Saunders NCLEX-RN 9th Edition PDF

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Go to evolve.elsevier.com/shop to search and browse for products. 2019v1.0 uploaded by medbooksvn SAUNDERS 9 EDITION COMPREHENSIVE REVIEW for the NCLEX-RN ® examination Linda Anne Silvestri, PhD, RN, FAAN Angela E. Silvestri, PhD, APRN, FNP-BC, Nursing Instructor CNE University of Nevada, Las Vegas Associate Professor and BSN Program Director Las Vegas, Nevada University of Nevada, Las Vegas President and Owner Las Vegas, Nevada Nursing Reviews, Inc. President Henderson, Nevada Clinical Judgment Test-Taking Strategy Creator Director and Owner Nurse Prep, LLC Professional Nursing Seminars, Inc. Henderson, Nevada Henderson, Nevada Elsevier Elsevier Next Generation NCLEX® (NGN) Subject Matter Expert Next Generation NCLEX® (NGN) Consultant and Subject Matter Expert Associate Editor Jessica Grimm, DNP, APRN, ACNP-BC, CNE Associate Professor of Nursing Touro University Nevada Henderson, Nevada Assistant Professor of Anesthesia and Perioperative Medicine Oregon Health State University Portland, Oregon Elsevier 3251 Riverport Lane St. Louis, Missouri 63043 SAUNDERS COMPREHENSIVE REVIEW FOR THE NCLEX-RN® EXAMINATION, NINTH EDITION ISBN: 978-0-323-79530-2 Copyright © 2023 by Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notice Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verication of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. NCLEX®, NCLEX-RN®, and NCLEX-PN® are registered trademarks of the National Council of State Boards of Nursing, Inc. Previous editions copyrighted 2020, 2017, 2014, 2012, and 2009. Content Strategist: Heather Bays-Petrovic Senior Content Development Specialists: Laura Goodrich and Rebecca Leenhouts Publishing Services Manager: Julie Eddy Senior Project Manager: Cindy Thoms Senior Book Designer: Margaret Reid Printed in Canada Last digit is the print number: 9 8 7 6 5 4 3 2 1 uploaded by medbooksvn  Contents Unit I Unit IV NCLEX-RN® Exam Preparation, 1 Growth and Development Across 1 Clinical Judgment and the Next Generation the Life Span, 234 NCLEX (NGN)-RN® Examination, 2 18 Theories of Growth and Development, 236 2 Self-Efcacy and Pathways to Success, 17 19 Growth, Development, and Stages of Life, 244 3 The NCLEX-RN® Examination from a Graduate’s 20 Care of the Older Client, 266 Perspective, 22 4 Clinical Judgment and Test-Taking Strategies, 24 Unit V Maternity Nursing, 275 Unit II 21 Reproductive System, 277 22 Prenatal Period, 285 Professional Standards in Nursing, 38 23 Risk Conditions Related to Pregnancy, 300 5 Population Health Nursing, 40 24 Labor and Birth, 323 6 Ethical and Legal Issues, 53 25 Problems with Labor and Birth, 336 7 Prioritizing Client Care: Leadership, Delegation, 26 Postpartum Period, 343 and Emergency Response Planning, 68 27 Postpartum Complications, 350 28 Care of the Newborn, 358 29 Maternity and Newborn Medications, 380 Unit III Foundations of Care, 85 Unit VI 8 Fluids and Electrolytes, 88 9 Acid-Base Balance, 106 Pediatric Nursing, 391 10 Vital Signs and Laboratory Reference 30 Integumentary Problems, 392 Intervals, 116 31 Hematological Problems, 399 11 Nutrition, 132 32 Oncological Problems, 406 12 Health and Physical Assessment of the Adult 33 Metabolic and Endocrine Problems, 416 Client, 143 34 Gastrointestinal Problems, 425 13 Safety and Infection Control, 166 35 Eye, Ear, and Throat Problems, 444 14 Medication Administration and Intravenous 36 Respiratory Problems, 451 Therapies, 178 37 Cardiovascular Problems, 467 15 Perioperative Nursing Care, 189 38 Renal and Genitourinary Problems, 479 16 Hygiene, Mobility, and Skin Integrity, 204 39 Neurological and Cognitive Problems, 487 17 Urinary and Bowel Elimination, 218 40 Musculoskeletal Problems, 498 41 Immune Problems and Infectious Diseases, 507 42 Pediatric Medication Administration and Calculations, 520 iii iv Contents Unit VII Unit XIV Integumentary Problems of the Adult Eye and Ear Problems of the Adult Client, 527 Client, 821 43 Integumentary Problems, 528 57 Eye and Ear Problems, 822 44 Integumentary Medications, 538 58 Eye and Ear Medications, 842 Unit VIII Unit XV Oncological and Hematological Neurological Problems of the Adult Problems of the Adult Client, 547 Client, 852 45 