules, facts, and processes they already know and then make decisions based on the situation about what is best for the patient’s care. What makes level 3 questions so difficult is that there is almost always going to be more than one correct answer—the individual will have to decide which answer is the best out of all the answer choices. Level 2 and Level 3 questions make up about 95 percent of the questions on the NCLEX exam. However, it is possible to not even be asked one Level 1 question on the exam.

NCLEX Format
The NCLEX exam is taken on a computer at a Pearson Professional Center. Pearson Professional Centers are testing centers for certifications and licenses all over the world. There are numerous testing centers in each state and can be found in 175 countries. The NCLEX is mostly a multiple-choice exam. Less than 10 percent of the questions asked will not be multiple-choice. For these types of questions an individual may be asked to fill in the blank, choose all of the correct answers from a list of options, put a number of steps in the correct sequence, or identify a correct area on a picture. Some of these alternative format questions could ask about information pertaining to a chart or graph, ask you information from an audio clip, or the question could use pictures as the answer choices instead of words. Each question will appear one at a time on the computer screen. Questions will not be repeated; however, questions based on a similar situation could be repeated.

Each individual that takes the NCLEX exam will take a different exam. Since each question depends on how the previous question is answered, an individual could take between 75 and 265 questions. The number of questions on the exam will vary for each individual. Only 60 out of the first 75 questions on the exam will count. The 15 that do not count are “trial” questions, and these will be used on future examinations. However, the individual will not know which questions are “trial” questions and which ones are not. Therefore, it is best to answer every question. If the individual continues to get questions from the same category, it could mean that the NCSBN is testing those types of questions, or it could mean that the individual keeps getting those types of questions incorrect. The computer will continue to randomly generate questions from that category until the individual has met the requirements of the test plan.

Each individual will have no longer than six hours to complete the exam. There is no minimum time limit, but there is a mandatory 10-minute break about 2 ½ hours after the start of the exam. Individuals can take another optional break at about 4 hours into the test. It is acceptable to take breaks any time during the exam, however test-takers will lose that time off of their total time.

Those who take the exam do not have to get a certain number of questions correct in order to pass the exam. Individuals’ scores will not be compared to other people’s scores to determine if they pass, either. The NCLEX is graded by comparing one person’s responses to a pre-established standard. If an individual meets or exceeds the standard they pass the exam, if not, they fail the exam.

History
The nurse’s cap originated from a group of women in the early Christian era, called “deaconesses.” Deaconesses are now recognized as religious order nuns. These women were separated from other women during this time by their white covering worn on their head. This particular head covering was worn to show that this group of women worked in the service of caring for the sick. Originally, this head covering was more of a veil, but it later evolved into a white cap during the Victorian era. It was during this era that “proper” women were required to keep their heads covered. The cap worn was hood-shaped with a ruffle around the face and tied under the chin, similar to cleaning ladies of that day. Long hair was fashionable during the Victorian era, so the cap kept the nurse’s hair up and out of their face, as well as kept it from becoming soiled.

Standardized Caps per School
Around 1874, the Bellevue Training School in New York City adopted a special nursing cap as a way to identify nurses who had graduated from Bellevue. The Bellevue cap covered the entire head except the ears, and can be compared to a current ski hat, although it was made out of white linen and had fringe around the bottom. As the number of nursing schools increased, so did the need for unique caps. Each nursing school decided to design their own style of nurse’s cap. Some became very elaborate and some were even different shapes. Because each school had their own cap, it became very easy to determine which school the nurse had graduated from.

Nurse’s caps since the 1980s
Healthcare facilities no longer required for their nurses to wear nurse’s caps, which led to nursing schools eliminating the cap as a mandatory part of the students’ uniform. In addition, with the growth of technology in the health-care setting, nurse’s caps became an obstacle for nurses wearing them.

Although the nursing cap is no longer required as a part of a nurse’s uniform, it still holds the same significance that it did during the time of Florence Nightingale. The nursing cap symbolizes the goal of nurse, which is to provide “service to those in need.” Furthermore, the cap is a sign of the industry’s ageless values of dedication, honesty, wisdom, and faith.