Saunders Comprehensive Review for the NCLEX-RN® Examination, 7th Edition PDF

Omaralamri 0500755706 Evolve Student Resources for Silvestri: Saunders Comprehensive Review for the NCLEX-RN® Examination, Seventh Edition, include the following: How to Use the Online Practice Questions: Customize your study session for your time and your own unique needs. Pre-test of 7 5 q...

Omaralamri 0500755706 Evolve Student Resources for Silvestri: Saunders Comprehensive Review for the NCLEX-RN® Examination, Seventh Edition, include the following: How to Use the Online Practice Questions: Customize your study session for your time and your own unique needs. Pre-test of 7 5 questions evaluates your current knowledge. These results feed into a personalized Study Calendar to help guide you in your preparation for the NCLEX-RN examination. Study Mode: Receive immediate feedback after each question. Select questions by Client Needs, Integrated Process, Alternate Item Format Type, Priority Concept, or specific Content Area. The answer, rationale, test-taking strategy, question codes, priority concepts, and reference sources for further remediation appear immediately after you answer each question. Exam Mode: Take a practice exam, and receive your results and feedback at the end. Select questions by Client Needs, Integrated Process, Alternate Item Format Type, Priority Concept, or specific Content Area. Then select the number of questions you'd like to take in your exam—1 0 , 2 5 , 5 0 , or 1 0 0. When you've finished the exam, the percentage of questions you answered correctly will be shown in a table, and you can go back to review the correct answers—as well as rationales, test-taking strategies, question codes, priority concepts, and reference(s)—for each question. Post-test of 7 5 questions simulating the NCLEX Client Needs percentages helps you evaluate your progress. Activate the complete learning experience that comes with each NEW textbook purchase by registering with your scratch-off access code at http://evolve.elsevier.com/Silvestri/comprehensiveRN/ If you purchased a used book and the scratch-off code at right has already been revealed, the code may have been used and cannot be re-used for registration. To purchase a new code to access these valuable study resources, simply follow the link above. *Evolve Student Resources are provided free with each NEW book purchase only. Instructor of Nursing Salve Regina University, Newport, Rhode Island President Nursing Reviews, Inc., Henderson, Nevada Nursing Reviews, Inc., Charlestown, Rhode Island and Profession al Nursing Sem inars, Inc., Charlestown, Rhode Island Elsevier Consultant HESI NCLEX-RN ® and NCLEX-PN ® Live Review Courses Assistant Professor Touro Un iversity Nevada—School of Nursing Henderson, Nevada 3251 Riverport Lane St. Louis, Missouri 63043 SAUNDERS COMPREHENSIVE REVIEW FOR THE ISBN: 978-0-323-35851-4 NCLEX-RN ® EXAMINATION, SEVENTH EDITION Copyrigh t © 2017 by Elsevier, In c. All righ ts reserved. No part of this publication m ay be reproduced or transm itted in any form or by any m eans, electronic or m echanical, including photocopying, recording, or any inform ation storage and retrieval system , without perm ission in writing from the publisher. Details on how to seek perm ission, further inform ation about the Publisher’s perm issions policies and our arrangem ents with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency can be found at our website: www.elsevier.com /perm issions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as m ay be noted herein). Notices Knowledge and best practices in this field are constantly changing. As new research and experience broaden our understanding, changes in research m ethods, professional practices, or m edical treatm ent m ay becom e necessary. Practitioners and researchers m ust always rely on their own experience and knowledge in evaluating and using any inform ation, m ethods, com pounds, or experiments described herein. In using such inform ation or m ethods, they should be m indful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharm aceutical products identified, readers are advised to check the m ost current inform ation provided (i) on procedures featured or (ii) by the m anufacturer of each product to be adm inistered to verify the recom m ended dose or form ula, the m ethod and duration of adm inistration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to m ake diagnoses, to determ ine dosages and the best treatm ent for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors assum e any liability for any injury and/or dam age to persons or property as a m atter of product liability, negligence or otherwise, or from any use or operation of any m ethods, products, instructions, or ideas contained in the m aterial herein. Previous editions copyrighted 2014, 2012, and 2009. NCLEX®, NCLEX-RN ®, and NCLEX-PN ® are registered tradem arks of the National Council of State Boards of Nursing, Inc. Library of Con gress Catalogin g-in -Publication Data Nam es: Silvestri, Linda Anne, author. Title: Saunders com prehensive review for the NCLEX-RN exam ination / Linda Anne Silvestri. Other titles: Com prehensive review for the NCLEX-RN exam ination Description: Seventh edition. j St. Louis, Missouri : Elsevier, j Includes bibliographical references and index. Identifiers: LCCN 2016011692 j ISBN 9780323358514 (pbk. : alk. paper) Subjects: j MESH: Nursing, Practical j Nursing Care j Nursing Process j Exam ination Questions Classification: LCC RT62 j NLM WY 18.2 j DDC 610.73076–dc23 LC record available at http://lccn.loc.gov/2016011692 Content Strategist: Jam ie Blum Content Development Manager: Laurie Gower Content Development Specialist: Laura Goodrich Publishing Services Manager: Jeff Patterson Book Production Specialist: Bill Drone Designer: Renee Duenow Printed in the United States of Am erica Last digit is the print num ber: 9 8 7 6 5 4 3 2 1  Contents UNIT I UNIT V NCLEX-RN ® Exam Preparation, 1 Growth and Development Across the 1 Th e NCLEX-RN ® Exam in ation , 2 Life Span, 255 2 Path ways to Success, 14 21 Th eo ries of Growth an d Develo pm en t, 257 3 Th e NCLEX-RN ® Exam in ation fro m 22 Developm en tal Stages, 265 a Graduate’s Perspective, 18 23 Care of th e Older Clien t, 281 4 Test-Takin g Strategies, 20 UNIT II UNIT VI Professional Standards in Nursing, 30 Maternity Nursing, 289 5 Cultural Awaren ess an d Health Practices, 32 24 Reprodu ctive System , 291 6 Eth ical an d Legal Issu es, 44 25 Pren atal Period , 299 7 Prioritizin g Clien t Care: Leadersh ip, 26 Risk Con d ition s Related to Pregn an cy, 314 Delegation , an d Em ergen cy Respon se 27 Labo r an d Birth , 332 Plan n in g, 59 28 Prob lem s with Labor an d Birth , 346 29 Postpartum Period , 356 30 Postpartum Com plication s, 364 UNIT III 31 Care of th e Newborn , 372 32 Matern ity an d Newborn Medication s, 393 Nursing Sciences, 76 8 Fluids an d Electrolytes, 78 9 Acid-Base Balan ce, 97 10 Vital Sign s an d Labo ratory Referen ce UNIT VII In tervals, 108 11 Nutrition , 124 Pediatric Nursing, 403 12 Paren teral Nutrition , 134 33 In tegum en tary Diso rders, 404 13 In traven ous Th erapy, 144 34 Hem atological Disord ers, 411 14 Adm in istratio n of Blood Prod ucts, 158 35 On cological Disord ers, 419 36 Metabolic an d En docrin e Disorders, 430 37 Gastroin testin al Disorders, 439 UNIT IV 38 Eye, Ear, an d Th roat Disorders, 457 39 Respiratory Disord ers, 463 Fundamentals of Care, 169 40 Cardiovascular Disorders, 479 15 Health an d Ph ysical Assessm en t of th e Adult 41 Ren al an d Urin ary Disorders, 491 Clien t, 171 42 Neurolo gical an d Cogn itive 16 Provision of a Safe En viron m en t, 192 Disord ers, 499 17 Calculation of Medication an d In traven ous 43 Musculoskeletal Diso rders, 511 Prescription s, 204 44 In fectious an d Com m u n icab le 18 Periop erative Nu rsin g Care, 215 Diseases, 520 19 Position in g Clien ts, 230 45 Pediatric Medication Adm in istratio n an d 20 Care of a Clien t with a Tube, 239 Calcu lation s, 536 iii iv Contents UNIT VIII UNIT XV Integumentary Disorders of the Adult Eye and Ear Disorders of the Adult Client, 543 Client, 860 46 In tegu m en tary System , 544 60 Th e Eye an d th e Ear, 861 47 In tegum en tary Medication s, 569 61 Eye an d Ear Medication s, 882 UNIT IX UNIT XVI Hematological and Oncological Neurological Disorders of the Adult Disorders of the Adult Client, 578 Client, 892 48 Hem atological an d On cological Disord ers, 580 62 Neurological System , 893 49 Hem atological an d On cological 63 Neurological Medicatio n s, 923 Medication s, 614 UNIT XVII UNIT X Musculoskeletal Disorders of the Endocrine Disorders of the Adult Adult Client, 936 Client, 625 64 Musculoskeletal System , 937 50 En docrin e System , 626 65 Musculoskeletal Medication s, 958 51 En docrin e Medication s, 653 UNIT XVIII UNIT XI Immune Disorders of the Adult Gastrointestinal Disorders of the Client, 965 Adult Client, 669 66 Im m un e Disord ers, 966 52 Gastroin testin al System , 671 67 Im m u n ological Medicatio n s, 980 53 Gastroin testin al Medicatio n s, 698 UNIT XII UNIT XIX Respiratory Disorders of the Adult Mental Health Disorders of the Adult Client, 706 Client, 987 54 Respiratory System , 708 68 Fo un dation s of Psych iatric Men tal Health Nursin g, 988 55 Respiratory Medication s, 737 69 Men tal Health Disorders, 1000 70 Addiction s, 1019 UNIT XIII 71 Crisis Th eory an d In terven tion , 1030 72 Psych iatric Medication s, 1043 Cardiovascular Disorders of the Adult Client, 754 56 Card iovascular System , 755 UNIT XX 57 Cardiovascular Medication s, 797 Comprehensive Test, 1056 UNIT XIV References, 1079 Renal and Urinary Disorders of the Glossary, 1081 Adult Client, 815 Index, 1090 58 Ren al an d Urin ary System , 817 59 Ren al an d Urin ary Medication s, 850 Priority Nursing Action List, Back of Inside Cover  To my parents— To my mother, Frances Mary, and in loving memory of my father, Arnold Lawrence, who taught me to always love, care, and be the best that I could be.  