Oncological and Hematological Problems, 549 59 Neurological Problems, 853 46 Oncological and Hematological 60 Neurological Medications, 877 Medications, 587 Unit XVI Unit IX Musculoskeletal Problems of the Adult Endocrine Problems of the Adult Client, 598 47 Endocrine Problems, 599 Client, 888 48 Endocrine Medications, 626 61 Musculoskeletal Problems, 889 62 Musculoskeletal Medications, 910 Unit X Unit XVII Gastrointestinal Problems of the Adult Immune Problems of the Adult Client, 641 49 Gastrointestinal Problems, 643 Client, 918 50 Gastrointestinal Medications, 671 63 Immune Problems, 919 64 Immune Medications, 933 Unit XI Unit XVIII Respiratory Problems of the Adult Client, 679 Mental Health Problems of the Adult 51 Respiratory Problems, 680 Client, 940 52 Respiratory Medications, 701 65 Foundations of Psychiatric Mental Health Nursing, 941 66 Mental Health Problems, 954 Unit XII 67 Addictions, 975 68 Crisis Theory and Intervention, 987 Cardiovascular Problems of the Adult 69 Psychotherapeutic Medications, 1001 Client, 719 53 Cardiovascular Problems, 720 54 Cardiovascular Medications, 760 Unit XIX Complex Care, 1015 Unit XIII 70 Complex Care, 1017 Renal and Urinary Problems of the Adult References, 1088 Index, 1090 Client, 778 55 Renal and Urinary Problems, 779 56 Renal and Urinary Medications, 811 uploaded by medbooksvn  In loving memory of my parents— To my mother, Frances Mary, and my father, Arnold Lawrence, who taught me to always love, care, and be the best that I could be. My memories of their love, support, and words of encouragement will remain in my heart forever! Linda Anne Silvestri To my parents, Mary Elizabeth and Lawrence Peter, who have instilled in me the values of working hard and being seless, and who have been my support system as I pursue my professional goals and life aspirations. My success thus far would not have been possible without them. From the bottom of my heart, thank you, Mom & Dad! Angela Elizabeth Silvestri  To All Future Registered Nurses, Congratulations to you! You should be very proud and pleased with yourself on your most recent well- deserved accomplishment of completing your nursing program to become a registered nurse. We know that you have worked very hard to become suc- cessful and that you have proven to yourself that indeed you can achieve your goals. In our opinion, you are about to enter the most wonderful 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 profes- sion makes it stimulating and dynamic. Your learning process will continue to expand and grow as the profession continues to evolve. Your next very impor- tant endeavor will be the learning process involved to achieve success in your examination to become a registered nurse. We are excited and pleased to be able to provide you with the Saunders Pyramid to Success products, which will help you prepare for your next important pro- fessional goal, becoming a registered nurse. We want to thank all of our former and current nursing students whom we have assisted in their studies for the NCLEX-RN® examination for their willingness to offer ideas regarding 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 everything that you need to ready yourself for the NCLEX-RN examination. These products include material that is required for the NCLEX-RN examination for all nursing stu- dents regardless of educational background, specic strengths, areas in need of improvement, or clinical experience during the nursing program. So let’s get started and begin our journey through the Saunders Pyramid to Success, and welcome to the wonderful profession of nursing! Sincerely, Dr. Linda Anne Silvestri and Dr. Angela Elizabeth Silvestri vi uploaded by medbooksvn  About the Authors Linda Anne Silvestri, Angela E. Silvestri, PhD, RN, FAAN PhD, APRN, FNP-BC, CNE L inda is a well-known nurse educator, entre- preneur, and philanthro- A ngela Silvestri is a well-known nurse pist whose professional educator, researcher, and aspirations focus on author. She has been assisting nursing students teaching and working in to become successful. She university administrative has been teaching at all roles for the last 10 years at levels of nursing education for many years. Linda is cur- all levels of nursing education. She