Bosher Workshop on Linguistic Modification of MC Test

Bosher Workshop on Linguistic Modification of MC Test Items MARILN Fall Conference October 26, 2018

Avoiding Item-Writing Flaws in Multiple-Choice Tests:

Criteria for Test Questions

1. Options follow grammatically from the stem. 2. Options are of equal length; key is not longer, more specific, or more complete. 3. Same word is not repeated in stem and key. 4. Lead-in is in question format, not completion format. 5. Negative phrasing is avoided. 6. Best-answer wording is capitalized, bolded and/or underlined. 7. Task/content of the stem is not tricky or unnecessarily complicated. 8. Stem is clear and unambiguous. 9. “None of the above” or “All of the above” are not used as options. 10. Options are grammatically consistent or parallel in form. 11. Repetitious wording in the options is avoided. 12. Complex multiple-choice format is avoided (i.e., only one answer per option). 13. Options are logically compatible with the stem. 14. There are no reduced or implied conditionals in the stem. 15. There are no embedded or reduced clauses.

2

16. Questions are placed at the beginning of the sentence, not at the end. 17. Unnecessary or inconsistent use of modals (e.g., may, would, should) is avoided. 18. Active voice is used rather than passive voice. 19. Referents of pronouns are unambiguous. 20. Subjects of active verbs and recipients of passive verbs are always clear. 21. There are no dangling participles. 22. The wording is clear and concise. 23. The wording is consistent between the stem and options and among the options. 24. Items do not include culturally specific information. Related Publications: Bosher, S.D. (2008). Removing language as a barrier to success on multiple-choice

nursing exams. In S.D. Bosher and M.D. Pharris (Eds.), Transforming nursing education: The culturally inclusive environment (pp. 259-284). New York: Springer Publishing.

Bosher, S.D. & Bowles, M. (2008, May-June). The effects of linguistic modification on ESL students’ comprehension of nursing course test items. Nursing Education Perspectives, 29(3), 165-172. Bosher, S.D. (2003, January-February). Barriers to creating a more culturally diverse nursing profession: Linguistic bias in multiple-choice nursing exams. Nursing Education Perspectives, 24(1), 25-34. Contact Information: Susan Bosher, PhD Professor and Director of ESL English Department St. Catherine University [email protected] 651-690-6862

mailto:[email protected]

3

Workshop on Linguistic Modification of

Multiple-Choice Test Items

MARILN Fall Conference

Sutton, MA

October 26, 2018

QUESTIONS FOR PRACTICE

SET A: #1-8

ORIGINAL:

1. When a nurse signs an informed consent as a witness, what is the nurse

affirming?

*a. That the client agreeing to the procedure was the person who signed the

consent.

b. That the client understood the information about the procedure before

making a decision.

c. That the physician explained all components of the informed consent.

d. That the nurse explained all the components of the informed consent.

REVISED:

4

ORIGINAL:

2. A 16-year-old client, who lives in a state with an emancipated minor law, needs

to have a dilation and curettage (D&C) after the manual delivery of the placenta.

Who can legally give informed consent for the client to have this procedure?

*a. The client.

b. The client’s physician.

c. The client’s mother.

d. The client’s best friend.

REVISED:

5

ORIGINAL:

3. Which of the following best describes the goal of childbirth education?

*a. It provides expectant parents with knowledge and skills necessary to cope

with the perinatal experience.

b. It prepares expectant parents for everything they need to know about labor

and delivery.

c. It provides time for expectant parents to express their fears and concerns

and to help them when interviewing potential providers.

d. It ensures infant health and maternal well-being.

REVISED:

6

ORIGINAL:

4. Two days ago a woman gave birth to a full-term infant. Last night she awakened

several times to urinate and noted that her gown and bedding were wet from profuse

diaphoresis. One mechanism for the diaphoresis and diuresis that this woman is

experiencing during the early postpartum period is:

a. Elevated temperature caused by postpartum infection.

b. Increased basal metabolic rate after giving birth.

*c. Loss of increased blood volume associated with pregnancy.

d. Increased venous pressure in the lower extremities.