To All Future Registered Nurses, Congratulations to you! You should be very proud and pleased with yourself on your m ost recent well- deserved accom plish m ent of com pleting your nursing program to becom e a regis- tered nurse. I know that you have worked very hard to becom e successful and that you have proven to yourself that indeed you can achieve your goals. In m y opinion, you are about to enter the m ost won derful and rewarding profession that exists. Your willingness, desire, and ability to assist those who need nursing care will bring great satisfaction to your life. In the profession of nursing, your learning will be a lifelong process. This aspect of the profession m akes it stim - ulating and dynam ic. Your learning process will continue to expand and grow as the profession continues to evolve. Your next very im portant endeavor will be the learning process involved to achieve success in your exam ination to becom e a registered nurse. I am excited and pleased to be able to provide you with the Saunders Pyramid to Success products, which will help you prepare for your next im portant professional goal, becom ing a registered nurse. I want to than k all of m y form er nursing studen ts whom I have assisted in their studies for the NCLEX-RN ® exam ination for their willingn ess to offer ideas regardin g their needs in preparing for licensure. Student ideas have certainly added a special uniqueness to all of the products available in the Saunders Pyramid to Success. Saunders Pyramid to Success products provide you with everyth ing that you need to ready yourself for the NCLEX-RN exam ination. These products include m aterial that is required for the NCLEX-RN exam ination for all nursing studen ts regardless of educational background, specific strengths, areas in need of im provem ent, or clin ical experience during the nursing program. So let’s get started and begin our journey through the Saunders Pyramid to Success, and welcom e to the wonderful profession of nursing! Sincerely, vi  About the Author Linda Anne Silvestri, PhD, RN I relocated to Rhode Island and began teaching ad- (Photo by Laurent W. Valliere.) vanced m edical-surgical nursing and psychiatric nursing to RN and LPN studen ts at the Com m unity College of A s a child, I always dream ed of becom ing either a nurse or a teacher. Initially I chose to Rhode Island. While teachin g there, a group of students approached m e for assistance in preparing for the NCLEX exam ination. I have always had a very special becom e a nurse because I really interest in test success for nursing studen ts because of wanted to help others, espe- m y own personal experiences with testin g. Taking tests cially those who were ill. Then I realized that both of was never easy for m e, and as a student I needed to find m y dream s could com e true; I could be both a nurse m ethods and strategies that would bring success. My and a teacher. So I pursued m y dream s. own difficult experiences, desire, and dedication to assist I received m y diplom a in nursing at Cooley Dickin- nursing students to overcom e the obstacles associated son Hospital School of Nursing in Northam pton, Mas- with testin g inspired m e to develop and write the m any sachusetts. Afterward, I worked at Baystate Medical products that would foster success with testin g. My expe- Center in Springfield, Massachusetts, where I cared for riences as a studen t, nursing educator, and item writer clients in acute m edical-surgical units, the intensive care for the NCLEX exam inations aided m e as I developed unit, the em ergency departm en t, pediatric units, and a com prehensive review course to prepare nursing other acute care units. Later I received an associate degree graduates for the NCLEX exam ination. from Holyoke Com m un ity College in Holyoke, Massa- Later, in 1994, I began teachin g m edical-surgical chusetts; m y BSN from Am erican Internation al College nursing at Salve Regina University in Newport, Rhode in Springfield, Massach usetts; and m y MSN from Anna Island, and I rem ain there as an adjunct faculty m em ber. Maria College in Paxton, Massachusetts, with a dual I also prepare nursing studen ts at Salve Regina Un iversity m ajor in Nursing Managem ent and Patient Education. for the NCLEX-RN exam ination. I received m y PhD in Nursing from the Un iversity of I established Professional Nursing Sem inars, Inc. in Nevada, Las Vegas, and conducted research on self- 1991 and Nursing Reviews, Inc. in 2000. These companies efficacy and the predictors of NCLEX® success. I am also are located in Charlestown, Rhode Island. In 2012, I estab- a m em ber of the Honor Society of Nursing, Sigm a Theta lished an additional company, Nursing Reviews, Inc. in Tau Internation al, Phi Kappa Phi, the Am erican Nurses Henderson, Nevada. Both com panies are dedicated to Association, the Nation al League for Nursing, the West- helping nursing graduates achieve their goals of becoming ern Institute of Nursing, the Eastern Nursing Research registered nurses, licensed practical/vocational nurses, Society, and the Golden Key Intern ational Honour Soci- or both. ety. In addition, I received the 2012 Alum na of the Year/ Today, I am the successful author of num erous Nurse of the Year Award from the University of Nevada, review products. Also, I serve as an Elsevier consultant Las Vegas, School of Nursing. for HESI Live Reviews, the review courses for the NCLEX As a native of Springfield, Massachusetts, I began m y exam inations conducted throughout the country. I am teachin g career as an instructor of m edical-surgical nurs- so pleased that you have decided to join m e on your ing and leadersh ip-m an agem ent nursing in 1981 at journey to success in testin g for nursing exam inations Baystate Medical Center School of Nursing. In 1989, and for the NCLEX-RN exam ination! vii  Contributors Consultants Nancy Curry, BSN, MSN Dianne E. Fiorentino Assistant Professor, Nursing Research Coordinator Northwestern State University College of Nursing and School Nursing Reviews, Inc. of Allied Health Henderson, Nevada Shreveport, Louisiana James Guibault, Jr., BS, PharmD Mattie Davis, DNP, MSN, RN Clinical Pharm acist Nursing Instructor, Health Sciences Wilbraham , Massachusetts J.F. Drake State Technical College Huntsville, Alabam a Nicholas L. Silvestri, BA Editorial and Com m unications Analyst Margie Francisco, EdD, MSN, RN Nursing Reviews, Inc. Nursing Professor Charlestown, Rhode Island Health Division Illinois Valley Com m unity College Jane Tyerman, RN, MScN, PhD Oglesby, Illinois Faculty Trent/Flem ing School of Nursing Marilyn Greer, MS, RN Peterborough, Ontario, Canada Associate Professor of Nursing Rockford College Contributors Rockford, Illinois Marilee Aufdenkamp, BSN, MS Assistant Professor Joyce Hammer, RN, MSN School of Nursing Adjunct Faculty, Nursing Creighton University Monroe County Com m unity College Om aha, Nebraska Monroe, Michigan Jaskaranjeet Bhullar, RN Donna Russo, MSN, CCRN, CNE Graduate Nursing Instructor School of Nursing ARIA Health School of Nursing Touro University Nevada Philadelphia, Pennsylvania Henderson, Nevada Mary Scheid, RN, MSN Jean Burt, BS, BSN, MSN NCMC Breast Center Instructor, Nursing North Colorado Medical Center City Colleges of Chicago Greeley, Colorado Chicago, Illinois Laurent W. Valliere, BS, DD Reitha Cabaniss, EdD, MSN Vice President of Nursing Reviews, Inc. Nursing Director Professional Nursing Sem inars, Inc. Bevill State Com m unity College Charlestown, Rhode Island Jasper, Alabam a Donna Wilsker, MSN, BSN Barbara Callahan, MEd, RN, NCC, CHSE Assistant Professor Retired Dishm an Departm ent of Nursing Lenoir Com m unity College Lam ar University Kinston, North Carolina Beaum ont, Texas viii  Contributors ix Item Writer and Section Editor Bethany Hawes Sykes, EdD, RN, CEN, CCRN Donna Russo, MSN, CCRN, CNE Em ergency Departm ent RN Nursing Instructor St Luke’s Hospital ARIA Health