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Exam Code: NCLEX-RN National Council Licensure Examination (NCLEX-RN) - 2023 answers January 2024 by Killexams.com team

NCLEX-RN National Council Licensure Examination (NCLEX-RN) - 2023

THE NCLEX-RN® EXAM

The National Council Licensure Examination (NCLEX-RN® exam) has one purpose: To determine if it's safe for you to begin practice as an entry-level nurse. It is significantly different from any test that you took in nursing school. While nursing school exams are knowledge-based, the NCLEX-RN® tests application and analysis using the nursing knowledge you learned in school. You will be tested on how you can use critical thinking skills to make nursing judgments.



NCLEX-RN® TEST FORMAT

FRAMEWORK

The NCLEX-RN® test is organized according to the framework, "Meeting Client Needs." There are four major categories and eight subcategories. Many nursing programs are based on the medical model where students take separate medical, surgical, pediatric, psychiatric, and obstetric classes. However, on the NCLEX-RN® exam, all of the content is integrated.



TYPES OF QUESTIONS

Questions are primarily multiple-choice with four possible answer choices; however, there are also alternate question types. Alternate question types include multiple-response, fill-in-the-blank, hot spots, chart/exhibit and drag-and-drop. All questions involve integrated nursing content.



Let's look at the following question:



A 23-year-old woman with insulin dependent diabetes mellitus (IDDM) is returned to the recovery room one hour after an uneventful delivery of a 9 lb., 8 oz., baby boy. The nurse would expect the woman's blood sugar to



- rise

- fall

- remain stationary

- fluctuate


Is this an obstetrical question or a medical/surgical question? In order to select the correct answer, (2), you must consider the pathophysiology of diabetes along with the principles of labor and delivery.



SAFE AND EFFECTIVE CARE ENVIRONMENT

The first Client Needs Category, Safe and Effective Care Environment, includes two concepts:



Management of Care accounts for 17-23% of questions on the NCLEX-RN® exam. Some of the nursing actions included in this subcategory are Advanced Directives, Advocacy, Case Management, Client Rights, Concepts of Management, Confidentiality, Continuity of Care, Quality Improvement, Delegation, Establishing Priorities, Ethical Practice, Informed Consent, Legal Responsibilities, Referrals, and Supervision.



Safety and Infection Control accounts for 9-15% of test questions. Nursing actions include Accident Prevention, Error Prevention, Hazardous Materials, Surgical Asepsis, Standard Precautions, and Use of Restraints.



HEALTH PROMOTION AND MAINTENANCE

The second Client Needs Category is Health Promotion and Maintenance. These questions account for 6-12% of the exam. Nursing actions tested include the Aging Process, Ante/Intra/Postpartum and Newborn Care, Developmental Stages and Transitions, Disease Prevention, Health Screening, Lifestyle Choices, Physical Assessment Techniques, Health Promotion Programs, High Risk Behaviors, and Self-Care.



PSYCHOSOCIAL INTEGRITY

The third Client Needs Category is Psychosocial Integrity. It accounts for 6-12% of the test and tested nursing actions include Coping Mechanisms, Grief and Loss, Mental Health Concepts, Spiritual Influence on Health, Sensory/Perceptual Alterations, Stress Management, Support Systems, Therapeutic Communication, Chemical Dependency, Behavioral Interventions, Crisis Intervention, Coping Mechanisms, End of Life Care, and Family Dynamics.



PHYSIOLOGICAL INTEGRITY

The final Client Needs Category is Physiological Integrity. It includes four concepts:



Basic Care and Comfort accounts for 6-12% of questions on the NCLEX-RN® exam. Nursing actions included in this subcategory are Assistive Devices, Elimination, Mobility, Nonpharmacological Comfort Interventions, Nutrition and Oral Hydration, Personal Hygiene, as well as Rest and Sleep.



Pharmacological and Parenteral Therapies accounts for 12-18% of the exam. Tested nursing actions include Adverse Effects, Contraindications, Blood and Blood Products, Central Venous Access Devices, Chemotherapy, Expected Effects, Intravenous Therapy, Medication Administration, Pharmacological Pain Management, Total Parenteral Nutrition, and Dosage Calculation.



Reduction of Risk Potential accounts for 9-15% of the exam. Its tested nursing actions include Diagnostic Tests, Laboratory Values, Potential for Complications from Surgical Procedures and Health Alterations, as well as Therapeutic Procedures.



Physiological Adaptation accounts for 11-17% of the exam. Its tested nursing actions include Alterations in the Body Systems, Fluid and Electrolyte Imbalances, Hemodynamics, Medical Emergencies, Pathophysiology, and Unexpected Response to Therapies.



NCLEX-RN® GRADING SYSTEM

PASS/FAIL

The NCLEX-RN® test is pass/fail—there is no numerical score. A determination will be made at the conclusion of the test as to whether you have passed or failed. However, the results will not be made available at the test site. You'll be notified by your State Board of Nursing approximately 2-4 weeks after your test date.



Your first step is to submit an application to the National Council of State Boards of Nursing (NCSBN). You will be required to follow the procedures established by the individual State Boards of Nursing. Some states have combined registration for the NCLEX-RN® test with the application for licensure. In all other states, you must apply for licensure with the State Board of Nursing in the state in which you wish to become licensed. Once you have applied, you will receive a Candidate Bulletin to register for the NCLEX-RN® exam.