REVISED:

7

ORIGINAL:

5. Through vaginal examination, the nurse determines that a woman is 4 cm dilated,

and the external fetal monitor shows uterine contractions every 3 1/2 to 4 minutes.

The nurse reports this as:

a. First stage, latent phase

*b. First stage, active phase

c. First stage, transition phase

d. Second stage, latent phase

REVISED:

8

ORIGINAL:

6. While evaluating an external monitor tracing of a woman in active labor, the

nurse notes that the fetal heart rate (FHR) for five sequential contractions begins to

decelerate late in the contraction, with the nadir of the decelerations occurring after

the peak of the contraction. The nurse’s first priority is to:

*a. Change the woman’s position.

b. Notify the health care provider.

c. Assist with an amnioinfusion.

d. Insert a scalp electrode.

REVISED:

9

ORIGINAL:

7. The labor and delivery nurse performs Leopolds’ maneuvers. A soft round mass

is felt in the fundal region. A flat object is noted on the left and small objects are

noted on the right of the uterus. A hard round mass is noted above the symphysis.

Which of the following positions is consistent with these findings?

*a. Left occipital anterior (LOA)

b. Left sacral posterior (LSP)

c. Right occipital posterior (ROP)

d. Right sacral posterior (RSP)

REVISED:

10

ORIGINAL:

8. One hour ago, a multipara was examined with the following results: 8 cm, 50%

effaced , and +1 station. She is now pushing with contractions and the fetal head is

seen at the vaginal introitus. The nurse concludes that the client is now:

a. 9 cm dilated, 70%effaced, and +2 station

b. 9 cm dilated, 80% effaced and +3 station

c. 10 cm dilated, 90% effaced and +4 station

*d. 10 cm dilated, 100% effaced and +5 station

REVISED:

11




Sutton, MA

October 26, 2018


SET B: #9-16

ORIGINAL:

9. Which time-based description of a stage of development in pregnancy is

accurate?

*a. Age of viability-22 to 37 weeks since the last menstrual period (assuming

a fetal weight greater than 500 g).

*b. Term—pregnancy from the beginning of week 38 of gestation to the end

of week 41.

c. Preterm—pregnancy from 20 to 28 weeks.

d. Postdate—pregnancy that extends beyond 38 weeks.

REVISED:

12

ORIGINAL:

10. A woman’s obstetric history indicates that she is pregnant for the fourth time,

and all her children from previous pregnancies are living. One was born at 39 weeks

of gestation, twins were born at 34 weeks of gestation, and another child was born

at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system?

a. 3-1-1-1-3

*b. 4-1-3-0-4

c. 3-0-3-0-3

d. 4-2-1-0-3

REVISED:

13

ORIGINAL:

11. Which physiological cervical changes associated with pregnancy should a nurse

expect to find during a physical assessment? (choose all that apply)

*a. Formation of mucous plug

*b. Chadwick’s sign

c. Presence of colostrum

*d. Goodell’s sign

e. Cullen’s sign

REVISED:

14

ORIGINAL:

12. A nurse is assessing a newborn girl who is 2 hours old. What finding warrants a

call to the physician?

a. Blood glucose of 50 mg/dl using a Dextrostix.

b. Heart rate of 160 beats/min after crying vigorously.

*c. A crepitous-like feeling when assessing the clavicles.

d. Passage of a dark black-green substance from the rectum.

REVISED:

15

ORIGINAL:

13. The laboratory results for a postpartum woman are as follows: blood type, A;

Rh status, positive; rubella titer negative, hematocrit, 30%. How would the nurse

best interpret this data?

*a. Rubella vaccine should be given.

b. A blood transfusion is necessary.

c. Rh immune globulin is necessary within 72 hours of birth.

d. A Kleihauer-Betke test should be performed.

REVISED:

16

ORIGINAL:

14. The volume of amniotic fluid is an important factor in assessing fetal well-

being. Oligohydramnios (an amniotic fluid volume of less than 300 ml) is

associated with what kind of fetal anomalies?