School of Nursing New Bedford, Massachusetts Philadelphia, Pennsylvania Adjunct Faculty Departm ent of Nursing Item Writers Salve Regina University Newport, Rhode Island Amber Ballard, MSN, RN Registered Nurse Linda Turchin, RN, MSN, CNE Em ergency Departm ent Assistant Professor, Nursing Sparrow Health System Fairm ont State University Lansing, Michigan Fairm ont, West Virginia Betty Cheng, MSN Donna Wilsker, MSN, BSN Assistant Professor Assistant Professor School of Nursing Dishm an Departm ent of Nursing MCPHS University Lam ar University Boston, Massachusetts Beaum ont, Texas Christina Keller, MSN, RN Olga Van Dyke, PhD (c), CAGS, MSN Instructor Assistant Professor School of Nursing School of Nursing Radford University MCPHS University Radford, Virginia Boston, Massachusetts Heidi Monroe, MSN, RN-BC, CAPA Assistant Professor of Nursing NCLEX-RN ® Coordinator Bellin College Green Bay, Wisconsin The author and publisher would also like to acknowledge the following individuals for contributions to the previous edition of this book: Marilee Aufden kam p, RN, MS Susan Golden , MSN, RN Debra L. Price, RN, MSN, CPNP Hastings, Nebraska Roswell, New Mexico Fort Worth, Texas Margaret Barn es, MSN, RN Marilyn L. Joh n essee Greer, MS, RN Don n a Russo, RN, MSN, CCRN Marion, Indiana Rockford, Illinois Philadelphia, Pennsylvania Reith a Caban iss, MSN, RN, CNE Jam ie Lyn n Jon es, MSN, RN, CNE An gela Silvestri, Ph D, RN, CNE Jasper, Alabam a Little Rock, Arkansas Henderson, Nevada Joan n a E. Cain , BSN, BA, RN Lyn n Korvick, Ph D, RN, CNE Ch ristin e Sum p, MSN, RN Austin, Texas Joplin, Missouri Norfolk, Virginia Barbara Callah an , MEd, RN, NCC, Tara McMillan -Queen , RN, MSN, Beth an y Hawes Sykes, EdD, RN, CHSE ANP, GNP CEN, CCRN Kinston, North Carolina Charlotte, North Carolina Newport, Rhode Island Mary C. Carrico, MS, RN Heidi Mon roe, MSN, RN-BC, CPAN, Lin da Turch in , RN, MSN, CNE Paducah, Kentucky CAPA Fairm ont, West Virginia Green Bay, Wisconsin Mary L. Dowell, Ph D, RN, BC Lauren t W. Valliere, BS, DD San Antonio, Texas David Morrow, BSN, RN Charlestown, Rhode Island Las Vegas, Nevada Beth B. Gaul, Ph D, RN Des Moines, Iowa  Reviewers Danese M. Boob, RN-BC, BSN, MSN/ ED Lilah M. Harper, RN, CA Certification in Perinatal Nursing and Medical-Surgical President, Harper Consulting Services Nursing Valley Center, California Departm ent of Nursing Lead Nurse Planner, Anderson Continuing Education Pennsylvania State University Sacram ento, California Hershey, Pennsylvania Laura Hope, MSN, RN Jean Elizabeth Burt, MS, RN Nursing Faculty Nursing Instructor Nursing Program Wilbur Wright College Florence-Darlington Technical College Chicago, Illinois Florence, South Carolina Betty Cheng, MSN, RN, FNP Donna Walker Hubbard, RN, MSN, CNNe Instructor of Nursing Assistant Professor, Retired School of Nursing Nursing Departm ent Quincy College University of Mary Hardin-Baylor Quincy, Massachusetts Belton, Texas Marguerite C. DeBello, RN, MSN, ACNS-BC, Paula Celeste Hughes, MSN, RN CNE, NP Nursing Faculty Assistant Professor Nursing and Allied Health Departm ent School of Nursing Georgia Northwestern Technical College Eastern Michigan University Rom e, Georgia Ypsilanti, Michigan Georgina Julious, RN, BSN, MSN Margie L. Francisco, EdD, MSN, RN BLS Instructor; Facility Adm inistrator Nursing Professor Nursing Departm ent Nursing/Health Professions Departm ent Illinois Out-Patient Dialysis Valley Com m unity College Hartsville, South Carolina Oglesby, Illinois Elizabeth B. McGrath, MS, APRN, AGACNP-BC, Shari Gould, MSN, RN AOCNP, ACHPN Associate Professor of Nursing Nurse Practitioner Career, Health and Technical Professions Departm ent Dartm outh Hitchcock Medical Center—Geisel School of Victoria College Medicine at Dartm outh Victoria, Texas Lebanon, New Ham pshire Sheila Grossman, PhD, APRN, FNP-BC, FAAN Pat A. Perryman, MSN, RN, PhD Professor & Coordinator, Fam ily Nurse Practitioner Track President Nursing Departm ent Adm inistration Fairfield University School of Nursing Dallas Nursing Institute Fairfield, Connecticut Dallas, Texas Joyce Hammer, RN, MSN Karen Robertson, RN, MSN, MBA, PhD(c) Adjunct Clinical Faculty Associate Professor Nursing Departm ent Nursing Departm ent Monroe County Com m unity College Rock Valley College x Monroe, Michigan Rockford, Illinois  Reviewers xi Charlotte D. Strahm, DNSc, RN, CNS Donna Wilsker, MSN, RN Assistant Professor Assistant Professor Departm ent of Nursing Dishm an Departm ent of Nursing Purdue University North Central Lam ar University Westville, Indiana Beaum ont, Texas Christine Sump, MSN, RN Karen Winsor, MSN, RN, ACNS-BC Nursing Lecturer APRN for Orthopedic Traum a Nursing Departm ent Austin, Texas Old Dom inion University Norfolk, Virginia Daryle Wane, PhD, ARNP, FNP-BC RN to BSN Coordinator Departm ent of Health Occupations Pasco-Hernando State College New Port Richey, Florida  “To laugh often and much, to appreciate beauty, to find the best in others, to leave the world a bit better, to know that even one life has breathed easier Preface because you have lived, this is to have succeeded.” —Ralph Waldo Emerson Welcome to Saunders Pyramid bold green type throughout the content section of each chapter. The definitions can be found in the Glossary at to Success! the end of the book. An Essential Resource for Test Success Saunders Comprehensive Review for the NCLEX-RN ® Exam- Pyramid to Success ination is one in a series of products designed to assist The Pyramid to Success, a featured part of each unit in- you in achieving your goal of becom ing a registered troduction, provides you with an overview, guidance, nurse. This text will provide you with a com prehensive and direction regardingthe focus ofreview in the particular review of all nursing content areas specifically related content area, as well as the content area’s relative impor- to the new 2016 test plan for the NCLEX-RN exam ina- tance to the 2016 test plan for the NCLEX-RN examina- tion, which is im plem ented by the Nation al Council tion. The Pyramid to Success reviews the Client Needs and of State Boards of Nursing. This resource will help provides learning objectives as they pertain to the content you achieve success on your nursing exam inations dur- in that unit. These learning objectives identify the specific ing nursing school and on the NCLEX-RN exam ination. components to keep in m ind as you review each chapter. Priority Concepts Organization Each chapter identifies two Priority Concepts reflective of its content. These Priority Concepts will assist you to focus This book contain s 20 units and 72 chapters. The chap- on the im portant aspects of the content and associated ters are design ed to identify specific com ponents of nurs- nursing interventions. ing content. They contain practice question s, includin g a critical thin king question, and both m ultiple-ch oice and Pyramid Points alternate item form ats that reflect the chapter content Pyramid Points ( ) are placed next to specific content and the 2016 test plan for the NCLEX-RN exam ination. throughout the chapters. The Pyramid Points highlight con- The final unit contains a 75-question Com prehensive tent that is important for preparing for the NCLEX-RN Test. All questions in the book and on the Evolve site examination and identify content that is likely to appear are presented in NCLEX-style form at. on the NCLEX-RN examination. The new test plan identifies a framework based on Client Needs. These Client Needs categories include Safe and Effective Care Environment, Health Promotion and Pyramid Alerts Maintenance, Psychosocial Integrity, and Physiological Pyramid Alerts are th e red text foun d th rough out th e Integrity. Integrated Processes are also identified as a com- ch apters th at alert you to im portan t in form ation ponent of the test plan. These include Caring, Com muni- about n ursin g con cepts. Th ese alerts iden tify con ten t cation and Docum entation, Culture and Spirituality, th at typically appears on th e NCLEX-RN exam in ation. Nursing Process, and Teaching and Learning. All chapters address the components of the test plan framework. Priority Nursing Actions Numerous Priority Nursing Actions boxes have been placed throughout the chapters. These boxes present a clinical Special Features of the Book nursing situation and the priority actions to take in the event of its occurrence. Arationale is provided that explains Pyramid Terms the correct order of action, along with a reference for addi- Pyramid Terms are im portant to the discussion of the con- tional research. A list of these boxes can be found in the xii tent in the chapters in each unit. Therefore, they are in backmatter of the book for easier location.  