Running head: TEST DEVELOPMENT

Test Development and Blueprint University of South Florida Hannah Dowling

TEST DEVELOPMENT

Test Blueprint
Knowledge (30%) 2 1 1 1 5 5 Comprehensio n (30%) 2 1 1 1 Application (20%) 1 1 2 1 1 6 Analysis (20%) 1 1 2

Outcomes Assessment (40%) Diagnosis (10%) Planning (10%) Intervention (20%) Evaluation (20%) Totals

Total

20

Questions 1-10: Multiple Choice

1. A nurse knows that which of the following body systems is responsible for the production of leukocytes? a. The spleen b. The bone marrow c. The lymph nodes d. The liver 2. A client has been taking filgrastim (Neupogen) for two weeks in preparation for chemotherapy. The nurse knows to expect which of the following side effects? a. Constipation b. Bone pain c. Rash d. Elevated hemoglobin level 3. A client was recently diagnosed with heparin-induced thrombocytopenia (HIT) and needs to have a central line placed for chemotherapy. The nurse tells the patients family that which of the following central lines poses the least risk of HIT-related complications? a. Port b. Leonard c. Broviac d. Groshong 4. A client is admitted with Stage 4 metastatic breast cancer and reports severe pain. Which of the following responses by the client best indicates that she understands the nurses teaching regarding oral opioid medications? a. I should check my pulse before taking pain medication b. I need to drink lots of water during the day c. If my pain is not gone in five minutes, I should take another pill d. I should not take more than 4 doses per day to avoid becoming addicted

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5. The nurse is caring for a client with a diagnosis of terminal liver cancer. The physician has discussed Hospice care with the family, but they are reluctant to speak with the Hospice representative. The clients daughter states, The doctor is giving up on my mother. How can the nurse describe the aim of hospice care to the family? a. Hospice hastens death when the person would be miserable otherwise b. Hospice focuses on pain relief and dignity c. Hospice is for those who need round-the-clock nursing care d. Hospice is a good choice for your mother as she cannot have a liver transplant

6. A client is admitted with bleeding, a decreased platelet count, and a history of lung cancer. Which of the following laboratory values would cause the nurse to predict a diagnosis of DIC (disseminated intravascular coagulation)? a. Elevated fibrinogen level b. Decreased D-dimer level c. Increased FDP level d. Elevated plasminogen levels 7. The nurse is caring for a client admitted to receive brachytherapy for prostate cancer. The nurse initiates all of the following precautions EXCEPT: a. Removes soiled linen from the room as soon as possible b. Wears a Geiger counter at all times c. Relies on the principle of ALARA d. Ensures portable shields are available for all staff members 8. A 15-year old client diagnosed with a highly proliferative neuroblastoma received Topotecan (Hycamtin) and Cytoxan (cyclophosphamide) at his Oncologists office this morning. The client is sent to the Oncology unit via EMS for severe diarrhea, muscle weakness, vomiting, and cramps. The nurse calls the physician and prepares to administer which of the following treatments? a. Infusions of IV potassium and bed rest b. IV ondansetron and loperamide c. An infusion of D5W and IV insulin d. Insert a Sengstaken-Blakemore tube 9. The nurse is caring for a client who is 1 day post-operative for a total abdominal hysterectomy, bilateral salpingo-oophorectomy with omentectomy and sigmoid resection for ovarian cancer. The nurse would question which of the following orders? a. Ambulate client twice a day b. Titrate basal dose of Dilaudid PCA for pain relief c. Irrigate the colostomy d. Remove NG tube when bowel sounds are heard

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10. A client is scheduled to receive a 48-hr infusion of 5FU (Fluorouracil) and Oxaliplatin (Eloxatin). Upon reviewing the clients laboratory results, the nurse notes the following: WBC 1.8 X 109/L; Hgb 7.2 g/dL; Hct 20.2 g/dL; Plt 89,000; RBC 3.9 x 1012/L. Which of the following actions should the nurse take FIRST? a. Call the physician b. Obtain IV access c. Review the MAR with a chemo-competent nurse d. Assist the client to the bedside commode e.