has experience teach- rently a nursing instructor at the University of Nevada, ing in both classroom and clinical settings and in working Las Vegas (UNLV). She earned her PhD in nursing from with graduate students on their culminating projects and UNLV and conducted research on self-efcacy and the research dissertations. She currently serves as the Program predictors of NCLEX® success. Her research ndings are Director for the undergraduate BSN program at the Uni- published in the Journal of Nursing Education and Prac- versity of Nevada, Las Vegas (UNLV). Dr. Silvestri is a suc- tice. Dr. Silvestri has received several awards and honors. cessful Elsevier author of numerous best-selling NCLEX® In 2019, she was inducted as a Fellow in the American preparation resources on the national and international Academy of Nursing. In 2012, she received the UNLV levels. She also serves as an Elsevier Subject Matter Expert School of Nursing Alumna of the Year Award. And in for the Next Generation NCLEX® (NGN). Angela earned 2010, she received the School of Nursing’s Certicate a bachelor’s in Nursing and in Sociology from Salve of Recognition for Outstanding PhD Student. Linda is Regina University in Newport, Rhode Island; she earned a member of several national nursing organizations, her master’s degree with a focus in nursing education and including the Honor Society of Nursing, Sigma Theta her PhD from the University of Nevada, Las Vegas. She Tau International, the National League for Nursing, the also has a post-master’s graduate certicate in advanced American Nurses Association, and the American Acad- practice and is a board-certied Family Nurse Practitio- emy of Nursing. Dr. Silvestri is a successful Elsevier ner. She is a Scholar in Sigma Theta Tau’s New Academic author of numerous best-selling NCLEX® preparation Leadership Academy. She works with faculty, staff, and resources on the national and international levels. She students on managing primary and episodic health care also serves as an Elsevier Subject Matter Expert for the needs at UNLV’s Student Wellness Center and Faculty and Next Generation NCLEX® (NGN), and has presented Staff Treatment Center as a Family Nurse Practitioner. Dr. numerous webinars on NCLEX® preparation and suc- Silvestri is passionate about college students’ success. She cess. Dr. Silvestri is the President and Owner of Nursing is an expert in creating clinical judgment test-taking strat- Reviews, Inc., and the Director and Owner of Profes- egies for NGN items. This passion also comes through sional Nursing Seminars, Inc. Both companies are dedi- in her work at UNLV, where she teaches leadership and cated to helping nursing graduates achieve their goals of licensure exam preparation, and in the publication of her becoming licensed nurses. research and best-selling licensure exam review resources. vii  Contributors Rossybel Aberle, RN, BSN Diana Rabbani Hagler, MSN-Ed, RN, CCRN Graduate TeleHealth ICU RN University of Nevada, Las Vegas Banner Health, Grand Canyon University, Las Vegas, Nevada Maricopa Community Colleges Adjunct Faculty Sarah R. Jean Baptiste, MS, PA-C Phoenix, Arizona Physician Assistant Oregon Health Science University Donna D. Ignatavicius, MS, RN, CNE, CNEcl, ANEF, Portland, Oregon FAADN Speaker and Curriculum Consultant for Academic Nursing Esmeralda Araceli Clark, MSN, APRN, FNP-BC Programs Lecturer Founder School of Nursing Boot Camp for Nurse Educators; University of Nevada, Las Vegas President Las Vegas, Nevada DI Associates, Inc. Littleton, Colorado; Next Generation NCLEX®(NGN) Consultant and Subject Eileen H. Gray, RN, DNP, CPNP Matter Expert Nursing Instructor Elsevier Inc. School of Nursing University of Nevada, Las Vegas Michael Johnson, PhD, RN, PMH-BC, CNE Las Vegas, Nevada Director of Clinical Affairs and Associate Professor School of Nursing Jessica Grimm, DNP, APRN, ACNP-BC, CNE Nevada State College Associate Professor of Nursing Henderson, Nevada Touro University Nevada Henderson, Nevada; Erica Shae Lee, MSN-Ed, RN Assistant Professor of Anesthesia and Perioperative Medicine Associate Program Director Oregon Health State University Prelicensure Nursing Portland, Oregon Arizona State University Phoenix, Arizona James Guilbault, PharmD, BS, RPh