Key to being successful in the NCLEX understands how the exam works. The NCLEX uses computer adaptive testing to provide candidates a truly objective, efficient, and comprehensive testing experience.
In order to understand CAT, we must first understand that there are four levels of learning. At the very superficial level, we have knowledge level; this is also known as recall and recognition level. At this level, you must demonstrate enough knowledge or factual information like anatomy & physiology, normal, lab and vital sign values, and signs & symptoms.
For example, if you were asked to identify a complication that you can anticipate during the 1st 24 hours after a percutaneous liver biopsy, could you identify “hemorrhage” as the potential complication? To answer this level of question, you were just asked to recall what you learned about the liver, a highly vascular organ that when punctured, like in a biopsy, internal hemorrhage can result.
The next level of questioning is Comprehension. In this level, you are to demonstrate an ability to interpret, classify, and organize information. So if we take the same topic of liver biopsy and ask why hemorrhage is a complication of a liver biopsy, you should be able to answer that it is because liver cells are bathed with a mixture of venous and arterial blood.
The level of questioning that you want to aim for and sustain is the level of application. At this level, you must demonstrate an ability to make decisions like a nurse regarding the next course of action because of what you know and understand.
For example, taking the liver biopsy question again, If you were asked what symptoms you expect to see if there is a complication from the procedure, you should be able to choose assessments that reflect signs of bleeding like tachycardia, hypotension, and tachypnea. All are signs of an internal hemorrhage. Abdominal distention and discomfort could also indicate bleeding but it is non-specific or what we call a probable vs. absolute sign.
The highest level of questioning is analysis. At this level you are able to compare and contrast a variety of elements of information and be able to adjust your response as a nurse in consideration of all the variations in standard case scenarios.
Let’s say you have a patient complaining of abdominal pain 1 hr. after a liver biopsy, what do you need to do 1st if you note abdominal distention and rigidity upon inspection? Well, in the previous questions, you understood that abdominal pain, distention, and rigidity could all be a symptom of internal bleeding, but as a nurse, you need to confirm your suspicion with additional data like vital signs to identify tachycardia, hypotension, and tachypnea.
Now, let us take a look at how the CAT works, utilizing these levels of questioning. Here is the minimum passing level and the four levels. Let us say the exam throws you a question that is at the level of application and you get it right, it will throw you another and another. Let us say you got one wrong; the exam will adjust the level of difficulty based on your previous answers and provide you a level of question slightly below until you start getting questions right again, which will titrate the level up. At the end of the minimal level of questions, the test will evaluate how many questions you got right above the level of passing, if enough…you have passed. The opposite can happen if the exam keeps throwing you questions and most of your questions fall below or near passing standard, in which case it would shut off.
So you see, if a candidate is performing at near passing, the test can go on longer and longer, until it can provide enough statistical proof that you are performing above, near, or below competency level for all the client care needs categories.
In conclusion, the CAT exam does a really great job in evaluating the depth of knowledge that a candidate has to perform as a competent nurse. So it is really important to not only review content but take it a step further and exercise your ability to make decisions like a nurse by taking practice questions that reinforce application levels and higher.
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