Questions 11-20: Alternate Format

11. A client with cancer has neutropenia. The nurse can expect to observe which of the following signs and symptoms? (check all that apply) a. b. c. d. e. hyperthermia tachycardia thirst LUQ abdominal pain thrush

12. A 52-year old client with uterine cancer weighs 145lbs and is 5ft 6in tall. Her body surface area is 1.75m2. The patient is to receive Paclitaxel (Taxol) 50mg/m2 as part of her cancer therapy. What is the correct dose that the nurse should administer? Record your answer using one decimal place. ________ 13. The nurse is assessing a client who is preparing to undergo an emergency splenectomy after a motor vehicle accident. The nurse should assess the spleen in which area of the abdomen, as labeled A, B, C, D, below?

14. The nurse is caring for a client diagnosed with Leukemia. In reviewing the clients recent laboratory values, the nurse sees the charts below. By evaluating trends, the nurse estimates that the client is at greatest risk for infection on which day?

TEST DEVELOPMENT __________________________________ April 30, 2012 7.4 21.8 62 2.56 1.1 45 12 13 29 May 1, 2012 7.2 20.1 36 2.66 0.8 55 14 8 38 May 2, 2012 8.1 22.9 71 2.89 1.3 52 10 7 21

Hemoglobin (g/dL) Hematocrit (g/dL) Platelets ( x 109/L) RBC ( x 1012/L) WBC ( x 109/L) Neutrophils (%) Monocytes Basophils Bands (%)

15. Based on the above question, calculate the clients Absolute Neutrophil Count to determine the clients risk for infection on May 1st. Infection Risk Not significant Minimal Moderate Severe ANC 1500-2000 1000-1500 500-1000 <500 x White blood cell (WBC) count

ANC (cells/mm3) = % Neutrophils + % Bands 100

(Note: In this formula, WBC is reported in cells/mm3. Therefore, WBC of 7.2 would be 7200 for the formula) What was the ANC on May 1st, 2012? ____________ 16. A nurse is preparing to administer a fentanyl patch (Duragesic) to a client. After explaining the procedure to the client and checking the five rights, the nurse takes all of these actions. Drag the actions from the first column and place them in order from first to sixth in the second column. All of the actions must be used, and each action should only be used once. A. B. C. D. E. F. G. Place the patch on the skin Document the administration Clean the skin appropriately Wash the hands Remove old patch Remove gloves Put on gloves 1. 2. 3. 4. 5. 6. 7.

17. The nurse reads a report of a clients KUB (kidneys, ureters, and bladder) X-ray that shows a large mass in the hepatic flexure of the colon. Choose the letter that best corresponds with the hepatic flexure in the picture below.

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18. A client returned to the unit after a CAT scan of the Abdomen and Pelvis to assess his Kidney cancer. The nurse reads the report, which states A 6cm tumor is seen in the right kidney, with metastases noted in one right lumbar lymph node. A PET scan showed no distant metastases. Using the charts below, what is the TNM staging for this client? Primary Tumor (T) TX Primary tumor cannot be assessed T0 No evidence of primary tumor T1 Tumor 7cm or less in greatest dimension, limited to kidney T2 Tumor more than 7cm in greatest dimension, limited to kidney T3 Tumor extends into major veins or invades adrenal gland T3a Tumor directly invades adrenal gland or perirenal and/or renal sinus T3b Tumor grossly extends into the renal vein or its segmental branches T3c Tumor grossly extends into vena cava above diaphragm T4 Tumor invades beyond Gerotas fascia

Regional Lymph Nodes (N) NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastases N1 Metastases in a single regional lymph node N2 Metastasis in more than one regional lymph node A. B. C. D. T2, N1, M0 T2, N0, M0 T1, N1, M0 T1, N2, M1