Pharmacy Manager and Clinical Staff Necole Leland, DNP, RN, PNP, CPN Pharmacist Assistant Professor Walgreens Pharmacy, Mercy Medical School of Nursing Center, MCPHS University University of Nevada, Las Vegas Springeld, Massachusetts Las Vegas, Nevada Debra Hagler, PhD, RN, aCNS-BC, cNE, CHSE, Lisa Nicholas, MSN, RN ANEF, FAAN Lecturer, Clinical Instructor Clinical Professor School of Nursing Edson College of Nursing and Health Innovation University of Nevada, Las Vegas Arizona State University Las Vegas, Nevada Phoenix, Arizona viii uploaded by medbooksvn  Contributors ix Karen L. Petersen, MSN-L, RN, MNN Laurent W. Valliere, BS, DD Nursing Faculty Vice President Paradise Valley Community College Marketing Phoenix, Arizona Nursing Reviews, Inc. Henderson, Nevada David Petersen, MSN-Ed, RN Visiting Professor Janelle Willis, MSN, APRN, CNE School of Nursing Lecturer, Clinical Instructor Chamberlain University School of Nursing Phoenix, Arizona University of Nevada, Las Vegas Las Vegas, Nevada Katherine M. Silvestri, MSN, APRN, FNP-BC Editorial and Reviewer Consultant Nursing Reviews, Inc. Henderson, Nevada Margaret Trnka, MSN, RN Lecturer, Clinical Instructor School of Nursing University of Nevada, Las Vegas Las Vegas, Nevada  Reviewers Emily Brown, MSN, APRN, FNP-BC Michael Johnson, PhD, RN, PMH-BC, CNE Family Nurse Practitioner Director of Clinical Affairs and Associate Professor University Medical Center School of Nursing Las Vegas, Nevada Nevada State College Henderson, Nevada Alena Grewal, MSN, APRN, FNP-BC Assistant Professor of Nursing Lisa M. Nicholas, MSN, RN University of Nevada, Las Vegas Lecturer, Clinical Instructor Las Vegas, Nevada University of Nevada, Las Vegas Las Vegas, Nevada Jessica Grimm, DNP, APRN, ACNP-BC, CNE Associate Professor of Nursing Karen L. Petersen, MSN-L, RN, MNN Touro University Nevada Nursing Faculty Henderson, Nevada; Paradise Valley Community College Assistant Professor of Anesthesia and Perioperative Medicine Phoenix, Arizona Oregon Health State University Portland, Oregon Paula Richards, BA Trauma Informed Care Interventionist James Guilbault, PharmD, BS, RPh Dialectical Behavior Therapy Trained Pharmacy Manager and Clinical Staff Pharmacist Clinical Counselor Walgreens Pharmacy, Mercy Medical Center, Baystate Medical Center MCPHS University Springeld, Massachusetts Springeld, Massachusetts Kelly Rybacki, MSN, RN Debra Hagler, PhD, RN, aCNS-BC, cNE, CHSE, ANEF, Instructor of Nursing FAAN Paradise Valley Community College Clinical Professor Phoenix, Arizona Edson College of Nursing and Health Innovation Arizona State University Dieu-My Thi Tran, PhD, RN, CNE Phoenix, Arizona Associate Professor of Nursing University of Nevada, Las Vegas Diana Hagler, MSN-Ed, RN, CCRN Las Vegas, Nevada TeleHealth ICU RN, Adjunct Faculty Banner Health, Grand Canyon University, Janelle Willis, MSN, APRN, CNE Maricopa Community Colleges Lecturer, Clinical Instructor Phoenix, Arizona School of Nursing University of Nevada, Las Vegas Hope Hinchman, MSN, RN Las Vegas, Nevada Clinical Instructor University of Nevada, Las Vegas Las Vegas, Nevada Sarah R. Jean Baptiste, MS-PA Physician Assistant Oregon Health Science University Portland, Oregon x uploaded by medbooksvn  Preface Linda Anne Silvestri, PhD, RN and Maintenance, Psychosocial Integrity, and Physi- “To laugh often and much, to appreciate beauty, to nd the ological Integrity. Integrated Processes are also identied best in others, to leave the world a bit better, to know that as a component of the test plan. These include Caring, even one life has breathed easier because you have lived, this Communication and Documentation, Culture and is to have succeeded.” Spirituality, Nursing Process, and Teaching and Learn- —Ralph Waldo Emerson ing. All chapters address the components of the test plan framework. Angela Elizabeth Silvestri, PhD, APRN, FNP-BC, CNE “The climb to the top is arduous and steep. People become Special Features of the Book exhausted, frustrated, and disenchanted, and are often tempted to give up. Genuine acts of caring draw people for- Pyramid Terms ward.” -James M. Kouzes Pyramid Terms are important to the discussion of the content in the chapters in each unit. Therefore, they are in bold green type