National Council Licensure Examination (NCLEX-RN) - 2023
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Question: 122 Section 7
A 35-year-old client is admitted to the hospital for elective tubal ligation. While the nurse is doing preoperative
teaching, the client says, "The anesthesiologist said she was going to supply me balanced anesthesia. What exactly is
that?" The best explanation for the nurse to supply the client would be that balanced anesthesia:
A. Is a type of regional anesthesia
B. Uses equal amounts of inhalation agents and liquid agents
C. Does not depress the central nervous system
D. Is a combination of several anesthetic agents or drugs producing a smooth induction and minimal
complications
Answer: D
(A) Regional anesthesia does not produce loss of consciousness and is indicated for excision of moles, cysts, and
endoscopic surgeries. (B) Varying amounts of anesthetic agents are used when employing balanced anesthesia.
Amounts depend on age, weight, condition of the client, and surgical procedure. (C) General anesthesia is a drug-
induced depression of the central nervous system that produces loss of consciousness and decreased muscle activity.
(D) Balanced anesthesia is a combination of a number of anesthetic agents that produce a smooth induction,
appropriate depth of anesthesia, and appropriate muscle relaxation with minimal complications.
Question: 123 Section 7
A 29-year-old client is admitted for a hysterectomy. She has repeatedly told the nurses that she is panic about having
this surgery, has not slept well lately, and is afraid that her husband will not find her desirable after the surgery.
Shortly into the preoperative teaching, she complains of a tightness in her chest, a feeling of suffocation,
lightheadedness, and tingling in her hands. Her respirations are rapid and deep. Assessment reveals that the client is:
A. Having a heart attack
B. Wanting attention from the nurses
C. Suffering from complete upper airway obstruction
D. Hyperventilating
Answer: D
(A) Classic symptoms of a heart attack include heaviness or squeezing pain in the chest, pain spreading to the jaw,
neck, and arm. Nausea and vomiting, sweating, and shortness of breath may be present. The client does not exhibit
these symptoms. (B) Clients suffering from anxiety or fear prior to surgical procedures may develop hyperventilation.
This client is not seeking attention. (C) Symptoms of complete airway obstruction include not being able to speak, and
no airflow between the nose and mouth. Breath sounds are absent. (D) Tightness in the chest; a feeling of suffocation;
lightheadedness; tingling in the hands; and rapid, deep respirations are signs and symptoms of hyperventilation. This is
almost always a manifestation of anxiety.
Question: 124 Section 7
A client develops complications following a hysterectomy. Blood cultures reveal Pseudomonas aeruginosa. The nurse
expects that the physician would order an appropriate antibiotic to treat P. aeruginosa such as:
A. Cefoperazone (Cefobid)
B. Clindamycin (Cleocin)
C. Dicloxacillin (Dycill)
D. Erythromycin (Erythrocin)
Answer: A
(A) Cefoperazone is indicated in the treatment of infection withPseudomonas aeruginosa.(B) Clindamycin is not
indicated in the treatment of infection withP. aeruginosa.(C) Dicloxacillin is not indicated in the treatment of infection
withP. aeruginosa.(D) Erythromycin is not indicated in the treatment of infection withP. aeruginosa.
Question: 125 Section 7
A couple is experiencing difficulties conceiving a baby. The nurse explains basal body temperature (BBT) by
instructing the female client to take her temperature:
A. Orally in the morning and at bedtime
B. Only one time during the day as long as it is always at the same time of day
C. Rectally at bedtime
D. As soon as she awakens, prior to any activity
Answer: D
(A) Monitoring temperature twice a day predicts the biphasic pattern of ovulation. (B) Prediction of ovulation relies on
consistency in taking temperature. (C)
Nightly rectal temperatures are more accurate in predicting ovulation. (D) Activity changes the accuracy of basal body
temperature and ability to detect the luteinizing hormone surge.
Question: 126 Section 7
A client is having episodes of hyperventilation related to her surgery that is scheduled tomorrow. Appropriate nursing
actions to help control hyperventilating include:
A. Administering diazepam (Valium) 1015 mg po q4h and q1h prn for hyperventilating episode
B. Keeping the temperature in the clients room at a high level to reduce respiratory stimulation
C. Having the client hold her breath or breathe into a paper bag when hyperventilation episodes occur
D. Using distraction to help control the clients hyperventilation episodes
Answer: C
(A) An adult diazepam dosage for treatment of anxiety is 210 mg PO 24 times daily. The order as written would place
a client at risk for overdose. (B) A high room temperature could increase hyperventilating episodes by stimulating the
respiratory system. (C) Breath holding and breathing into a paper bag may be useful in controlling hyperventilation.
Both measures increase CO2 retention. (D) Distraction will not prevent or control hyperventilation caused by anxiety
or fear.
Question: 127 Section 7
A client delivered a stillborn male at term. An appropriate action of the nurse would be to:
A. State, "You have an angel in heaven."
B. Discourage the parents from seeing the baby.
C. Provide an opportunity for the parents to see and hold the baby for an undetermined amount of time.
D. Reassure the parents that they can have other children.
Answer: C
(A) This is not a supportive statement. There are also no data to indicate the familys religious beliefs. (B) Seeing their
baby assists the parents in the grieving process. This gives them the opportunity to say "good-bye." (C) Parents need
time to get to know their baby. (D) This is not a comforting statement when a baby has died. There are also no
guarantees that the couple will be able to have another child.
Question: 128 Section 7
A pregnant client is having a nonstress test (NST). It is noted that the fetal heart beat rises 20 bpm, lasting 20 seconds,
every time the fetus moves. The nurse explains that:
A. The test is inconclusive and should be repeated
B. Further testing is needed
C. The test is normal and the fetus is reacting appropriately
D. The fetus is distressed
Answer: C
(A) The test results were normal, so there would be no need to repeat to determine results. (B) There are no data to
indicate further tests are needed, because the result of the NST was normal. (C) An NST is reported as reactive if there
are two to three increases in the fetal heart rate of 15 bpm, lasting at least 15 seconds during a 15-minute period. (D)
The NST results were normal, so there was no fetal distress.
Question: 129 Section 7
Which stage of labor lasts from delivery of the baby to delivery of the placenta?
A. Second
B. Third
C. Fourth
D. Fifth
Answer: B
(A) This stage is from complete dilatation of the cervix to delivery of the fetus. (B) This is the correct stage for the
definition. (C) This stage lasts for about 2 hours after the delivery of the placenta. (D) There is no fifth stage of labor.
Question: 130 Section 7
On the third postpartum day, the nurse would expect the lochia to be:
A. Rubra
B. Serosa
C. Alba
D. Scant
Answer: A
(A) This discharge occurs from delivery through the 3rd day. There is dark red blood, placental debris, and clots. (B)
This discharge occurs from days 410. The lochia is brownish, serous, and thin. (C) This discharge occurs from day 10
through the 6thweek. The lochia is yellowish white. (D) This is not a classification of lochia but relates to the amount
of discharge.
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Nursing test Pass Rates Appear to Be Rising. Why?

In January 2023, we reported on the reasons why nursing test pass rates fell in 2020 and 2021. In this report, we follow up on what has happened since.

During the first 2 years of the COVID-19 pandemic, the share of candidates who passed the national licensure test to work as a registered nurse fell sharply, from 88.2% to 82.5%, for first-time U.S.-educated candidates, with a smaller decline -- from 72.8% to 68.9% -- for all candidates, including internationally educated and repeat test-takers.

In 2022, pass rates continued to drop, averaging 79.9% (8 percentage points lower than in 2019) for first-time U.S.-educated candidates, and 63.4% for all candidates, the lowest point in the last decade.

In 2023, to most experts' surprise, that spiral appears to be turning around.

Things Are Looking Up

The reason for this reversal depends on whom you ask. Test developers have argued that rates improved due to radical transparency and massive outreach to stakeholders, while some online critics have suggested the test simply got easier. Other nurse educators agreed that the increased transparency and outreach impacted rates, but worry those same measures exacerbated a culture of "teaching to the test."

Understanding trends in test pass rates also requires context.

image
Year-to-Date NCLEX Pass rates for 2023

The National Council of State Boards of Nursing (NCSBN) produces the test that aspiring nurses take to gain licensure: the National Council Licensure Examination (NCLEX). This test uses computerized adaptive testing, which means each test-taker gets virtually a different exam, the difficulty of which changes based on the response given.