Distant Metastases (M) MX Distant metastasis cannot be assessed M0 No distant metastasis M1 Distant metastasis

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19. A client has been admitted to the unit for an adverse reaction to chemotherapy. During the admission assessment, the nurse notes ulcers and redness in the mucosal membranes of the clients mouth. The client states his mouth is painful and he has not been able to eat solid foods for the last three days. What are some suggestions the nurse might give to the client? (check all that apply) a. b. c. d. e. f. g. Encourage oral hygiene Limit fluid intake to 1 liter per day Encourage a soft, bland diet with high-calorie foods Suggest that the client refuse his next chemotherapy treatment Use antimicrobial rinses such as Peridex Do not use topical anesthetics, such as viscous lidocaine Report more than 5 stools a day to your doctor

20. A client is 3 days post-op from a small bowel resection, sigmoid resection, and creation of colostomy with Hartmanns pouch for stage III colorectal cancer. The nurse is to change the clients stoma appliance and empty the stoma draining bag. The nurse will take all of the following actions. Place the actions in order from first to last by dragging the action from the left column to the right. A. B. C. D. E. F. Empty the stoma bag into a measurement device Apply the new appliance Measure the wafer to the stoma and cut the wafer Clean the area around the stoma Assess the stoma Remove the old stoma appliance 1. 2. 3. 4. 5. 6.

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References 1. a. Rote, N.S., & McCance, K.L. (2010). Structure and Function of the Hematologic System. In K. L. McCance, & S.E. Huether (Eds.), Pathophysiology: The Basis for Disease in Adults and Children (pp. 954-956). Missouri: Mosby Elsevier. b. Leukocytes. (2009). In D. Venes (Ed.), Tabers Cyclopedic Medical Dictionary, (pp. 1321).
Philadelphia: F.A. Davis Company.

2. Kaushansky, K., & Kipps, T.J. (2006). Hematopoietic Agents. In L.L. Brunton, J.S. Lazo, & K.L. Parker (Eds.), Goodman & Gilmans The Pharmacological Basis of Therapeutics (pp. 1440-1441). New York: McGraw Hill. b. Neupogen. (2012). Drug Information by Drugs.com. Retrieved from http://www.drugs.com/pro/neupogen.html 3. a. Rote, N.S., & McCance, K.L. (2010). Alterations of Leukocyte, Lymphoid, and Hemostatic
Function. In K. L. McCance, & S.E. Huether (Eds.), Pathophysiology: The Basis for Disease in Adults and Children (pp. 1043-1044). Missouri: Mosby Elsevier.

b. Groshong C.V. Catheters. (2011). Bard Access Systems. Retrieved from http://www.bardaccess.com/assets/pdfs/nursing/ng-grosh-cath.pdf 4. Gutstein, H.B. & Akil, H. (2006). Opioid Analgesics. In L.L. Brunton, J.S. Lazo, &
K.L. Parker (Eds.), Goodman & Gilmans The Pharmacological Basis of Therapeutics

(pp. 561-566). New York: McGraw Hill. b. Benyamin, R., Trescot, A.M., Datta, S., Buenaverntura, R., Adlaka, R., Sehgal, N., & Vallejo, R. (2008). Opioid Complications and Side Effects. Pain Physician, 11, pp. S105S120. 5. a. Crowley, M.J. (2008). Supportive Care: Dying and Death. In S. Newton, M. Hickey, &

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J. Jackowski (Eds.), Mosby's Oncology Nursing Advisor: A Comprehensive Guide to Clinical Practice (pp. 102-104). St. Louis: Mosby Elsevier.
b. Hospice. (2009). In D. Venes (Ed.), Tabers Cyclopedic Medical Dictionary, (pp. 1094). Philadelphia: F.A. Davis Company.