*a. Renal

b. Cardiac

c. Gastrointestinal

d. Neurologic

REVISED:

17

ORIGINAL:

15. The nurse is using the New Ballard Scale to determine the gestational age of a

newborn. Which assessment finding is consistent with a gestational age of 40

weeks?

*a. Flexed posture

b. Abundant lanugo

c. Smooth, pink skin with visible veins

d. Faint red marks on the soles of the feet

REVISED:

18

ORIGINAL:

16. With regard to rubella and Rh issues, nurses should be aware that:

a. Breastfeeding mothers cannot be vaccinated with the live attenuated

rubella virus.

*b. Women should be warned that the rubella vaccination is teratogenic and

they must avoid pregnancy for at least 1 month after vaccination.

c. Rh immune globulin is safely administered intravenously because it cannot

harm a nursing infant.

d. Rh immune globulin boosts the immune system and thereby enhances the

effectiveness of vaccinations.

REVISED:

19




Sutton, MA

October 26, 2018


SET C: #17-24

ORIGINAL:

17. The nurse administers vitamin K to the newborn for what reason?

a. Most mothers have a diet deficient in vitamin K, which results in the infant

being deficient.

b. Vitamin K prevents the synthesis of prothrombin in the liver and must be

given by injection.

*c. Bacteria that synthesize vitamin K are not present in the newborn’s

intestinal tract.

d. The supply of vitamin K is inadequate for at least 3 to 4 months, and the

newborn must be supplemented.

REVISED:

20

ORIGINAL:

18. A client enters the labor and delivery suite. It is essential that the nurse note the

woman’s status in relation to which of the following infectious diseases in

anticipation of any medications that may need to be given during labor? (choose all

that apply)

a. Hepatitis B

b. Rubeola

c. Varicella

*d. Group B streptococcus

*e. HIV/Aids

REVISED:

21

ORIGINAL:

19. A labor nurse is caring for a client 30 weeks gestation who is symptomatic from

a complete placenta previa. Which of the following orders should the nurse

question?

a. Administer betamethasone (Celestone) 12 mg IM daily times 2.

b. Maintain strict bed rest.

*c. Assess cervical dilation.

d. Regulate IV to 150 mL/hr.

REVISED:

22

ORIGINAL:

20. Which of the following lab values should the nurse report to the physician as

being consistent with the diagnosis of HELLP syndrome?

a. Hematocrit 48%

b. Potassium 5.5 mEq/L

*c. Platelets 60,000

d. Sodium 130 mEq/L

REVISED:

23

ORIGINAL:

21. Four minutes after completion of the second stage of labor, there is a sudden

gush of blood from the patient’s vagina and about six inches of umbilical cord

slides out of her vagina. What should the nurse do?

a. Give IV oxytocin to stop the bleeding.

b. Place the bed in Trendelenberg position and fingers on the presenting part.

c. Wrap the cord in normal saline.

*d. Watch for emergence of the placenta.

REVISED:

24

ORIGINAL:

22. A physician writes an order to administer Ampicillin 1 g IV every 4 hrs until

delivery for a newly admitted client who is group B strep positive with ruptured

membranes. Which of the following is the rationale for this order?

a. The client is at high risk for chorioamnionitis.

*b. The baby is at high risk for neonatal sepsis.

c. The bacterium is sexually transmitted.

d. The bacterium causes puerperal sepsis.

REVISED:

25

ORIGINAL:

23. All of these statements about physiologic jaundice are true EXCEPT:

a. Neonatal jaundice is common, but kernicterus is rare.

b. The appearance of jaundice during the first 24 hours or beyond day 7

indicates a pathologic process.

c. Because jaundice may not appear before discharge, parents need

instruction on how to assess it and when to call for medical help.

*d. Breastfed babies have a lower incidence of jaundice

REVISED:

26

ORIGINAL:

24. Four babies are in the nursery. The nurse pages the neonatologist to see the baby

who exhibits which of the following?

*a. Intracostal retractions

b. Erythema toxicum

c. Pseudostrabismus

d. Vernix caseosa

REVISED:

27




Sutton, MA

October 26, 2018


SET D: #25-31

ORIGINAL:

25. A newborn in the nursery is exhibiting signs of neonatal abstinence syndrome.

Which of the following signs/symptoms is the nurse observing?