Preface xiii Critical Thinking: What Should You Do? Questions prioritizin g, decision-m aking, and critical thinkin g Each chapter contains a Critical Thinking: What Should You skills. Chapter 1 of this book provides a description of Do? question. These questions provide a brief clinical sce- each question type and the answer section. The answer nario related to the content of the chapter and ask you section includes the correct answer, rationale, test-taking what you should do about the client situation presented. strategy, question categories, and reference. A narrative answer is provided along with a reference In each practice question, the specific test-taking strat- source for researching further inform ation. egy that will assist you in answering the question correctly is highlighted in bold blue type. Specific suggestions for review are identified in the test-taking strategy and are Special Features Found on Evolve highlighted in bold m agen ta type to provide you with direction for locating the specific content in this book. This Pretest and Study Calendar highlighting of the specific test-taking strategies and spe- The accom panying Evolve site contains a 75-question pre- cific content areas in the practice questions will provide test that provides you with feedback on your strengths and you with guidance on what topics to review for further weaknesses. The results of your pretest will generate an remediation in both Saunders Strategies for Test Success: individualized study calendar to guide you in your prepa- Passing Nursing School and the NCLEX® Exam and Saunders ration for the NCLEX-RN examination. Comprehensive Review for the NCLEX-RN ® Examination. Heart, Lung, and Bowel Sound Questions The categories identified in each practice question include Level of Cognitive Ability, Client Needs, Integrat- Th e accom pan yin g Evolve site con tain s Audio Questions ed Process, Priority Concepts, and the specific nursing represen tative of con ten t ad dressed in th e 2016 test Content Area. Every question on the accompanying Evolve plan for th e NCLEX-RN exam in ation. Each question site is organized by these question codes, so you can cus- presen ts an audio clip as a com pon en t of th e question. tom ize your study session to be as specific or as generic Video Questions as you need. Additionally, normal laboratory reference The accom pan ying Evolve site contains Video Questions intervals are provided with each laboratory question. representative of conten t addressed in the 2016 test plan for the NCLEX-RN exam ination. Each question presents a video clip as a com ponent of the question. Pharmacology and Medication Calculations Review Testlet Questions The accom panying Evolve site contains testlet question s. Students consistently state that pharm acology is an area These question types include a client scenario and sev- with which they need assistance. The 2016 NCLEX-RN test eral accom panyin g practice question s that relate to the plan continues to incorporate pharm acology in the exam - content of the scenario. ination, but only the generic drug nam es will be included. Therefore, pharm acology chapters have been included for Audio Review Summaries and Animations your review and practice. This book includes 13 pharm a- The com panion Evolve site includes three Audio Review cology chapters, a m edication and intravenous calculation Summaries that cover challenging subject areas addressed chapter, and a pediatric m edication calculation chapter. in the 2016 test plan for the NCLEX-RN exam ination, Each ofthese chapters is followed bya practice test that uses includin g Pharmacology, Acid-Base Balance, and Fluids the sam e question form at described earlier. This book con- and Electrolytes. Anim ation s that present various content tains num erous pharmacology questions. Additionally, areas are also available for viewing. m ore than 900 pharm acology questions can be found on the accompanying Evolve site. Practice Questions While preparing for the NCLEX-RN examination, it is How to Use This Book crucial for students to practice taking test questions. This book contains 996 NCLEX-style multiple-choice and SaundersComprehensiveReviewfor theNCLEX-RN ® Examina- alternate item format questions. The accompanying soft- tion is especially designed to help you with your successful ware includes all questions from the book plus additional journey to the peak of the Saunders Pyramid to Success: Evolve questions for a total of more than 5200 questions. becoming a registered nurse! As you begin your journey through thisbook,you willbeintroduced to allofthe impor- Multiple-Choice and Alternate Item Format Questions tant points regardingthe 2016 NCLEX-RN examination, the Startin g with Unit II, each chapter is followed by a prac- processoftesting, and uniqueand special tipsregardinghow tice test. Each practice test contains several question s to prepare yourself for this very important examination. reflective of those presented on the NCLEX-RN exam ina- You should begin your process through the Saunders tion. These questions provide you with practice in Pyramid to Success by reading all of Unit I in this book xiv Preface and becom ing fam iliar with the central points regarding The purpose of this book is to provide a com preh en- the NCLEX-RN exam ination. Read Chapter 3, written by sive review of the nursing content you will be tested on a nursing graduate who recently passed the exam ination, during the NCLEX-RN examination. However, Saunders and note what she has to say about the testing experience. Comprehensive Review for the NCLEX-RN ® Examination is Chapter 4 will provide you with the critical testing strate- intended to do m ore than sim ply prepare you for the rigors gies that will guide you in selecting the correct option or of the NCLEX-RN examination; this book is also m eant to assist you in selecting an answer to a question if you m ust serve as a valuable study tool that you can refer to through- guess. Keep these strategies in m ind as you proceed out your nursing program, with custom izable Evolve site through this book. Continue by studying the specific con- selections to help identify and reinforce key content areas. tent areas addressed in Units II through XIX. Review the After using this book for comprehensive content definitions of the Pyramid Terms located in the Glossary review, your next step on the Pyramid to Success is to get and the Pyramid to Success notes, and identify the Client additional practice with a Q&A review product. Saunders Needs and Learning Objectives specific to the test plan Q&A Review for the NCLEX-RN ® Examination offers m ore in each area. Read through the chapters and focus on the than 6000 unique practice questions in the book and on Pyramid Points and Pyramid Alerts that identify the areas the companion Evolve site. The questions are focused on m ost likely to be tested on the NCLEX-RN exam ination. the Client Needs and Integrated Processes of the NCLEX- Payparticular attention to the PriorityNursingActionsboxes RN test plan, m aking it easy to access your study area of because they provide inform ation about the steps you will choice. For on-the-go Q&A review, you can pick up Saun- take in clinical situations requiring prioritization. ders Q&A Review Cards for the NCLEX-RN ® Examination. As you read each chapter, identify your areas of Your final step on the Pyramid to Success is to m aster strength and those in need of further review. Highligh t the on lin e review. Saunders Online Review for the NCLEX- these areas and test your abilities by answering the Crit- RN ® Examination provides an interactive and individual- ical Thinking: What Should You Do? question and taking ized platform to get you ready for your final licensure all practice tests provided at the end of the chapters. Be exam. This online course provides 10 high-level content sure to review all ration ales and test-taking strategies. m odules, supplem ented with instructional videos, ani- After reviewing all chapters in the book, turn to Unit m ation s, audio, illustrations, testlets, and several subject XX, the Com prehensive Test. Take this exam ination m atter exam s. End-of-m odule practice tests are provided and then review each question, answer, and ration ale. along with several Crossing the Finish Line practice tests. Identify any areas requiring further review; then take In addition, you can assess your progress with a pretest, the tim e to review those areas in both the book and Test Yourself quizzes, and a com prehensive exam in a the companion Evolve site. In preparation for the com puterized environ m ent that prepares you for the NCLEX-RN exam ination, be sure to take the pretest and actual NCLEX-RN exam ination. generate your study calendar. Follow the calendar for At the base of the Pyramid to Success are m y test- your review because the calendar represents your pretest taking strategies, which provide a foundation for under- results and the best study path to follow based on your standing and unpacking the com plexities of NCLEX-RN strong and weak content areas. Also, be sure to access exam ination questions, including alternate item formats. the Testlets and the Audio Review