6. a. Holmes Gobel, B. (2008). Metabolic Emergencies. In S. Newton, M. Hickey, & J. Jackowski (Eds.), Mosby's Oncology Nursing Advisor: A Comprehensive Guide to Clinical Practice (pp. 385-388). St. Louis: Mosby Elsevier. b. Rote, N.S., & McCance, K.L. (2010). Alterations of Leukocyte, Lymphoid, and Hemostatic Function.
In K. L. McCance, & S.E. Huether (Eds.), Pathophysiology: The Basis for Disease in Adults and Children((pp. 1050-1054). Missouri: Mosby Elsevier.

7. Witt, M.E. (2008). Nursing Implications of Radiation Therapy. In S. Newton, M. Hickey, & J. Jackowski (Eds.), Mosby's Oncology Nursing Advisor: A Comprehensive Guide to Clinical Practice (pp. 749-761). St. Louis: Mosby Elsevier. b. Radiation Safety Manual: Management of Brachytherapy Patients. (2002). University of Southern California. Retrieved from http://capsnet.usc.edu/labsafety/rad/documents/COMBINE5.pdf 8. a. Holmes Gobel, B. (2008). Metabolic Emergencies. In S. Newton, M. Hickey, & J. Jackowski (Eds.), Mosby's Oncology Nursing Advisor: A Comprehensive Guide to Clinical Practice (pp. 395-399). St. Louis: Mosby Elsevier.
b. Hyperkalemia. (2009). In D. Venes (Ed.), Tabers Cyclopedic Medical Dictionary, (pp. 1116-1117). Philadelphia: F.A. Davis Company.

9. a. Szopa, T.J. (2008). Nursing Implications of Surgical Treatment. In S. Newton, M. Hickey, & J. Jackowski (Eds.), Mosby's Oncology Nursing Advisor: A Comprehensive Guide to Clinical Practice (pp. 736-746). St. Louis: Mosby Elsevier.

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b. Post-Operative Care. (2003). World Health Organization. Retrieved from http://www.who.int/surgery/publications/Postoperativecare.pdf 10. a. Vogt Temple, S., & Poniatowski, B.C. (2008). Nursing Implications of Antineoplastic Therapy. In S. Newton, M. Hickey, & J. Jackowski (Eds.), Mosby's Oncology Nursing Advisor: A Comprehensive Guide to Clinical Practice (pp. 785-800). St. Louis: Mosby Elsevier. b. Virshup, D.V. (2010). Biology, Clinical Manifestations, and Treatment of Cancer. In K. L.
McCance, & S.E. Huether (Eds.), Pathophysiology: The Basis for Disease in

Adults and Children (pp. 387-391). Missouri: Mosby Elsevier. 11. a. Campbell-Sorrell, D. (2008). Myelosuppression. In S. Newton, M. Hickey, & J. Jackowski (Eds.), Mosby's Oncology Nursing Advisor: A Comprehensive Guide to Clinical Practice (pp. 259-264). St. Louis: Mosby Elsevier. b. Goodwin, J.E. (2011). Neutropenia Clinical Presentation. Medscape Reference. Retrieved from http://emedicine.medscape.com/article/204821-clinical 12. a. Chabner, B.A., Amrein, P.C., Druker, B.J., Dror Michaelson, M., Mitsiades, C.S., Goss, P.E.& Wilson, W.H. (2006). Antineoplastic Agents. In L.L. Brunton, J.S. Lazo, &
K.L. Parker (Eds.), Goodman & Gilmans The Pharmacological Basis of Therapeutics

(pp. 1352-1354). New York: McGraw Hill. b. Body Surface Area. (2000). Weill Medical College of Cornell University. Retrieved from http://www-users.med.cornell.edu/~spon/picu/calc/bsacalc.htm
13. a. Rote, N.S., & McCance, K.L. (2010). Structure and Function of the Hematologic System. In K. L. McCance, & S.E. Huether (Eds.), Pathophysiology: The Basis for Disease in Adults and Children (pp. 957-958). Missouri: Mosby Elsevier. b. Spleen. (2009). In D. Venes (Ed.),Tabers Cyclopedic Medical Dictionary, (pp. 2177-2178).