Every 3 years, the NCSBN assesses the pass rates for the test and determines whether the current passing standard is appropriate. If the NCSBN's board of directors decides that the level of clinical judgment required of nurses in practice has increased, it can vote to raise the passing standard.

In December 2022, the NCSBN's board voted to keep the current passing standard on the NCLEX through March 31, 2026. Months later, on April 1, the NCSBN launched the Next Generation NCLEX (NGN), a new version of the NCLEX that aims to more effectively measure test-takers' clinical judgment.

Anytime a new test is introduced, pass rates tend to dip by a few percentage points in the first two to three quarters, explained Philip Dickison, PhD, RN, CEO of the NCSBN. He said he was naturally a bit concerned about a new test compounding the "drastic drop in the ability curve" seen during the pandemic, "but it was still the right thing to do."

Keith Rischer, PhD, RN, a nurse educator and owner of KeithRN, a nursing education company, recalled that the last major change to the NCLEX occurred when the passing standard was raised by 0.16 percentage points in 2012. Pass rates fell more than 7 percentage points -- from 90.34% for first-time candidates to 83.04% -- in a single year.

While the NCSBN kept the same passing standard in 2022, the stronger emphasis on clinical judgment and the "unique six-question case studies" in the NGN was predicted to increase the difficulty of the test in some respects.

"There was an anticipation that this was going to be another precipitous decline in NCLEX pass rates," Rischer said.

Post-Pandemic Rebound

However, that wasn't what happened. Instead, preliminary data showed a jump in pass rates, from 79.9% in 2022 to 88.6% in 2023, for all first-time U.S.-educated candidates. Importantly, the 2023 data exclude the fourth quarter of the calendar year, which typically has the lowest pass rate, experts noted.

Still, Dickison said he was "pretty amazed" at the speed of the recovery. Some viewed the change as a "huge increase," but he stressed that rates were starting from a low baseline following a 3-year period when other variables, namely pandemic-related disruptions, impacted pass rates.

"What I think you're seeing ... is that we have rebounded to pre-pandemic ability levels in our measurements," he said.

Dickison credits the rebound to NCSBN's decision to let educators, regulators, and -- controversially -- preparatory groups "under the hood" of the new test for several years before the NGN actually launched.

"The idea was to be as transparent as possible to all stakeholders," Dickison said. This meant leveraging opportunities at conferences and during webinars, and sharing what to expect of the new test -- from case studies and measurement models -- in newsletters. Dickison also credited educators for the big role they played in helping prepare students.

Rayna Letourneau, PhD, RN, executive director of the Florida Center for Nursing, said that while some nurse educators have noted the test has gotten "too easy," she suggested that perhaps the NGN is simply "a more logical way to measure what nursing students are being taught."

Similarly, she attributes the rise in pass rates to the focus on increased resources and preparation of candidates, including the implementation of "student success" coaching programs.

Teaching to the Test?

Rischer seemed to have a different view, pointing out that the NGN offers partial credit for certain "select-all-that-apply" multiple-choice questions. He said that he believes the real reason for improved pass rates is a shift in nursing education, though he added that his hypothesis is, at this point, "conjecture."

"What we have in the nursing literature for over almost 50 years ... is this widening gap between how nursing is taught in the university and college settings and how it's actually practiced at the bedside," he said. "We're not preparing our graduates for real-world practice realities."

Rischer said he grew even more concerned when he learned from online discussions that some professors were using NGN trial items to teach first-semester students.

"That's called teaching to the test," he argued. Instead of teaching students "alternative multiple-choice items, we need to be teaching our students the open-ended thinking of clinical practice."

For example, for a patient who had an appendectomy, Rischer said the appropriate steps are to take vital signs and conduct a head-to-toe assessment.

"There is not a 'select-all-that apply' multiple-choice item on your forehead that I could say, 'You know what? This is the correct answer,'" he added, noting that the NCSBN "is part of the problem." Currently, the primary mechanism that state nursing boards use to measure a program's performance is their first-time pass rate on the NCLEX, which only "reinforc[es] this unhealthy culture of teaching to the test."

The end result of that, as studies have shown, is that "currently less than 10% [of new nurses] have what practice partners would say is entry-level clinical judgment competency," Rischer said, citing a 2021 study. "Complications develop when a nurse doesn't notice or recognize what's most important until it's too late. So ... clinical judgment competency is a big deal. And teaching to the test ... isn't going to solve that."

He said one solution is to move away from first-time test-taker metrics and potentially allow students to take the test twice and then average their score.

Another, more dramatic, change would be to include a skills test or what Rischer calls "demonstrable competencies" for essential skills involved in clinical decision making, which could be evaluated by an "objective observer."

"It will take more time. It will take more money, but this is something that we can and should be doing," he said.

'Not the Only Measurement'

For his part, Dickison noted that the NGN, like any exam, has limitations.

While it "measures your cognitive and your thinking ability, our test does not measure the affective domain, doesn't measure character," he said. For example, the test cannot assess a "less-than-acceptable social interaction" a student has with a professor, nor does the test know which student is always late to class.

"If they don't show up to class on time every day, that might be a [sign] that they're not going to show up to a patient when they need to," Dickison explained. "That's why you have a regulatory system. That's why we have an education [system] ... these all have to work together. If you don't pass the NCLEX, you don't go to work, but it is not the only measurement that tells us we have a good nurse."

  • Shannon Firth has been reporting on health policy as MedPage Today's Washington correspondent since 2014. She is also a member of the site's Enterprise & Investigative Reporting team. Follow

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Exam Procedures & Technology

How Exams Work

Colorado Law exams are computer-based. Students input their answers into Exam4, our computer-based bluebook application, that securely saves and transmits test submissions to the Law School Registrar.  Students are assigned a unique, anonymous six-digit test ID for each test they are scheduled to take.  Students must input the appropriate six-digit test ID into Exam4. The six-digit test ID is your personal identifier used with your exam. Each student has their own test ID for each test they take each test season.

Students will receive detailed instructions via email from the Registrar prior to each test season.

Exams occur remotely. As a result, test questions will appear within the Exam4 program itself once a student has put in their credentials to start their exam. Students should take care to enter essay and multiple-choice answers in the correct answer area within the software.

Exam4 Software

Colorado Law uses Extegrity's Exam4 software.  Exam4 is a simple, lightweight, and secure test tool that is compatible with Windows and macOS.  It is the electronic equivalent of a paper bluebook for essay and short answer responses and a bubble sheet for multiple choice and true/false responses. 

Students must download a new Exam4 software package for each test season. The software is available here:  https://www.exam4.com/org/599. Students are encouraged to download the latest Exam4 software package in advance of their exams so they can take a practice test to familiarize themselves with Exam4's functionality and features.  Make sure you know what materials are allowed by your professor during the test and whether or not you are allowed to copy/paste.