throughout the content section of each chapter. Denitions can be reviewed in the Audio Welcome to Saunders Pyramid to Glossary on the Evolve site. Success! Pyramid to Success An Essential Resource for Test Success The Pyramid to Success, a featured part of each unit intro- Saunders Comprehensive Review for the NCLEX-RN® Exami- duction, provides you with an overview, guidance, and nation is one in a series of products designed to assist you direction regarding the focus of review in the particular in achieving your goal of becoming a registered nurse. content area, as well as the content area’s relative impor- This text will provide you with a comprehensive review tance to the test plan for the NCLEX-RN examination. of all nursing content areas specically related to the cur- The Pyramid to Success reviews the Client Needs and pro- rent test plan for the Next Generation NCLEX-RN exami- vides learning outcomes as they pertain to the content nation, which is implemented by the National Council in that unit. These learning outcomes identify the spe- of State Boards of Nursing. This resource will help you cic components and cognitive skills to keep in mind as achieve success on your nursing examinations during you review each chapter. nursing school and on the NCLEX-RN examination. Priority Concepts Each chapter identies two Priority Concepts reective Organization of its content. These Priority Concepts will assist you to focus on the important aspects of the content and asso- This book contains 19 units and 70 chapters. The chap- ciated nursing interventions. These Priority Concepts ters are designed to identify specic components of are also helpful for those students who are learning in a nursing content. They contain practice questions, both concept-based curriculum. multiple-choice and alternate item formats, that reect the chapter content and the current test plan for the Pyramid Points NCLEX-RN examination. All questions in the book and Pyramid Points ( ) are placed next to specic content on the Evolve site are presented in NCLEX-style format. throughout the chapters. The Pyramid Points highlight The NCLEX test plan identies a framework based content that is important for preparing for the NCLEX- on Client Needs. These Client Needs categories include RN examination and identify content that is likely to Safe and Effective Care Environment, Health Promotion appear on the NCLEX-RN examination. xi xii Preface Pyramid Alerts Audio Review Summaries Pyramid Alerts are the red text found throughout the The companion Evolve site includes three Audio Review chapters that alert you to important information about Summaries that cover challenging subject areas addressed nursing concepts. These alerts identify concepts that are in the test plan for the NCLEX-RN examination, including important to remember and relate to content that typi- Pharmacology, Acid-Base Balance, and Fluids and Electrolytes. cally appears on the NCLEX-RN examination. Clinical Judgment Boxes Practice Questions Clinical Judgment (CJ) Boxes are located in every chap- ter in the book. These boxes present a clinical scenario While preparing for the NCLEX-RN examination, it is that relates to one of the six cognitive skills (recognize crucial for students to practice answering test questions. cues, analyze cues, prioritize hypotheses, generate solutions, This book contains multiple-choice and alternate item take action, evaluate outcomes) that will be measured in format questions. The accompanying software includes the Next Generation NCLEX (NGN) exam. These CJ all the questions from the book, plus additional new boxes provide the thinking process needed and neces- Evolve questions for a total of more than 5700 ques- sary information to make a clinical decision. tions. The alternate item format questions in the book and on the accompanying Evolve site may be presented as one of the following: Special Features Found on Evolve ◼ Fill-in-the-blank question Pretest and Study Calendar ◼ Multiple-response question ◼ Prioritizing (ordered response) question The accompanying Evolve site contains a 75-question ◼ Figure/illustration question pretest and a 75-question posttest that provide you ◼ Graphic options question, in which each option con- with