*a. Hyperphagia

b. Lethargy

c. Prolonged periods of sleep

*d. Increased tone

*e. Tachypnea

REVISED:

28

ORIGINAL:

26. A nurse is assessing a full-term, breastfeeding newborn who is 9 lb 2 oz, 21

inches long, TPR: 96.6 degrees F, 158, 62, jittery, pink body with bluish hands and

feet, crying. Which of the following actions is of highest priority to initiate?

a. Swaddle the baby to provide warmth.

*b. Assess the glucose level of the baby.

c. Take the baby to the mother for feeding.

d. Administer the neonatal medications.

REVISED:

29

ORIGINAL:

27. A woman gave birth to a 7 lb 6 oz infant girl 1 hour ago. The birth was vaginal

and the estimated blood loss (EBL) was 1500 ml. When assessing the woman’s

vital signs, the nurse is concerned to see:

*a. Temperature 37.9° C, heart rate 120, respirations 20, blood pressure

90/50.

b. Temperature 37.4° C, heart rate 88, respirations 36, blood pressure 126/68.

c. Temperature 38° C, heart rate 80, respirations 16, blood pressure 110/80.

d. Temperature 36.8° C, heart rate 60, respirations 18, blood pressure 140/90.

REVISED:

30

ORIGINAL:

28. The nurse should suspect puerperal infection when a client exhibits which of the

following?

a. Temperature of 100.2 degrees F.

b. White blood cell count of 14,500 cells/mm3.

c. Diaphoresis during the night.

*d. Malodorous lochial discharge.

REVISED:

31

ORIGINAL:

29. Which symptom would the nurse expect to observe in a postpartum client with a

vaginal hematoma?

*a. Pain

b. Bleeding

c. Warmth

d. Redness

REVISED:

32

ORIGINAL:

30. A nurse is caring for a pregnant patient who is positive for human

immunodeficiency virus (HIV). To help prevent the transmission of HIV from the

woman to her baby the nurse will try to avoid:

a. A cesarean section.

b. An intrauterine pressure catheter.

c. An epidural.

*d. Internal fetal scalp monitoring.

REVISED:

33

ORIGINAL:

31. The estrogen content in the contraceptive pill performs which of the following

actions?

a. Decreases the permeability of the cervical mucous.

b. Increases the level of luteinizing hormone (LH).

c. Interferes with endometrial proliferation.

*d. Suppresses the follicle-stimulating hormone (FSH).

REVISED

34




Sutton, MA

October 26, 2018


SET E

Leadership-Delegation: #1-5

ORIGINAL:

1. A LPN/VN is the team leader working on the chronic respiratory rehabilitative

care unit and assigns the UAP specific patient care activities. The RN intervenes

and speaks directly to the LPN/VN if the UAP is initially assigned to which

activity?

a. Documenting routine data on patients after daily physical therapy activities

b. Feeding a patient after a bronchoscopic procedure at the bedside

c. Ambulating a patient post thoracotomy who has been stable for 24 hours

d. Completing a set of vital signs on a newly transferred patient

REVISED:

35

ORIGINAL:

2. The UAP reports that a client who is three days status post hip replacement

refuses to get out of bed to walk in the hall as ordered. What is the nurse’s best

initial action?

a. Assess the client for the reason for not wanting to walk.

b. Ask the LPN/LVN to administer a prn pain medication.

c. Tell the UAP that the client needs to walk to prevent pneumonia.

d. Remind the UAP that the client has the right to refuse.

REVISED:

36

ORIGINAL:

3. A client is prepared for a bronchoscopic procedure. The RN administers an

intravenous sedative to the client. Which activity could then be delegated to the

LPN/LVN?

a. Giving the client small sips of water for dry mouth.

b. Checking the client’s blood pressure and pulse.

c. Teaching the client about the procedure.

d. Walking with the client to the bathroom.