Anonymous test IDs

Students are assigned an anonymous, unique test ID for each exam which facilitates anonymous test grading.  Prior to each exam, students must obtain their anonymous six-digit test ID from Colorado Law's test ID tool at https://www.colorado.edu/law/examid. To obtain each unique test ID, students must know their Identikey and password.  

Document IDs

Get your document IDs from https://www.colorado.edu/law/examid.The document ID is needed to securely fetch your test questions within the test software.

Practice Document ID

The test Document ID for the practice test is D0000000. Click on the Practice test tab on this website for more information about the practice exam.

Taking an Exam

Once the test is underway, students will input test answers into Exam4 which records and saves the typed information every minute. When students complete an exam, they submit their answers within the Exam4 tool.  When the student acknowledges completion of the exam, Exam4 will unlock the computer and seek an internet connection to upload the completed test to the Law School's Exam4 Receiver. The Registrar’s Office then processes the test and distributes it to your professor by anonymous test ID.

Students take all Exam4 exams remotely. Thusly, the exams will not be proctored and students are free to take exams at home or on campus as they see fit. Students are on their honor to follow the Honor Code.

Exam Modalities

  • CLOSED:  Only the Exam4 application is available.  Exam4 locks out access to other applications and the internet on your computer when this mode is enabled. Students can only use one computer screen and must not be connected to a VPN. Once you end your exam, you may not go back and re-edit it. Your computer will run through a 1-2 minute security check prior to beginning. If your computer fails the security check, you can try re-booting and re-starting the software.
  • OPEN-LAPTOP: You may access your hard drive and other applications, but do not have access to the internet. Make sure to print and/or download any materials you need before starting an exam. Students can only use one computer screen and must not be connected to a VPN. Once you end your exam, you may not go back and re-edit it.
  • TAKEHOME test Mode: You may access your hard drive, other applications, and the internet. You will be able to cut and paste external text into your exam. You may got into and out of this test as many times as you want while you are working on your exam. You may exit an test in TAKEHOME mode, it will be saved, and you can start it again later.

Disclaimer

Exam4, which is a product of the company Extegrity, is not a Colorado Law product. While the Registrar’s Office and Law School IT staff will help troubleshoot and assist students during their exams, it is the student’s responsibility to follow the instructions on the Exam4 website for the correct operation of Exam4. This includes system requirements, computer maintenance, and adherence to any other instructions given by Exam4. Prior to any exam, students should review the instructions on the Exam4 website.

Extegrity Support Contact information

https://www.exam4.com/support/

Law school test administration is executed by the Law Registrar.

 

Students must download a new Exam4 software package for each test season. 

The Exam4 software package is available for download here:  https://www.exam4.com/org/599.

Installation Instructions

  1. Complete the registration information and download the Windows or macOS version as appropriate.
  2. To install Exam4, double-click the install file you downloaded and follow the on screen prompts. 

macOS users:  If you have a previous test season install of Exam4, select "Replace" when prompted.

Note: Tablets and iPads are not allowed for exams. Only laptops are permitted.

Students are encouraged to take a practice test to familiarize themselves with Exam4's functionality and features.

Exam4 Best Practices

  1. Turn off auto updates.
  2. Close all running programs & applications (Word, Safari, Chrome, etc.)
  3. Exam4 does not require students to disable antivirus.
  4. Administrator rights are required.
  5. Reboot your computer before each exam.

Support

Students can contact Extegrity at usersupport@extegrity.com or Law School IT at lawit@colorado.edu.

 

Students must download a new Exam4 software package for each test season. 

Step 1:  Register, download, and install the current Exam4 package at https://www.exam4.com/org/599

Step 2:  Launch Exam4.

Exam4 icon with lowercase letter e

Step 3:  Prepare to start a new test >> Next

Initial start screen for Exam4 to prepare new exam.

Step 4:  Input a made-up Exam ID twice and select "Practice Exam" from the course dropdown list (twice) and select Next. 

Make sure you play around with the software and complete the survey once you are finished.

Exam4 - Course or  test title

Step 5: Check confirmation box and select OK.

Exam 4 Re-confirm information

Step 6: Set timer and viewer preferences and select Next.  Exam4 does not automatically close when test time is exceeded.  We recommend experimenting with the timer so you are comfortable with its operation.

Exam4 Timer

Step 7: Review instructions, check "Got it" box, and select Next.

Exam 4 - Got it

Step 8: Type in the name of the test Mode you would like to test in the input box, confirm selection, and press Next.

The test mode will be automatically programmed in Exam4 for your exams. Students will not have to choose an test mode in most cases. Make sure you are aware of how your computer will function in different modes (OPEN vs. CLOSED, etc).

Exam 4 Mode

Step 9: Begin Exam

Exam 4 - Begin Exam

Step 10: Choose the test document from the drop-down.

Exam 4 -  test document selection

Once in the exam, students will need to click on the "Exam Document" button once in the exam. When you do that, enter the code given to you by the Law Registrar and click "Fetch" to get the test questions. A pop-up box will appear with the test questions. The test Document ID for the "Practice Exam" is D0000000.

Exam 4 - document id fetch

The next step is to click "side-by-side view" so that you can see both the test questions and test answer entry area at the same time. You can use the scrollbar on the bottom right to make the text smaller or larger.

Exam 4 - Side By Side View

Play around with the Exam4 functions so that you understand how to use them.

The essay section of the test is essentially a blank sheet of paper.  You will need to annotate for your professor which responses go with which questions.  You can insert answer separators that allow you to check word count.  Spell check is available from the tools menu, but does not check automatically as you type.  The multiple choice menu will pull up the multiple choice/true false response sheet.

Exam4  trial Essay Response

MAKE SURE YOU ENTER YOUR MULTIPLE CHOICE ANSWERS IN THE MULTIPLE CHOICE AREA OF EXAM4. Answers are saved as you enter them and you can then click the "hide" button to go back to the essay portion of Exam4.

Exam 4 Multiple Choice Answers

Step 11: Notice on the right you have the ability to keep track of word count within each answer. There is also a timer. It is possible to set timers for one hour remaining, 15 minutes remaining, and five minutes remaining. When there is less than one minute remaining, the area above the timer will say "less than one minute remaining." Keep in mind that there is not a pop up reminder when there is less than one minute remaining. Lastly, make sure that you keep your timer visible.

If you are still working on your test when you set a timer and the time runs out, you will receive a message that looks like this (below). You should immediately close your exam. Note: The timer is a notification that your test time has run out. Exam4 will not end the test for you, You must close and submit the test as described in the steps below.

Step 12: To close your exam, select End test and then choose End test Now. 

Step 13:  The software will ask you to confirm your choice to end the exam. Click to confirm and then on Okay, end exam.

Step 14: Choose the Submit Electronically button and click okay.

 

A box will pop up that says "Exam Submittal Successful. Please note you will NOT receive an upload notification email from Exam4.