feedback on your strengths and areas in need of tains a gure or illustration improvement. The results of your pretest will generate ◼ Chart/exhibit question an individualized study calendar to guide you in your ◼ Audio question preparation for the NCLEX examination. Once you ◼ NGN stand-alone items and unfolding case studies have completed your review of the practice questions in this resource, you can take the posttest to evaluate The NGN stand-alone items and unfolding case studies your improvement and need for any additional review provide you with practice in prioritizing, decision- in preparation for the NCLEX. After completion of each making, and critical thinking, and strengthen your test you are provided with the opportunity to review clinical judgment skills. the answers, rationales, and strategies, and we highly encourage you to do this. Multiple-Choice and Alternate Item Format Questions Starting with Unit II, each chapter is followed by a Audio Questions practice test. Each practice test contains several ques- The accompanying Evolve site contains Audio Questions tions reective of the content in the chapter and those representative of content addressed in the current test presented on the NCLEX-RN examination. These ques- plan for the NCLEX-RN examination. These questions tions provide you with practice in prioritizing, decision- are in NCLEX-style format, and each question presents making, critical thinking, and clinical judgment skills. an audio sound, such as lung sounds, as a component Chapter 1 of this book provides a description of each of the question. question type. The Next Generation NCLEX (NGN) is also discussed in this chapter. Next Generation NCLEX® (NGN) Case Studies and The answer section for each practice question through- NGN Test Questions out the chapters and on the Evolve site provides the cor- The accompanying Evolve site contains stand-alone rect answer, the rationale for the correct and incorrect items and unfolding case studies. The clinical judgment options, and a test-taking strategy that will assist you in stand-alone items provide a clinical scenario and are answering the question correctly. The test-taking strategy accompanied by one NGN test question in either a Bow- is highlighted in bold blue type. This highlighting will tie or a Trend item format. These stand-alone items can provide you with guidance and direction for further reme- measure up to all of the cognitive skills of the NCSBN diation in the Saunders Clinical Judgment and Test-Taking Clinical Judgment Measurement Model (NCJMM). Strategies: Passing Nursing School and the NCLEX® Exam. These cognitive skills include Recognize Cues, Analyze The categories identied in each practice question on Cues, Prioritize Hypotheses, Generate Solutions, Take the Evolve site include Level of Cognitive Ability, Client Action, and Evaluate Outcomes. Each unfolding case Needs, Integrated Process, Clinical Judgment/Cognitive study is accompanied by six NGN test items, each mea- Skill, the nursing Content Area, the Health Problem, and suring one of the cognitive skills in sequential order. Priority Concepts. Every question on the accompanying uploaded by medbooksvn  Preface xiii Evolve site is organized by these question codes, so you journey through this book, you will be introduced to all can customize your study session to be as specic or as of the important points regarding the current NCLEX- generic as you need. Additionally, a link to view nor- RN examination, the process of testing, and unique mal laboratory reference intervals is provided with each and special tips regarding how to prepare yourself for practice question. this very important examination. You will also be intro- duced to the NGN and the types of case studies and test items that will be on the NCLEX-RN. Pharmacology and Medication You should begin your process through the Saun- Calculations Review ders Pyramid to Success by reading all of Unit I in this book and becoming familiar with the central points Students consistently state that pharmacology is an regarding the NCLEX-RN examination, including the area with which they need assistance. The NCLEX-RN NGN. Chapter 2 describes self-efcacy and the unique test plan continues to incorporate