Summaries as part of Saunders Strategies for Test Success: Passing Nursing School your preparation for the NCLEX-RN exam ination. and the NCLEX® Exam takes a detailed look at all of the test-taking strategies you will need to know in order to pass Climbing the Pyramid to Success any nursing examination, including the NCLEX-RN. Spe- cial tips are integrated for nursing students, and there are m ore than 1200 practice questions included so you can apply the testing strategies. Good luck with your journey through the Saunders Pyramid to Success. I wish you continued success through- out your new career as a registered nurse! Linda Anne Silvestri  Acknowledgments Sincere appreciation and warm est than ks are exten ded I sincerely acknowledge and thank m any very im por- to the m any individuals who in their own ways have tant individuals from Elsevier who are so dedicated to contributed to the publication of this book. m y work in creating NCLEX products for nursing stu- First, I want to thank all of m y nursing students at the dents. I thank Yvonne Alexopoulos, Senior Content Com m unity College of Rhode Island in Warwick who Strategist, for her continuous assistance, enthusiasm , approached m e in 1991 and persuaded m e to help them support, and expert profession al guidance as I prepared prepare to take the NCLEX-RN ® exam ination. Their this publication, and Laurie Gower, Content Develop- enthusiasm and inspiration led to the com m encem ent m ent Manager, for her expert ideas as we planned the of m y profession al endeavors in conducting review project and for her continuous support throughout the courses for the NCLEX-RN exam ination for nursing stu- production process. dents. I also than k the num erous nursing studen ts who And, a special and sincere than k you to Laura have attended m y review courses for their willingness to Goodrich, Content Developm ent Specialist, for her share their needs and ideas. Their input has certainly trem endous am oun t of support and assistance, for prior- added a special uniquen ess to this publication. itizing for m e to keep m e on track, for her ideas for the I wish to acknowledge all of the nursing faculty who product, and for her profession al and expert skills in taught in m y review courses for the NCLEX-RN exam ina- organizing and m aintaining an enorm ous am ount of tion. Their com m itm en t, dedication, and expertise have m anuscript for production. I could not have com pleted certainly helped nursing studen ts to achieve success with this project without Laura—than k you, Laura! I also the exam. want to acknowledge Jam ie Randall, Conten t Strategist I want to extend a very special than k you to m y niece for all of her assistance in com pleting this project— Dr. Angela Silvestri-Elm ore, who functioned as m y thank you, Jam ie! “super-editor” for this book. In m y eyes she is defin itely I thank Elodia Dianne Fiorentino for research ing “super,” and her trem endous theoretical and clinical conten t and preparing references for each practice ques- knowledge and expertise and her consistent ideas and tion; Nich olas Silvestri for editin g, form atting, and orga- input certainly added to the excellent quality of this nizing m anuscript files for m e; Jam es Guilbault for product. Thank you Angela! research ing and updatin g m edications; and m y personal I also wish to offer a very special acknowledgm ent team who participated in reviewing the Evolve site that and than k you to Jane Tyerm an for reviewing this entire accom panies this product. A special thank you to all book to ensure that it included Canadian nursing prac- of you for providing continuous support and dedication tice and standards. Thank you, Jane! to m y work in preparing this publication and m aintain- I want to acknowledge and sincerely thank m y hus- ing its excellent quality. band, Laurent W. Valliere, or Larry, for his contribution I want to acknowledge all of the staff at Elsevier for to this publication, for teaching in m y review courses for their trem endous assistance throughout the preparation the NCLEX-RN exam ination, and for his com m itm ent and production of this publication and all of the Elsevier and dedication in helping m y nursing studen ts prepare staff involved in the publication of previous editions of for the NCLEX-RN exam ination from a nonacadem ic this outstandin g NCLEX review product. A special than k poin t of view. Larry has supported m y m any profes- you to all of them. I thank all of the im portant people in sional endeavors and was so loyal and loving to m e each the production and m arketing departm en t, including Bill and every m om ent as I worked to achieve m y profes- Drone, Book Production Specialist; Dan ielle LeCom pte, sional goals. Larry, than k you so m uch ! Marketin g Manager; Jeff Patterson, Publish ing Services And, a special thank you also goes to Jaskaranjeet Manager; Am y Sim pson, Multim edia Producer; and Bhullar, RN, BSN, for writing a chapter for this book Renee Duenow, Designer. about her experiences preparing for and taking the And a special thank you to Loren Wilson, form er NCLEX-RN exam ination. Senior Vice President, for her years of expert guidance xv xvi Acknowledgments and continuous support for all of the products in the their thoughts and ideas. A very special thank you to Pyramid to Success. all of you! I would also like to acknowledge Patricia Mieg, for- I also need to thank Salve Regina University for the m er educational sales representative, who encouraged opportun ity to educate nursing students in the baccalau- m e to subm it m y ideas and initial work for the first edi- reate nursing program and for its support during m y tion of this book to the W.B. Saunders Com pany. research and writing of this publication. I would like A very special and heartfelt than k you goes to m y to especially acknowledge m y colleagues Dr. Eileen parents, who opened the door of opportunity in educa- Gray, Dr. Ellen McCarty, and Dr. Bethany Sykes for all tion for m e. I than k m y m other, Frances Mary, for all of of their encouragem ent and support. her love, support, and assistance as I continuously I wish to acknowledge the Com m unity College of worked to achieve m y professional goals. I thank m y Rhode Island, which provided m e with the opportunity father, Arnold Lawrence, who always provided insightful to educate nursing studen ts in the Associate Degree of words of encouragem ent. My m em ories of his love Nursing Program. A special thank you goes to Patricia and support will always rem ain in m y heart. I am certain Miller, MSN, RN, and Michelina McClellan, MS, RN, that he would be very proud of m y professional from Baystate Medical Cen ter, School of Nursing, in accom plishm ents. Springfield, Massachusetts, who were m y first m entors I also than k m y entire fam ily for bein g continuously in nursing education. supportive, giving, and helpful during m y research and Finally, a very special than k you to all of m y nursing preparation of this publication. students—past, present, and future. All of you light up I want to especially acknowledge each and every m y life! Your love and dedication to the profession of individual who contributed to this publication—the nursing and your com m itm ent to providing health care reviewers, contributors, item writers, and updaters— will bring never-ending rewards! for their expert input and ideas. I also thank the m any faculty and studen t reviewers of the m anuscript for Linda Anne Silvestri  UNIT I p e r P X E L C N ® NCLEX-RN Exam Preparation  C H AP T E R 1 p e r P ® The NCLEX-RN Examination X E L C N The Pyramid to Success Needs category, the Integrated Process, Priority Con- cepts, and the nursing content area. Welcome to the Pyramid to Success Saunders Q&A Review for the NCLEX-RN ® Saunders Comprehensive Review for the Examination NCLEX-RN ® Examination Following the com pletion of your com prehensive review Saunders Comprehensive Review for the NCLEX-RN ® Exam- in this book, continue on your journey through the Pyr- ination is specially design ed to help you begin your suc- am id to Success with the com pan ion book, Saunders cessful journey to the peak of the pyram id, becom ing a Q&A Review for the NCLEX-RN ® Examination. This book registered nurse. As you begin your journey, you will be provides you with m ore than 6000 practice question s in introduced to all of the im portant poin ts regardin g the the m ultiple-ch oice and alternate item form ats, includ- NCLEX-RN exam ination and the process of testing, ing audio and video questions. The book is designed and to the unique and special tips regarding how to pre- based on the NCLEX-RN exam ination test plan fram e- pare yourself for this im portant exam ination. You will work, with a specific focus on Client Needs and Inte- read what a nursing graduate who recently passed the grated Processes. In addition, each practice question in NCLEX-RN exam ination has to say about