Step 15: To exit the software, select exit from the File and Save Options tab. In the pop-up screen, check "I'm sure" and then Exit test Software. At this point you have successfully taken and submitted your exam. You're done!

If you have any technical issues or questions, contact lawit@colorado.edu or visit https://www.exam4.com/support/.  

If you have any questions about the test process, contact the Registrar at lawreg@colorado.edu.

Checklist before taking your exam: 

  • Verify that you have downloaded and installed the Exam4 software package for the current test season.
  • Turn off auto updates on your computer.
  • Close all other programs (Word, Safari, Chrome, etc.)
  • Reboot your computer before each test (very important).
  • Have your unique six-digit test ID ready for this exam.  Lookup the test ID at https://www.colorado.edu/law/examid.  Remember, each test has its own unique test ID for each student and document ID (all students have the same document ID in any given class).
  • Have your laptop's power adapter handy.

A healthy computer is less likely to experience problems during an exam.  Be sure your computer is free of malware and operating normally.  Instructions for running TrendMicro's free HouseCall malware scanner are available for macOS and Windows.  Contact Law School Information Technology at lawit@colorado.edu if you have questions about your computer's fitness for exams.

Before Exams Begin

Prior to taking an exam, test takers should make sure they have the Exam4 software package for the current test season. This can be checked by opening Exam4 and verifying the version dates. 

If you are taking an test at the law school, make sure you are connected to the UCB Wireless network. Otherwise, you will not be able to submit your exam. Directions about connecting to the university network can be found here.

Exam takers should ensure their laptop is ready to go and fully charged. Have your power adapter for your laptop handy.

 

General test Information

  • Download the Exam4 software package ahead of time.
  • Computer-based timers which count time and provide countdown alerts are acceptable. These will not work with CLOSED mode exams. Students are responsible for testing to make sure the timer works with the test mode of their exam(s).
  • If you need to use the restroom during an exam, the time on your test will continue to count down.
  • Make sure you know what materials your professor allows during the test and whether or not you are allowed to copy/paste. 
  • Do not discuss the test afterwards with other students as they might be taking it at a later date. If you have questions or concerns about the exam, contact the Law Registrar's Office, not your professor. Do not email your professor about anything related to exams until after the test and grading period is complete. This preserves anonymity for grading purposes.
  • Students must work on their test in the Exam4 software. It causes errors if students draft their test in Word or some other program and then copy/paste their test into Exam4. Students are expected to write and edit their test only in Exam4. Even if allowed in the test setting, students should not copy and keep any portion of their submitted test on their computer.
  • The timer in Exam4 is a notification that your test time has run out.  Be aware that you must close and submit the exam.  Exam4 will not end the test when your time runs out!
  • NOTE: The use of dual screens is allowed for law school exams. It is advisable that students who wish to use more than one computer screen do a practice test to ensure it will work with your setup. This is especially true for Mac users. Dual screens will not work with the test modes of CLOSED or OPEN-LAPTOP. Dual screens will only work with test mode of TAKEHOME.

Rescheduled Exams

The Registrar’s Office coordinates all rescheduled exams and communicates with students about the date and time accordingly. test rescheduling is governed by law school rules. Inquiries can be directed to the Law Registrar’s Office at lawreg@colorado.edu. Exam takers with approved rescheduled exams take their exams remotely. Do you contact your professor asking to reschedule your exam.

Students With Accommodations

Exam takers who are registered with Disability Services work directly with the Law Registrar’s Office. Inquiries can be made to lawreg@colorado.edu.

Computer issues

See the "Getting Help" tab for how to acess help during remote exams. Help is available during regular business hours. Most IT issues can be avoided by taking the practice test and trying out dual screen setups in advance.

It is extremely important for students to download the Exam4 software prior to each test season and take a practice exam. This helps to identify potential laptop malfunctions ahead of time. The law school has a limited number of emergency laptops available on a first come, first serve basis.

Sometimes Exam4 causes your computer to change back to the factory default background picture setting after you exit the program. Therefore, you may need to change your background picture back to what it was prior to using the software (if applicable).

Honor Code

Students are held to the Honor Code at the law school and the CU Student Code of Conduct. It is recommended that all test takers review it prior to exams. 

Exam Day

  • Earplugs, sound muffling earmuffs, and headphones are acceptable if you are taking exams at the law school.
  • A wristwatch or little clock is okay as long as it does not make noise.
  • Do not use items, materials, or resources not allowed by the professor. Remember the Honor Code.
  • Make sure to use a power cord.

Starting Exams

All exams occur remotely and are not proctored. test questions will appear in the Exam4 software once proper credentials have been inputted. This is when the timer for your test begins (if the test is timed).

1) Put in your unique, six-digit test ID:

Exam4  test ID, course selection and  test code info.

2) Confirm your settings.

Exam4 confirmation screen

3) Set your timer (if desired) and view preferences. 

Exam4 timer and view settings.

4) Acknowledge the honor code and instructions.

Exam4 honor code acceptance.

5) The test Mode settings should be pre-populated for you.

Verify  test mode for Exam4.

6) The test time begins once students input the Document ID on the next page.

Exam4 Begin Exam

7) Access your test questions by clicking on the test Document button.

8) Enter the Document ID and click "Fetch" to retrieve the test questions. Your test time doesn't begin until you can see the questions.

Exam4 saves information for your exam.  Exam4 tracks time spent on the exam, but will not automatically close the test when your time runs out. It is the student's responsibility to self-monitor their time and close the test on time.  To finish and close an exam, click on on the upper-left hand corner “End Exam” button and "End test Now."  The test will close and the student will be prompted to submit their exam.  Exam4 will then upload the test to the Colorado Law Exam4 Receiver. Please note that Exam4 does not send out upload notification emails. Students can close out Exam4 and go back into the software to see their confirmation by clicking on the "Select Existing Exam" and then click on "View test Submittal Receipt" to see their test submission.

Any questions or concerns about the test should be directed to the Registrar’s Office and not the professor to preserve anonymity for grading purposes.  

 

Each test you take has a unique, anonymous six-digit ID assigned to you.  You can look up the test IDs that you have been assigned for your exams at https://www.colorado.edu/law/examid.  NOTE: All Exam4 exams will occur remotely. test questions will appear in the software once the test begins.

Exam4 is Colorado Law's secure testing software.  Essentially, it is an electronic bluebook for essay and short answer responses and an electronic bubble sheet for multiple choice and true/false responses.  You will need to download a new version of the Exam4 software package for each test season AND take a practice test for each test season.

TAKEHOME: What you use for a take-home exam. You may access your hard drive, other applications and the internet. You will be able to cut and paste external text into your exam. You may go into and out of this test as many times as you want during the 9-hours that you are working your exam. Once you have exited an test in the CLOSED, OPEN or OPEN +NETWORK mode, you will not be able to get back into it. You may exit an test in TAKEHOME mode, it will be saved, and you can start it again later.