pharmacology in and special tips regarding how to prepare yourself both the examination, but only the generic drug names will academically and nonacademically for this important be included. Therefore, pharmacology chapters have examination. Be sure to read Chapter 3, written by a been included for your review and practice. This book nursing graduate who recently passed the examination, includes 13 pharmacology chapters, a medication and and note what the graduate has to say about the testing intravenous prescriptions calculation chapter, and a experience. Chapter 4 will provide you with the critical pediatric medication administration and calculation testing strategies that will guide you in selecting the cor- chapter. Each of these chapters is followed by a practice rect option or assist you in selecting an answer to a ques- test that uses the same question format described earlier. tion if you must guess. Keep these strategies in mind as This book contains numerous pharmacology questions. you proceed through this book. Continue by studying Additionally, more than 1000 pharmacology questions the specic content areas addressed in Units II through can be found on the accompanying Evolve site. XIX. Review the denitions of the Pyramid Terms, located in each chapter, and the Pyramid to Success notes and the Client Needs and Learning Outcomes, located in each Next Generation NCLEX (NGN) unit introduction. Read through the chapters and focus Questions on the Pyramid Points and Pyramid Alerts, which iden- tify the areas most likely to be tested on the NCLEX- As described above, the accompanying Evolve site con- RN examination. Pay particular attention to the Clinical tains stand-alone items and unfolding case studies. The Judgment boxes because they provide information about NCSBN has conducted rigorous research over the past the cognitive skills in the NCSBN Clinical Judgment several years to develop NGN case studies and test items Measurement Model and the thinking processes in mak- that will effectively measure clinical judgment. The ing an interpretation or decision. NCSBN will launch the NGN questions on the exami- As you read each chapter, identify your areas of nation starting in April 2023, and these item types are strength and those in need of further review. Highlight designed to test the candidate’s ability to make safe and these areas, and test your abilities by taking all prac- competent clinical judgments. The information in this tice tests provided at the end of the chapters. Be sure to book about the NGN reects the most up-to-date infor- review all rationales and test-taking strategies. mation at the time of the printing of this book. Since After reviewing all chapters in the book, reect and the NCSBN continues to research and collect data on identify any areas requiring further review; then take the NGN items, additional and continuous changes the time to review those areas in both the book and the could be made. We encourage you to access the NCSBN companion Evolve site. In preparation for the NCLEX- website at www.ncsbn.org for these latest updates. The RN examination, be sure to take the pretest on the Evolve site for this resource provides you with NGN Evolve site and generate your study calendar. Follow the stand-alone items and unfolding case studies with calendar for your review because the calendar represents accompanying test items that are reective of the item your pretest results and the best study path to follow types that NCSBN has indicated (as of the time of this based on your strong areas and content areas in need of publication) will be presented. review. Also, be sure to access the NGN cases and items and the Audio Review Summaries as part of your prepara- tion for the NCLEX-RN examination. How to Use This Book Saunders Comprehensive Review for the NCLEX-RN® Exam- Climbing the Pyramid to Success ination is especially designed to help you with your suc- cessful journey to the peak of the Saunders Pyramid to The purpose of this book is to provide a comprehensive Success: becoming a registered nurse! As you begin your review of the nursing content you will be tested on during xiv Preface the NCLEX-RN examination. However, Saunders Compre- content modules, supplemented