the test. this book includes a Priority Nursing Tip, which pro- Im portant test-taking strategies are detailed. These vides you with an im portant piece of inform ation that details will guide you in selecting the correct option or will be helpful to answer question s. Then, you will be assist you in selectin g an answer to a question at which ready for HESI/Saunders Online Review for the NCLEX- you m ust guess. RN ® Examination. Additional products in Saunders Pyr- Each unit in this book begins with the Pyram id to am id to Success include Saunders Strategies for Test Suc- Success. The Pyram id to Success addresses specific points cess: Passing Nursing School and the NCLEX® Exam and related to the NCLEX-RN exam ination. Client Needs as Saunders Q&A Review Cards for the NCLEX-RN ® Exam. identified in the test plan fram ework for the exam ination These products are described next. are listed as well as learning objectives for the unit. Pyr- am id Term s are key words that are defined in the glossary HESI/ Saunders Online Review for the at the end of the book and set in color throughout each NCLEX-RN ® Examination chapter to direct your attention to significant points for This product addresses all areas of the test plan identified the exam ination. by the National Council of State Boards of Nursing Through out each chapter, you will find Pyram id (NCSBN). The course contain s a pretest that provides Point bullets that iden tify areas m ost likely to be tested feedback regardin g your strengths and weaknesses and on the NCLEX-RN exam ination. Read each chapter, and generates an individualized study schedule in a calen dar identify your strengths and areas that are in need of fur- form at. Conten t review is in an outline form at and ther review. Test your strengths and abilities by taking all includes self-check practice questions and testlets (case practice tests provided in this book and on the accom pa- studies), figures and illustrations, a glossary, and anim a- nying Evolve site. Be sure to read all of the ration ales and tions and videos. Num erous online exam s are included. test-taking strategies. The ration ale provides you with There are 2500 practice question s; the types of questions significant inform ation regardin g the correct and incor- in this course include m ultiple-choice and alternate item rect option s. The test-taking strategy provides you with form ats. the logical path to selectin g the correct option. The test-taking strategy also iden tifies the content area to Saunders Strategies for Test Success: Passing review, if required. The reference source and page num - Nursing School and the NCLEX® Exam ber are provided so that you can easily find the inform a- This product focuses on the test-taking strategies that will tion that you need to review. Each question is coded on help you to pass your nursing exam ination s while in 2 the basis of the Level of Cognitive Ability, the Client nursing school and will prepare you for the NCLEX-RN  CHAPTER 1 The NCLEX-RN ® Examination 3 exam ination. The chapters describe various test-taking (http://www.n csbn.org) and from the NCSBN 2016 test strategies and include sam ple question s that illustrate plan for the NCLEX-RN and includes som e procedures how to use the strategies. Also included in this book is related to registering for the exam , testin g procedures, inform ation on cultural characteristics and practices, and the answers to the question s m ost com m on ly asked p pharm acology strategies, m edication and intravenous by nursing students and graduates preparing to take the e r P calculations, laboratory values, position ing guidelines, NCLEX. You can obtain additional inform ation regard- X and therapeutic diets. This book has m ore than 1200 ing the test and its developm ent by accessing the NCSBN E L practice questions, and each question provides a tip for Web site and clickin g on the NCLEXExam tab or by writ- C N the beginnin g nursing studen t. The practice questions ing to the Nation al Coun cil of State Boards of Nursing, reflect the fram ework and the content identified in the 111 East Wacker Drive, Suite 2900, Chicago, IL 60601. NCLEX-RN test plan and include m ultiple-choice and You are encouraged to access the NCSBN Web site alternate item form at questions, includin g audio and because this site provides you with valuable inform ation video questions. about the NCLEX and oth er resources available to an NCLEX candidate. Saunders Q&A Review Cards for the NCLEX-RN ® Exam This product is organized by content area and the fram e- Computer Adaptive Testing work of the NCLEX-RN test plan. It provides you with 1200 unique practice test questions on portable and The acron ym CAT stands for com puter adaptive test, easy-to-use cards. The cards have the question on the front which m eans that the exam ination is created as the of the card, and the answer, rationale, and test-taking test-taker answers each question. All the test questions strategy are on the back of the card. This product includes are categorized on the basis of the test plan structure m ultiple-choice questions and alternate item format and the level of difficulty of the question. As you answer questions, including fill-in-the-blank, m ultiple-response, a question , the com puter determ ines your com peten cy ordered-response, figure, and chart/exhibit questions. based on the answer you selected. If you selected a cor- rect answer, the com puter scans the question bank and Saunders RNtertainment for the NCLEX-RN ® Exam selects a m ore difficult question. If you selected an incor- RNtertainm ent: The NCLEX® Review Gam e, 2nd Edition rect answer, the com puter scans the question bank and is a revolution ary board gam e that offers nursing stu- selects an easier question. This process continues until dents a fun and challenging chan ge of pace from stan- all test plan requirem ents are m et and a reliable pass- dard review options. 800 clinical questions and or-fail decision is m ade. scenarios cover all the m ajor nursing categories on the When taking a CAT, once an answer is recorded, all NCLEX® test plan—including Health Prom otion and subsequent questions adm inistered depen d, to an Maintenance, Physiological Integrity, Psychosocial extent, on the answer selected for that question. Skip- Integrity, and Safe and Effective Care Environm ent. This ping and returning to earlier questions are not com pat- com pletely redesigned second edition also features new ible with the logical m ethodology of a CAT. The inability alternate item form ats, test-taking tips and test-taking to skip question s or go back to change previous answers traps covering helpful test taking strategies and tech- will not be a disadvantage to you; you will not fall into niques, and a ration ales booklet that provides justifica- that “trap” of changin g a correct answer to an incorrect tion for correct answers. one with the CAT system. All products in the Saunders Pyram id to Success can If you are faced with a question that contains unfa- be obtained onlin e by visitin g http://elsevierhealth.com m iliar content, you m ay need to guess at the answer. or by calling 800-545-2522. There is no penalty for guessing but you need to m ake Let’s begin our journey through the Pyram id to an educated guess. With m ost of the questions, the Success. answer will be right there in front of you. If you need to guess, use your nursing knowledge and clinical expe- riences to their fullest extent and all of the test-taking Examination Process strategies you have practiced in this review program. You do not need any com puter experience to take this An im portant step in the Pyram id to Success is to exam ination. A keyboard tutorial is provided and becom e as fam iliar as possible with the exam ination adm inistered to all test-takers at the start of the exam ina- process. Candidates facing the challen ge of this exam i- tion. The tutorial will instruct you on the use of the on- nation can experience significant anxiety. Knowing what screen optional calculator, the use of the m ouse, and the exam ination is all about and knowing what you will how to record an answer. The tutorial provides instruc- encoun ter during the process of testin g will assist in alle- tions on how to respond to all question types on this viating fear and anxiety. The inform ation contain ed in exam ination. This tutorial is provided on the NCSBN this chapter was obtained from the NCSBN Web site Web site, and you are encouraged to view the tutorial 4 UNIT I NCLEX-RN ® Exam Preparation when you are preparing for the NCLEX exam ination. In BOX 1-1 Level of Cognitive Ability: Applying addition, at the testin g site, a test adm inistrator is present to assist in explain ing the use of the com puter to en sure The nurse notes blanching, coolness, and edema at the your full understanding of how to proceed. peripheral intravenous (IV) site. On the basis of these find- p ings, the nurse should implement which action? e r 1. Remove the IV. P X 2. Apply a warm compress. Development of the Test Plan E 3. Check for a blood return. L C 4. Measure the area of infiltration. N The test plan for the NCLEX-RN exam ination is devel- oped by the NCSBN. The exam ination is a nation al Answer: 1 exam ination; the NCSBN considers the legal scope of This question requires that you focus on the data in the ques- nursing practice as governed by state laws and regula- tion and determine that the client is experiencing an infiltra- tion. Next, you need to consider the harmful effects of tions, including the Nurse Practice Act, and uses these infiltration and determine the action to implement. Because laws to defin e the areas on the exam ination that will infiltration can be damaging to the surrounding tissue, the assess the com petence of the test-taker for licen sure. appropriate action is to remove the IV to prevent any further The NCSBN also conducts an im portan t study every damage. 