CLOSED: You have access only to the test you are typing. You may not access your hard drive, applications, or the internet. Once you end your exam, you may not go back and re-edit it.Your computer will run through a 1-2 minute security check prior to beginning. If your computer fails the security check, you can try re-booting and re-starting the software. If this doesn’t work, you should contact IT for help. Students can only use one computer screen and must not be connected to a VPN.

OPEN-LAPTOP: You may access your hard drive and other applications, but do not have access to the internet. Make sure to print and/or download any materials you need before starting an exam. Students can only use one computer screen and must not be connected to a VPN. Once you end your exam, you may not go back and re-edit it.

We highly recommend that you take a practice test to familiarize yourself with Exam4. It is easy to use, but puts responsibility on the student for formatting/sectioning their essay responses, timing the exam, and for spell check.

Yes, Exam4 has a spell check function available in the tools menu.  However, Exam4 will not check spelling as you type.

Exam4 supports select, undo/redo, copy/paste, and delete.  If your test mode is OPEN or OPEN + Network, you can copy/paste between Exam4 and your applications. Do not copy/paste between Exam4 and your other applications (such as Microsoft Word). You are expected to draft your test in the software. It may cause errors to your test or it may not save properly if you draft your test outside of the software. Make sure you know what materials your professor will allow you to use during the test and whether or not you are allowed to copy/paste. It is not possible to copy/paste content from the test questions into the test answer area.

The Answer Separator is a feature of Exam4 that allows you to separate out the word counts by question. Do NOT edit the Answer Separators in any way – it will not count your words correctly if you do.

Yes, you can choose to either show or hide the document stats for your test by clicking a box on the right that says "Show/Hide Doc Stats" (see the practice test tab for a picture of this). The Answer Separator in Exam4 allows you to separate word count by question. If you alter the Answer Separators in any way it will not count your words correctly.

 

It is not possible to annotate or make notes in the test software itself. Students need to make notes on paper if they would like before drafting a final answer in Exam4. Notes should be shredded once the test is complete. Students can highlight portions of the test questions to reference while they are taking an exam.

If a student loses internet access during an exam, they will be able to continue working on it if the test is in TAKE HOME mode. From Exam4's point of view, the only issue is that they cannot fetch the test questions again. So long as you do not close the questions, you will be okay. While the internet is down, the test file will remain saved on your computer with all the secure time stamps, etc., so the student can upload it later. If you lose internet in other test modalities (OPEN, OPEN+Network, or CLOSED), report the issue to the Law Registrar or IT.

Fall 2023 Law School test Schedule

 

 

Last Day Of Class For Fall 2023: December 8, 2023

Exams should be taken and submitted using Mountain Time (MT). If you are no longer in Colorado and in a different time zone, please plan accordingly. Make sure you review the test schedule. Exam4 exams will not be proctored. Do not contact your professor about the test for any reason. All exams will be taken remotely. If you write anything on scratch paper during your exam, make sure to shred it once your test has been submitted.

Students must upload their test answers by test deadline listed on the schedule using Mountain Time.  

The test Document ID for the "Practice Exam" is D0000000.

Total time spent on exams is only reported to faculty in instances where students went over the allowed test time (which may vary with accommodations).

Reminders For Exams: 

  • NOTE: The use of dual screens is allowed for law school exams . It is advisable that students who wish to use more than one computer screen do a practice test to ensure it will work with your setup.
  • If you need to use the restroom during a timed exam, please do so. The time on your test will continue to count down.  
  • Make sure you know what materials your professor will allow and whether or not you are allowed to copy/paste. Follow all directions given to you (if any) about what to do with the test questions after completing your exam(s). 
  • Do not discuss the test afterwards with other students as they might be taking it at a later date. If you have questions or concerns about the exam, contact the Registrar's Office, not your professor.
  • Do not email your professor about anything related to exams until after the test and grading period is complete. This preserves anonymity for grading purposes.  
  • Students are held to the Honor Code at the law school and the CU Student Code of Conduct. It is recommended that all test takers review it prior to exams. 
  • Final course grades are due from faculty in early January for fall term and late May for spring term. Grades are posted as they are received. Grading will utilize normal A-F grading. Non-law, LLM, and MSL students are not subject to the B+ median.

 

 

 

 

 

 

 

 

Watch a short Exam4 demo for macOS or Windows

Loaner test Laptops are available.  If you have any doubts or concerns about your computer’s OS version, performance, or reliability for exams, you may request a loaner laptop from Law IT at lawit@colorado.edu.  test laptops may be picked up now or at any time before finals and returned at the beginning of the spring semester.

If you are taking an test at the law school, make sure you are connected to the UCB Wireless network. Otherwise, you will not be able to submit your exam. Directions about connecting to the university network can be found here.

How To Handle Loss Of Internet Access and/or Power During An Exam: If a student loses internet access and/or power during an exam, they will be able to continue working on it if in TAKE HOME mode. From Exam4's point of view, the only issue is that they cannot fetch the test questions again. Exam4 saves your work often. If you are in OPEN, OPEN+Network, or CLOSED mode and lose internet, reach out to the Law Registrar or IT.

If you need immediate assistance during exams (or the week before), contact lawreg@colorado.edu or call 303-492-1865/303-492-6755 (as a backup option). Staff will help you through your technical questions. It is important to take a practice test to ensure viability of your laptop for the upcoming test period. If you have questions about the test questions themselves, you should address this in your test answer.

If you have any problems or confusion with specific test questions, please address those issues within your test answer. Do not contact the Registrar or your professor with questions regarding the content of your exam.

Why is there a grey rectangle blocking my screen? See here for instructions to fix this Mac issue.

How can I fix scaling issues if I cannot see the entire test question? See here.

How To Fix Your Settings If You Have Trouble Seeing Multiple Choice Area

Sun, 12 Feb 2023 18:34:00 -0600 en text/html https://www.colorado.edu/law/academics/exam-procedures-technology
Exam Pass Rates

The National Council Licensure Examination (NCLEX) test is used by all state boards of nursing across the United States to assess a graduate’s competency and are required for licensure. In Pennsylvania, a student must graduate from a recognized education program before sitting for the exam.

The following table shows the NCLEX-RN first-time pass rates for Wilkes University's traditional and accelerated nursing programs.

Wed, 31 Aug 2022 06:44:00 -0500 en text/html https://www.wilkes.edu/academics/school-of-nursing/exam-pass-rates.aspx
Neumann says its nursing NCLEX pass rate again tops 98%

More than 98% of Neumann University nursing graduates who took the NCLEX test in the last year passed the test that is required to become a licensed RN, the collrge said.

Neumann’s current pass rate of 98.44% among first-time test takers from October 2022 to September 2023 edged last year’s success rate of 98.25%.

Neumann’s press release continues:

Sixty-three of 64 Neumann nursing graduates passed the exam.