REVISED:

37

ORIGINAL:

4. A staff nurse from the adult respiratory unit is floated to the pediatric unit for the

night shift and assigned, by a new charge nurse, to the following patients. Which

patient would be better assigned to a pediatric unit nurse and not to the float nurse?

a. an 8-year-old admitted with asthma

b. a 6-year-old admitted in sickle cell crisis

c. a 7 year-old with a recent chest tube insertion

d. a 5-year-old who had a bronchoscopy earlier in the day

REVISED:

38

ORIGINAL:

5. The RN, LPN, and UAP have been assigned to care for clients on the pediatric

unit. Which nursing task will most likely be assigned to the LPN?

a. Administer PO medications to the client diagnosed with sickle cell anemia.

b. Take routine vital signs for all clients on the pediatric unit.

c. Transcribe the healthcare provider’s orders into the computer.

d. Assess the urinary output of a client newly diagnosed with nephrotic

syndrome.

REVISED:

39




Sutton, MA

October 26, 2018


SET F

Practical Nursing: #1-5

ORIGINAL:

1. The nurse is caring for a patient with pericarditis. Which of the following

assessment findings would support this diagnosis?

a. Patechiae

b. Murmur

c. Rash

d. Friction Rub

REVISED:

40

Bosher Working Effectively with EAL Writers in Nursing MARILN Fall Conference October 26, 2018

Sample Paper: Clinical Reflection Paper Introduction.

Experience that I’ve got during my clinical hours gave me a lot of knowledge and

understanding of the hospital setting. I didn’t have any conflicts with my patients and stuff. I

would consider myself as an easy person. I am trying to prevent any sort of conflict. There are

different situations in our life. We are proud of ourselves in some of them and feel regret in

others. This is important to learn lessons from situations that are not really pleasant.

What?

My preceptorship was my first clinical experience in the United States. I wish we had

more clinical hours before preseptorship. I really enjoyed working at the hospital. As a new to the

setting and to the culture I had to learn a lot. I was working with one of my patients who just

came from surgery and had problems with hearing. He left his hearing aid at home and could not

hear very well. I tried to speak as loud as I could but he could not hear me. I was coming to his

room to assess and administer medications. There were relatives at the bedside that could talk

louder then me so they were telling him what I was asking. After three or four of my visits my

patient told my preceptor that he doesn’t want me to be his nurse because he could not hear me. I

said to my preceptor that I want our patients to be satisfied and this is fine with me. My preceptor

started taking care of that person.

So what?

I felt really uncomfortable in that situation. I was not sure what would be the right action

to do. It was embarrassing to me at the same time that patient could not hear me. I really wish him

to get better. I thought that I don’t have to do anything. So I just said ok to my preceptor and

didn’t say anything to the patient. Now I feel that I should of go and apologies for any

inconvenience and wish the patient the best in his recovery. It was an easy outcome for me;

however, if I would be an employee I definitely should talk to the patient and try to find the way

to improve communication. What I think of bad this situation brought to me is my preceptor or

other stuff opinion about my ability to care for the patients.

Now what?

41

Now I am working on speaking louder. If I will have this kind of situation again I should

talk to the patient and find the best way in our communication. I also need to ask what patient

think need to be improved in order to provide the best care, and try to improve in that kind of

area. If patients still would not want to work with me I need to talk to the manager or charge nurse

and explain the situation. Then I should wish the best for my patient and let it go.

Conclusion.

This is very important to provide the best care to the patients. Conflict situations

sometimes help us to find the better way. I think that reflecting on the conflicts helps to analyze

the situation and get outcomes that can be effective in the future. I would really appreciate any

suggestion on how to solve that kind of situations because I am new to the American culture and

may not really know how patient and stuff expect me to act.

42

Sample Paper: Research Paper on Maternal Sensitivity Researchers have not been able to determine the factors that impact maternal

sensitivity, few implementations are well to enhance maternal sensitivity (Cooklin, Rowe, &

Fisher, 2012; Ekstrom & Nissen, 2006; Tharner, Marinus H. IJzendoorn, Henriette A. Moll, &

Frank C. Verhulst, 2012). One of the factors that may play a role in improving sensitivity is

breastfeeding (Britton et al., 2006a; Kim et al., 2011a; Kristie A. Brandt & Kvale, 1998; Kuzela,

Stifter, & Worobey, 1990; A. Tharner et al., 2012). Yet, there are few studies focus on

breastfeeding and maternal sensitivity concepts. Some literature exists that shows breastfeeding

has no effect on maternal sensitivity (Clark, Hyde, Essex, & Klein, 1997; Drake, Humenick,

Amankwaa, Younger, & Roux, 2007; Tluczek, Clark, McKechnie, Orland, & Brown, 2010). Such a

discrepancy in literature caused us to question what the true effect of breastfeeding was,

whether such an effect was an effect or not, and why the results in the various studies differed.