3 years, known as a practice analysis study, to determ ine the fram ework for the test plan for the exam ination. The participants in this study include newly licensed regis- tered nurses from all types of basic nursing education program s. From a list of nursing care activities provided, TABLE 1-1 Client Needs Categories and Percentage the participants are asked about the frequen cy and of Questions on the NCLEX-RN Examination im portance of perform ing them in relation to client Percentage safety and the setting in which they are perform ed. A Client Needs Category of Questions panel of conten t experts at the NCSBN analyzes the Safe and Effective Care Environment results of the study and m akes decision s regardin g the Management of Care 17-23 test plan fram ework. The results of this recen tly con- Safety and Infection Control 9-15 ducted study provided the structure for the test plan im plem ented in April 2016. Health Promotion and Maintenance 6-12 Psychosocial Integrity 6-12 Physiological Integrity Test Plan Basic Care and Comfort 6-12 Pharmacological and Parenteral Therapies 12-18 The content of the NCLEX-RN exam ination reflects the activities identified in the practice analysis study con- Reduction of Risk Potential 9-15 ducted by the NCSBN. The questions are written to Physiological Adaptation 11-17 address Level of Cognitive Ability, Client Needs, and Integrated Processes as iden tified in the test plan devel- oped by the NCSBN. Psychosocial Integrity, and Physiological In tegrity Level of Cognitive Ability (Table 1-1). Levels of cognitive ability include knowledge, under- standing, applying, analyzing, synthesizing, evaluating, Safe and Effective Care Environment and creating. The practice of nursing requires com plex The Safe and Effective Care Environm ent category thought processing and critical thinking in decision m ak- includes 2 subcategories: Managem ent of Care, and ing. Therefore, you will not encounter any knowledge or Safety and Infection Control. According to the NCSBN, understanding questions on the NCLEX. Questions on Managem ent of Care (17% to 23% of question s) this exam ination are written at the applying level or at addresses prioritizin g content and content that will higher Levels of Cognitive Ability. Box 1-1 presents an ensure a safe care delivery settin g to protect clien ts, fam - exam ple of a question that requires you to apply data. ilies, significant others, visitors, and health care person- nel. The NCSBN indicates that Safety and Infection Client Needs Control (9% to 15% of question s) addresses content The NCSBN identifies a test plan fram ework based on that will protect clients, fam ilies, significant others, vis- Client Needs, which includes 4 m ajor categories. Som e itors, and health care personnel from health and envi- of these categories are divided further into subcategories. ronm en tal hazards within health care facilities and in The Client Needs categories are Safe and Effective Care com m un ity settings. Box 1-2 presents exam ples of ques- Environm ent, Health Prom otion and Maintenance, tions that address these 2 subcategories.  CHAPTER 1 The NCLEX-RN ® Examination 5 BOX 1-2 Safe and Effective Care Environment BOX 1-3 Health Promotion and Maintenance Management of Care The nurse is choosing age-appropriate toys for a toddler. Which toy is the best choice for this age? The nurse has received the client assignment for the day. p 1. Puzzle e Which client should the nurse assess first? r 2. Toy soldiers P 1. The client who needs to receive subcutaneous insulin X 3. Large stacking blocks before breakfast E 4. A card game with large pictures L 2. The client who has a nasogastric tube attached to intermit- C Answer: 3 N tent suction 3. The client who is 2 days postoperative and is complaining This question addresses the Client Needs category Health of incisional pain Promotion and Maintenance and specifically relates to the 4. The client who has a blood glucose level of 50 mg/ dL principles of growth and development of a toddler. Note the (2.8 mmol/ L) and complaints of blurred vision strategic word, best. Toddlers like to master activities indepen- dently, such as stacking blocks. Because toddlers do not have Answer: 4 the developmental ability to determine what could be harmful, This question addresses the subcategory Management of toys that are safe need to be provided. A puzzle and toy sol- Care in the Client Needs category Safe and Effective Care Envi- diers provide objects that can be placed in the mouth and ronment. Note the strategic word, first, so you need to estab- may be harmful for a toddler. A card game with large pictures lish priorities by comparing the needs of each client and may require cooperative play, which is more appropriate for a deciding which need is urgent. The client described in the cor- school-age child. rect option has a low blood glucose level and symptoms reflec- tive of hypoglycemia. This client should be assessed first so that treatment can be implemented. Although the clients in options 1, 2, and 3 have needs that require assessment, their Psychosocial Integrity assessments can wait until the client in the correct option is The Psychosocial Integrity category (6% to 12% of ques- stabilized. tions) addresses content required to prom ote and sup- port the ability of the clien t, clien t’s fam ily, and Safety and Infection Control client’s significant oth er to cope, adapt, and problem - The nurse prepares to care for a client on contact precautions solve during stressful even ts. The NCSBN also indicates who has a hospital-acquired infection caused by methicillin- that this Client Needs category addresses the em otional, resistant Staphylococcus aureus (MRSA). The client has an m ental, and social well-bein g of the client, fam ily, or sig- abdominal wound that requires irrigation and has a tracheos- nificant other, and care for the client with an acute or tomy attached to a mechanical ventilator, which requires fre- quent suctioning. The nurse should assemble which chronic m en tal illness. See Box 1-4 for an exam ple of necessary protective items before entering the client’s room? a question in this Client Needs category. 1. Gloves and gown 2. Gloves and face shield Physiological Integrity 3. Gloves, gown, and face shield Th e Ph ysiological In tegrity category in cludes 4 subcat- 4. Gloves, gown, and shoe protectors egories: Basic Care an d Com fort, Ph arm acological an d Answer: 3 Paren teral Th erapies, Reduction of Risk Poten tial, an d This question addresses the subcategory Safety and Infection Control in the Client Needs category Safe and Effective Care Environment. It addresses content related to protecting one- BOX 1-4 Psychosocial Integrity self from contracting an infection and requires that you con- A client with coronary artery disease has selected guided sider the methods of possible transmission of infection, imagery to help cope with psychological stress. Which client based on the client’s condition. Because splashes of infective statement indicates an understanding of this stress reduction material can occur during the wound irrigation or suctioning measure? of the tracheostomy, option 3 is correct. 1. “This will help only if I play music at the same time.” 2. “This will work for me only if I am alone in a quiet area.” 3. “I need to do this only when I lie down in case I fall asleep.” Health Promotion and Maintenance 4. “The best thing about this is that I can use it anywhere, anytime.” The Health Prom otion and Maintenan ce category (6% to 12% of question s) addresses the principles related Answer: 4 to growth and developm ent. According to the NCSBN, This question addresses the Client Needs category Psychoso- this Client Needs category also addresses content cial Integrity and the content addresses coping mechanisms. required to assist the client, fam ily m em bers, and signif- Guided imagery involves the client creating an image in the mind, concentrating on the image, and gradually becoming icant others to prevent health problem s; to recognize less aware of the offending stimulus. It can be done anytime alteration s in health; and to develop health practices that and anywhere; some clients may use other relaxation tech- prom ote and support wellness. See Box 1-3 for an niques or play music with it. exam ple of a question in this Client Needs category. 