Neumann’s pass rate is significantly higher than the pass rate in Pennsylvania (90.70%) and in the United States (86.73%)

NCLEX, National Council Licensure Examination, refers to standardized tests that nursing students are required to pass to obtain state licenses and become registered nurses.

“I am grateful for the graduates who reached their professional goal, the faculty who spent countless hours working with our students, and the administrative support that the university has given to the School of Nursing and Health Sciences,” said Theresa Pietsch, dean of the School of Nursing and Health Sciences, when she learned the test results.

She noted that most of the Neumann nursing graduates who passed the NCLEX this year were enrolled in spring 2020 when COVID-19 caused colleges across the country to alter the way in which they delivered course content.

“Despite the obstacles caused by the pandemic, these students demonstrated extraordinary dedication and focus,” Pietsch pointed out. “Their remarkable pass rate is evidence of their hard work and commitment to join the nursing profession.”

Nursing is Neumann University’s most popular undergraduate major and attracts approximately 120 first-year students annually. One hundred percent of the nursing faculty have clinical experience in a hospital or other health care setting.

To learn more about the nursing program at Neumann University, visit www.neumann.edu.

Aston Lions brighten Christmas for 59 kids

The Aston Lions said they entertained 59 children on Saturday Dec. 16 by providing toys at Walmart.

The families then met at Pennell Elementary School cafeteria where they were served pizza, soda, ice cream and cookies.

The Aston Lions Club huddle around Santa and his elf Saturday after making the holiday special for 59 children. (COURTESY OF CHARLES HOYT)
The Aston Lions Club huddle around Santa and his elf Saturday after making the holidays special for 59 children. (COURTESY OF CHARLES HOYT)

he children had an opportunity to meet Santa and his elf, sit on Santa’s lap, and have their parents take pictures. Santa gave them a small toy.

Thanks to all who provided cookies, the Lions said. The Aston Township Lions want to thank all who support the club’s activities throughout the year.

$5M-plus in grants going into 26th Senatorial District water/sewer projects

State Sen. Tim Kearney announced that 14 Delaware County municipalities will receive nearly $5.4 million in total funding to support 15 projects in the 26th Senatorial District.

The money comes through the H2O and Small Water & Sewer programs, which was recently approved by the Commonwealth Financing Authority and will be administered by the Department of Community and Economic Development.

The awards:

COVID-19 ARPA H2O PA Awardees

• $1.03 million for Media for the Ridge Road Stormwater Facilities project.

• $603,750 for Ridley Township for a sanitary sewer system inflow/infiltration abatement project in the Crum Lynne area.

• $670,932 for Upper Darby Township for stormwater improvements in Drexel Gardens Park.

COVID-19 ARPA PA Small Water and Sewer Awardees

• $213,563 for Aldan for storm sewer system improvements.

• $425,000 for Clifton Heights to replace the deteriorated stormwater management piping on West Madison Avenue, between Cherry Street and Springfield Avenue.

• $342,873 for East Lansdowne for the replacement of sanitary sewer pipes.

• $200,000 for Lansdowne for the rehabilitation of a sanitary sewer wastewater conveyance system.

• $250,000 for Marple Township for the Lindbergh Avenue Storm Sewer Rehabilitation project.

• $262,057 for Morton to complete sewer system rehabilitation.

• $227,500 for Newtown Township for stormwater management along Sawmill Road.

• $100,000 for Ridley Township for stormwater improvements.

• $150,000 for Rutledge to rehabilitate its storm sewer system.

• $300,000 for Swarthmore for stormwater infrastructure rehabilitation.

• $500,000 for Upper Darby Township for sanitary sewer upgrades to the Cobbs Creek Interceptor.

• $95,500 for Upper Providence Township to replace a collapsed stormwater sewer line.

The H2O PA was established by the General Assembly in July 2008. The Act provides for single-year and multi-year grants for the construction of drinking water, sanitary sewer, and storm sewer projects; the construction or renovation of flood control projects; and the repair or rehabilitation of high-hazard unsafe dams.

Act 54 of 2022 appropriated $105.6 million of American Rescue Plan Act funds to the PA Small Water and Sewer Program which provides grants for small water, sewer, and stormwater infrastructure projects.

“I am proud to have voted for federal APRA funding to be allocated to our H2O and Small Water & Sewer programs to address critical water management issues and support stormwater improvements and rehabilitation projects in my district,” Kearney said in the press release. “Investing in these essential initiatives is not just about infrastructure, but it’s also a commitment to the well-being of our communities.“

Energy Transfer makes annual $50K donation to rink

Representatives from Energy Transfer, the Delaware County Veterans Memorial Association, Flight on Ice, VisitDelco, and Edgmont Township celebrated the annual tree lighting and check presentation last week at the Energy Transfer Veterans Memorial Rink at 4901 West Chester Pike in Newtown Square, according to a press release.

“We are thrilled to be open for the third winter season in Edgmont Township, and we are grateful for the support of Energy Transfer, which makes this all possible,” said Jon Schaffer, president of Flight Entertainment and Flight On Ice, which operates the rink. “With the expanded beer park and other new attractions for kids and families, this should be the best season yet, all to support Delaware County veterans.”

The rink is a short distance from the veterans memorial at 4599 West Chester Pike.

With a $50,000 donation this year, Energy Transfer has invested $150,000 into the project, which to date has contributed more than $100,000 to the memorial association in support of local veterans.

The Energy Transfer check presentation last week at the
The Energy Transfer check presentation last week at the Energy Transfer Veterans Memorial Rink in Newtown Square (COURTESY PHOTO)

The company operates pipelines and other facilities in Delaware County.

“Energy Transfer and Sunoco have been ingrained in Delaware County for many decades, and it’s important for us to supply back in our communities,” said Joe McGinn, vice president of public affairs at Energy Transfer. “We feel strongly about supporting our veterans and have many right here at home. It is an honor to support the DCVMA and to help provide family fun for the third winter in Edgmont Township.”

The Delaware County Veterans Memorial, operated by the association in Newtown Square since 2013, is an open-air testament to our nation’s military history and active service members. Open year-round and free to the public, it offers visitors a chance to learn, honor, and reflect on American Wars and Conflicts from the War of 1812 to the Wars of the Middle East.

The memorial was built in 2013 thanks to land donor and major benefactor Claude de Botton and family. It is managed today by Nicole de Botton Robinson and Paul de Botton, both of Delaware County-based National Realty Corp.

“It has been an honor to bring our beautiful memorial to Delaware County, and this ice rink is an added bonus to bring attention to our veterans and garner more support,” said DCVMA Director of Development Nicole de Botton Robinson. “We are so grateful for Energy Transfer’s partnership over the years, which has helped us realize this dream.”

The Energy Transfer Veterans Memorial Rink is open through Feb. 25. For more information or to purchase tickets, visit www.flightonice.com/delaware-county/newtown-square-ice-rink.