TEST DEVELOPMENT Philadelphia: F.A. Davis Company.

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14. a. McDonald. M.E. (2007). Selected-Response Format: Developing Multiple-Choice Items. In The Nurse Educators Guide to Assessing Learning Outcomes (pp. 81-124). Boston: Jones and Bartlett Publishers. b. Pagana, K.D., & Pagana, T.J. (2009). Mosbys Diagnostic and Laboratory Test Reference: White blood cell count and differential count (pp. 998-1001). St. Louis: Mosby Elsevier. 15. a. Patient Education: Understanding Your Complete Blood Count. (2008). National Institutes of Health Clinical Center. Retrieved from http://www.cc.nih.gov/ccc/patient_education/pepubs/cbc97.pdf b. Campbell-Sorrell, D. (2008). Myelosuppression. In S. Newton, M. Hickey, & J. Jackowski (Eds.), Mosby's Oncology Nursing Advisor: A Comprehensive Guide to Clinical Practice (pp. 259-264). St. Louis: Mosby Elsevier. 16. McDonald. M.E. (2007). Selected-Response Format: Developing Multiple-Choice Items. In The Nurse Educators Guide to Assessing Learning Outcomes (pp. 81-124). Boston: Jones and Bartlett Publishers. 17. Strohl, R.A. (2008). Nursing Care of the Client with Cancers of the Gastrointestinal Tract. In S. Newton, M. Hickey, & J. Jackowski (Eds.), Mosby's Oncology Nursing Advisor: A Comprehensive Guide to Clinical Practice (pp. 537-549). St. Louis: Mosby Elsevier.
b. Colon. (2009). In D. Venes (Ed.),Tabers Cyclopedic Medical Dictionary, (pp. 487-488). Philadelphia: F.A. Davis Company.

18. ORourke, M. (2008). Nursing Care of the Client with Cancers of the Urinary System. In S. Newton, M. Hickey, & J. Jackowski (Eds.), Mosby's Oncology Nursing Advisor: A Comprehensive Guide to Clinical Practice (pp. 584-593). St. Louis: Mosby Elsevier.

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b. National Cancer Institute at the National Institutes of Health. (2012). Renal Cell Cancer Treatment (PDQ): Stage Information for Renal Cell Cancer. Retrieved from http://www.cancer.gov/cancertopics/pdq/treatment/renalcell/HealthProfessional/page3 19. Berendt, M., & DAgostino, S. (2008). Alterations in Nutrition. In S. Newton, M. Hickey, & J. Jackowski (Eds.), Mosby's Oncology Nursing Advisor: A Comprehensive Guide to Clinical Practice (pp. 284-289). St. Louis: Mosby Elsevier. b. National Cancer Institute at the National Institutes of Health (2012). Oral Complications of Chemotherapy and Head/Neck Radiation (PDQ). Retrieved from http://www.cancer.gov/cancertopics/pdq/supportivecare/oralcomplications/HealthProfessi onal/page5 20. Kuck, A.W., & Ricciardi, E. (2008). Alterations in Elimination. In S. Newton, M. Hickey, & J. Jackowski (Eds.), Mosby's Oncology Nursing Advisor: A Comprehensive Guide to Clinical Practice (pp. 336-340). St. Louis: Mosby Elsevier. b. American Cancer Society. (2007). Colostomy: A Guide. Retrieved from http://www.cancer.org/acs/groups/cid/documents/webcontent/002823-pdf.pdf

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Test Key 1. b 2. b 3. d 4. b 5. b 6. c 7. a 8. c 9. c 10. a 11. a, b, e 12. 87.5 mg 13. b 14. May 1st, 2012 15. 744 16. 1. d, 2. g, 3. e 4. c 5. a 6. F, 7. b 17. b 18. c 19. a, c, e, g 20. 1. a, 2. f, 3. d, 4. e, 5.c, 6. b