6 UNIT I NCLEX-RN ® Exam Preparation Ph ysiological Adaptation. Th e NCSBN describes th ese any prescribed treatments or procedures. Physiological subcategories as follows. Basic Care an d Com fort (6% Adaptation (11% to 17% of questions) addresses to 12% of question s) addresses con ten t for providin g content for providing care to clients with acute, chronic, com fort an d assistan ce to th e clien t in th e perform an ce or life-threatening conditions. See Box 1-5 for exam ples p of activities of daily livin g. Ph arm acological an d Par- of questions in this Client Needs category. e r P enteral Therapies (12% to 18% of questions) addresses X content for adm inistering m edications and parenteral Integrated Processes E L therapies such as intravenous therapies and parenteral The NCSBN iden tifies 5 processes in the test plan that are C N nutrition, and adm inistering blood and blood products. fundam ental to the practice of nursing. These processes Reduction of Risk Potential (9% to 15% of questions) are incorporated throughout the m ajor categories of Cli- addresses content for preventing complications or ent Needs. The Integrated Process subcategories are Car- health problems related to the client’s condition or ing, Com m unication and Docum entation , Nursing BOX 1-5 Physiological Integrity Basic Care and Comfort Reduction of Risk Potential Aclient with Parkinson’s disease develops akinesia while ambu- A magnetic resonance imaging (MRI) study is prescribed for a lating, increasing the risk for falls. Which suggestion should the client with a suspected brain tumor. The nurse should imple- nurse provide to the client to alleviate this problem? ment which action to prepare the client for this test? 1. Use a wheelchair to move around. 1. Shave the groin for insertion of a femoral catheter. 2. Stand erect and use a cane to ambulate. 2. Remove all metal-containing objects from the client. 3. Keep the feet close together while ambulating and use a 3. Keep the client NPO (nil per os; nothing bymouth) for 6 hours walker. before the test. 4. Consciously think about walking over imaginary lines on the 4. Instruct the client in inhalation techniques for the adminis- floor. tration of the radioisotope. Answer: 2 Answer: 4 This question addresses the subcategory Reduction of Risk This question addresses the subcategory Basic Care and Com- Potential in the Client Needs category Physiological Integrity, fort in the Client Needs category Physiological Integrity, and and the nurse’s responsibilities in preparing the client for the addresses client mobility and promoting assistance in an activ- diagnostic test. In an MRI study, radiofrequencypulses in a mag- ity of daily living to maintain safety. Clients with Parkinson’s dis- netic field are converted into pictures. All metal objects, such as ease can develop bradykinesia (slow movement) or akinesia rings, bracelets, hairpins, and watches, should be removed. In (freezing or no movement). Having these clients imagine lines addition, a historyshould be taken to ascertain whether the client on the floor to walk over can keep them moving forward while has any internal metallic devices, such as orthopedic hardware, remaining safe. pacemakers, or shrapnel. NPO status is not necessary for an MRI study of the head. The groin may be shaved for an angio- gram, and inhalation of the radioisotope may be prescribed with Pharmacological and Parenteral Therapies other types of scans but is not a part of the procedures for an MRI. The nurse monitors a client receiving digoxin for which early manifestation of digoxin toxicity? Physiological Adaptation 1. Anorexia A client with renal insufficiency has a magnesium level of 2. Facial pain 3.5 mEq/ L (1.75 mmol/ L). On the basis of this laboratory result, 3. Photophobia the nurse interprets which sign as significant? 4. Yellow color perception 1. Hyperpnea Answer: 1 2. Drowsiness This question addresses the subcategory Pharmacological and 3. Hypertension Parenteral Therapies in the Client Needs category Physiological 4. Physical hyperactivity Integrity. Note the strategic word, early. Digoxin is a cardiac gly- Answer: 2 coside that is used to manage and treat heart failure and to con- This question addresses the subcategory Physiological Adap- trol ventricular rates in clients with atrial fibrillation. The most tation in the Client Needs category Physiological Integrity. common early manifestations of toxicity include gastrointesti- It addresses an alteration in body systems. The normal nal disturbances such as anorexia, nausea, and vomiting. Neu- magnesium level is 1.5 to 2.5 mEq/ L(0.75 to 1.25 mmol/ L). rological abnormalities can also occur early and include fatigue, A magnesium level of 3.5 mEq/ L (1.75 mmol/ L) indicates hyper- headache, depression, weakness, drowsiness, confusion, and magnesemia. Neurological manifestations begin to occur when nightmares. Facial pain, personality changes, and ocular distur- magnesium levels are elevated and are noted as symptoms of bances (photophobia, diplopia, light flashes, halos around neurological depression, such as drowsiness, sedation, leth- bright objects, yellow or green color perception) are also signs argy, respiratory depression, muscle weakness, and areflexia. of toxicity, but are not early signs. Bradycardia and hypotension also occur.  CHAPTER 1 The NCLEX-RN ® Examination 7 provide you with data about a client situation and 4 BOX 1-6 Integrated Processes answers, or option s. A client is scheduled for angioplasty. The client says to the nurse, “I’m so afraid that it will hurt and will make me worse Fill-in-the-Blank Questions p off than I am.” Which response by the nurse is therapeutic? Fill-in-the-blank questions m ay ask you to perform a e r 1. “Can you tell me what you understand about the P m edication calculation, determ ine an intravenous flow X procedure?” rate, or calculate an intake or output record on a client. E 2. “Your fears are a sign that you really should have this L You will need to type only a num ber (your answer) in C procedure.” N 3. “Those are very normal fears, but please be assured that the answer box. If the question requires rounding the everything will be okay.” answer, this needs to be perform ed at the end of the cal- 4. “Try not to worry. This is a well-known and easy procedure culation. The rules for rounding an answer are described for the health care provider.” in the tutorial provided by the NCSBN, and are also pro- vided in the specific question on the com puter screen. In Answer: 1 This question addresses the subcategory Caring in the cate- addition, you m ust type in a decim al point if necessary. gory Integrated Processes. The correct option is a therapeutic See Box 1-7 for an exam ple. communication technique that explores the client’s feelings, determines the level of client understanding about the proce- Multiple-Response Questions dure, and displays caring. Option 2 demeans the client and For a m ultiple-response question, you will be asked to does not encourage further sharing by the client. Option 3 select or check all of the options, such as nursing interven- does not address the client’s fears, provides false reassurance, tions, that relate to the information in the question. In and puts the client’s feelings on hold. Option 4 diminishes the these question types, there m ay be 2 or m ore correct client’s feelings bydirecting attention awayfrom the client and answers. No partial credit is given for correct selections. toward the health care provider’s importance. You need to do exactly as the question asks, which will be to select all of the options that apply. See Box 1-8 for Process (Assessment, Analysis, Planning, Implementation, an example. and Evaluation), Culture and Spirituality, and Teaching and Learning. See Box 1-6 for an exam ple of a question Ordered-Response Questions that incorporates the Integrated Process of Caring. In this type of question , you will be asked to use the com - puter m ouse to drag and drop your nursing actions in order of priority. Inform ation will be presented in a Types of Questions on the Examination question and, based on the data, you need to determ ine what you will do first, second, third, and so forth. The The types of questions that m ay be adm inistered on the unordered option s will be located in boxes on the left exam ination include m ultiple-choice; fill-in-the-blank; side of the screen, and you need to m ove all options m ultiple-response; ordered-response (also known as drag in order of priority to ordered-respon se boxes on the and drop);