Eaton employees expand angel tree tag efforts at the holidays

The holiday spirit is alive and well at the Aerospace FED Division of Eaton Corp. in Glenolden.

The plant designs and manufactures a full line of early warning oil debris monitors, fluid sensors, and gearbox accessories for aerospace, military, mobile, marine and industrial applications.

Eaton employees have held a toy drop to help children who might not otherwise receive a toy at Christmas. In 2007, the employees decided to add “angel” tags to the lobby’s Christmas tree.

It went over very well, helping two families. After seeing the enthusiasm of the employees, they reached out further over the years and adopted a family from the community.

The Eaton Corp. employees and their angel tree gifts that will help brighten the season for a few families in Delaware County (COURTESY OF JANET OWSIANY) 
The Eaton Corp. employees and their angel tree gifts that will help brighten the season for a few families in Delaware County (COURTESY OF JANET OWSIANY)

Employees were asked to take a tag from the tree, buy and wrap the gift and place it under the tree. The response was overwhelming.

Their efforts this year will brighten the holiday for two adults and seven children who may not have had much of a Christmas without the generosity of these employees.

The angel tag tree project was headed up by Janet Owsiany, a human resources generalist who is a member of the plant’s Community Involvement Team.

All the employees at Eaton send warm wishes to Delaware County residents and their families and hope the holiday season that is your best ever.

Text adapted from a submission by Owsiany.

Send items of community interest to editor@delcotimes.com.

Tue, 19 Dec 2023 17:01:00 -0600 Daily Times en-US text/html https://www.delcotimes.com/2023/12/20/neumann-says-its-nursing-nclex-pass-rate-again-tops-98/
NCMC sees 100% first-time pass rate for registered nurses NCLEX exam Your browser is not supported | petoskeynews.com
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Thu, 14 Dec 2023 19:05:00 -0600 en-US text/html https://www.petoskeynews.com/story/news/education/2023/12/15/ncmc-sees-100-first-time-pass-rate-for-registered-nurses-nclex-exam/71917144007/
ChatGPT bombs test on diagnosing kids’ medical cases with 83% error rate
Dr. Greg House has a better rate of accurately diagnosing patients than ChatGPT.
Enlarge / Dr. Greg House has a better rate of accurately diagnosing patients than ChatGPT.

ChatGPT is still no House, MD.

While the chatty AI bot has previously underwhelmed with its attempts to diagnose challenging medical cases—with an accuracy rate of 39 percent in an analysis last year—a study out this week in JAMA Pediatrics suggests the fourth version of the large language model is especially bad with kids. It had an accuracy rate of just 17 percent when diagnosing pediatric medical cases.

The low success rate suggests human pediatricians won't be out of jobs any time soon, in case that was a concern. As the authors put it: "[T]his study underscores the invaluable role that clinical experience holds." But it also identifies the critical weaknesses that led to ChatGPT's high error rate and ways to transform it into a useful tool in clinical care. With so much interest and experimentation with AI chatbots, many pediatricians and other doctors see their integration into clinical care as inevitable.

The medical field has generally been an early adopter of AI-powered technologies, resulting in some notable failures, such as creating algorithmic racial bias, as well as successes, such as automating administrative tasks and helping to interpret chest scans and retinal images. There's also lot in between. But AI's potential for problem-solving has raised considerable interest in developing it into a helpful tool for complex diagnostics—no eccentric, prickly, pill-popping medical genius required.

In the new study conducted by researchers at Cohen Children’s Medical Center in New York, ChatGPT-4 showed it isn't ready for pediatric diagnoses yet. Compared to general cases, pediatric ones require more consideration of the patient's age, the researchers note. And as any parent knows, diagnosing conditions in infants and small children is especially hard when they can't pinpoint or articulate all the symptoms they're experiencing.

For the study, the researchers put the chatbot up against 100 pediatric case challenges published in JAMA Pediatrics and NEJM between 2013 and 2023. These are medical cases published as challenges or quizzes. Physicians memorizing along are invited to try to come up with the correct diagnosis of a complex or unusual case based on the information that attending doctors had at the time. Sometimes, the publications also explain how attending doctors got to the correct diagnosis.

Missed connections

For ChatGPT's test, the researchers pasted the relevant text of the medical cases into the prompt, and then two qualified physician-researchers scored the AI-generated answers as correct, incorrect, or "did not fully capture the diagnosis." In the latter case, ChatGPT came up with a clinically related condition that was too broad or unspecific to be considered the correct diagnosis. For instance, ChatGPT diagnosed one child's case as caused by a branchial cleft cyst—a lump in the neck or below the collarbone—when the correct diagnosis was Branchio-oto-renal syndrome, a genetic condition that causes the abnormal development of tissue in the neck, and malformations in the ears and kidneys. One of the signs of the condition is the formation of branchial cleft cysts.

Overall, ChatGPT got the right answer in just 17 of the 100 cases. It was plainly wrong in 72 cases, and did not fully capture the diagnosis of the remaining 11 cases. Among the 83 wrong diagnoses, 47 (57 percent) were in the same organ system.

Among the failures, researchers noted that ChatGPT appeared to struggle with spotting known relationships between conditions that an experienced physician would hopefully pick up on. For example, it didn't make the connection between autism and scurvy (Vitamin C deficiency) in one medical case. Neuropsychiatric conditions, such as autism, can lead to restricted diets, and that in turn can lead to vitamin deficiencies. As such, neuropsychiatric conditions are notable risk factors for the development of vitamin deficiencies in kids living in high-income countries, and clinicians should be on the lookout for them. ChatGPT, meanwhile, came up with the diagnosis of a rare autoimmune condition.

Though the chatbot struggled in this test, the researchers suggest it could Excellerate by being specifically and selectively trained on accurate and trustworthy medical literature—not stuff on the Internet, which can include inaccurate information and misinformation. They also suggest chatbots could Excellerate with more real-time access to medical data, allowing the models to refine their accuracy, described as "tuning."

"This presents an opportunity for researchers to investigate if specific medical data training and tuning can Excellerate the diagnostic accuracy of LLM-based chatbots," the authors conclude.

Wed, 03 Jan 2024 09:46:00 -0600 Beth Mole en-us text/html https://arstechnica.com/science/2024/01/dont-use-chatgpt-to-diagnose-your-kids-illness-study-finds-83-error-rate/
Stone Academy students sue CT health, higher ed departments

Nearly a dozen former Stone Academy students filed a federal class action lawsuit against officials in the state’s Office of Higher Education and Department of Public Health Tuesday, alleging that the departments violated their 14th amendment rights. 

The lawsuit alleges that Stone Academy students were deprived of the rights to their academic credits and degrees without due process of law and that the “defendants have made defamatory statements about the education and preparedness of Plaintiffs and their abilities to competently and safely practice as LPNs.”





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