Finding the answer for this question is the goal of this study.

Some maternal sensitivity literature has strongly supported the breastfeeding as a factor

in enhancing maternal sensitivity. Describing results from Kim (2011) cited important study as

evidence that doing breastfeeding increases maternal sensitivity. Kim (2011) used two high valid

procedures in study observing 657 mother and infant dyad to measure maternal sensitivity in

including Ainsworth Maternal sensitivity Scale (AMSS) which videotaped interaction between 17

mothers and infants, Then, Kim used MRI to scan active area in mother’s brain during

interaction. The finding of this study found that mother breastfeed show more active area in

area responsible of maternal sensitivity in the brain than bottle feeding mother. Similarly,

Britton (2006) suggested that breastfeeding is a means of increasing maternal sensitivity by

43

using a highly valid questionnaire called Nursing Child Assessment Satellite Training Feeding

Scale (NCAST) at 6 month to measure interaction between mothers and infants. Britton (2006)

results highlighted that breastfeeding mothers had more score in NCAST comparing to bottle

feeding mother. Another study, Pystova (2009) experimental study compared the difference

between early contact and early separation in 176 mothers and infants dyads. Pystova (2009)

found that the practice of early skin-to-skin contact by early breastfeeding during the first two

hours after child birth when compared with early separation between the infants and mothers

affected the maternal sensitivity to her infant, and dyadic and reciprocity and dyadic at the first

year after childbirth. The effect of early separation during the first two hours negatively impact

mother sensitivity. The findings of Pystova’s study support the period after birth (the early

“sensitive period”) during which close contact between mother and infant which include early

practice of breastfeeding may increase long positive relationship between mother and infant.

The results provided by Kim (2011), Britton (2006), and Pystova (2009); suggest breastfeeding

may be related to higher maternal sensitivity.

The previous section aimed to describe the breastfeeding as an important factor of

higher maternal sensitivity, but there are other factors besides breastfeeding impacted maternal

sensitivity includes (skin to skin contact, support from husband and family members caregiving

classes and maternal characteristic). Tessier (1998) found by using observational procedure of

kangaroo care (which is part from skin to skin contact) to compare maternal sensitivity between

kangaroo care group and traditional care shown that mother’s sensitivity was higher in the

kangaroo care Interaction between mother and infant effects many aspect of infant life including

44

duration of the infant’s hospital stay mothers in the traditional care were less sensitive to the

infant staying in hospital longer (14 days) compared with mothers kangaroo care group. Also

find mother kangaroo care group show more responding to the child’s distress than did those in

the traditional group. Similarly, Bystrova (2009) examine the relationship of early mother-infant

interaction versus separation on maternal sensitivity found that the practice of early suckling,

skin-to-skin contact during the first two hour after childbirth, when compared with early

separation effect many variables include dyadic reciprocity and mutuality period and maternal

sensitivity during infancy period. When mother separated from infant was noted the separation

impact mother and infant negatively.

45

Susan Bosher, PhD Working Effectively with EAL Writers in Nursing MARILN Fall Conference October 26, 2018

Questions for Discussion

1. What do you see?

2. Does this writing meet the requirements of the assignment?

3. Does this writing reflect mastery of academic conventions? What

are the writer’s main challenges in that regard?

4. Does this writing reflect mastery of discipline-specific

conventions? What are the writer’s main challenges in that

regard?

5. Does this writing reflect critical literacy?

6. What would you focus on in the feedback you give the student?

7. What writing strategies would you recommend for this student?

Documents

Bosher Workshop on Linguistic Modification of MC Test