with instructional vid- hensive Review for the NCLEX-RN® Examination is intended eos, animations, audio, illustrations, case studies, and to do more than simply prepare you for the rigors of the several subject matter exams. End-of-module practice NCLEX-RN examination; this book is also meant to serve tests are provided, along with several Crossing the Finish as a valuable study tool that you can refer to throughout Line practice tests. In addition, you can assess your prog- your nursing program, with specic customizable Evolve ress with a Pretest, Test Yourself quizzes, and a Comprehen- site selections, including a selection for NGN cases and sive Exam in a computerized environment that prepares test items, to help identify and reinforce key content areas you for the actual NCLEX-RN examination. NGN cases and prepare you for your nursing exams. and test items are also provided. After using this book for comprehensive content At the base of the Pyramid to Success are our test- review, your next step in the Pyramid to Success is to get taking strategies, which provide a foundation for under- additional practice with the Q&A review product. Saun- standing and unpacking the complexities of NCLEX-RN ders Q&A Review for the NCLEX-RN® Examination offers examination questions, including alternate item formats, more than 6000 unique practice questions in the book NGN stand-alone items, and unfolding case studies with and on the companion Evolve site. The questions are accompanying NGN items. Saunders Clinical Judgment focused on the Client Needs and Integrated Processes and Test-Taking Strategies: Passing Nursing School and the of the NCLEX-RN test plan, making it easy to access NCLEX® Exam takes a detailed look at clinical judgment your study area of choice. The Evolve site for this book and all of the test-taking strategies you will need to know also provides you with NGN cases and test items. For in order to pass any nursing examination, including the on-the-go Q&A review, you can pick up Saunders Q&A Next Generation NCLEX-RN. Special tips are integrated Review Cards for the NCLEX-RN® Examination. for nursing students, and more than 1200 practice ques- Your nal step on the Pyramid to Success is to mas- tions are included so that you can apply the testing strate- ter the online review. The HESI/Saunders Online Review gies. NGN questions are included on the Evolve site. for the NCLEX-RN® Examination provides an interactive Good luck with your journey through the Saun- and individualized platform to get you ready for your ders Pyramid to Success. We wish you continued success NCLEX exam. This online course provides 10 high-level throughout your new career as a registered nurse! uploaded by medbooksvn  Acknowledgments is wonderful to work with. Her tremendous theoretical and A Few Words From Linda clinical knowledge and expertise and her consistently out- standing ideas and work in creating clinical judgment test- There are many individuals who in their own ways have taking strategies certainly added to the excellent quality of contributed to my success in making my professional this product and all of the other products in the Pyramid to dreams become a reality. My sincere appreciation and Success. She is very dedicated to promoting and ensuring warmest thanks are extended to all of them. student success. Thank you, Angela! First, I want to acknowledge my parents, who opened A special thank-you goes to Loren Wilson, former my door of opportunity in education. I thank my Senior Vice President, for her years of expert guidance mother, Frances Mary, for all of her love, support, and and continuous support for all of the products in the assistance as I continuously worked to achieve my pro- Pyramid to Success. fessional goals. I thank my father, Arnold Lawrence, who I would also like to acknowledge Patricia Mieg and always provided insightful words of encouragement. My Jeff Price, former educational sales representatives, who memories of their love and support will always remain encouraged me to submit my ideas and initial work in my heart. I am certain that they are very proud of my for the rst edition of this book to the W.B. Saunders professional accomplishments. Company. I also thank my best friend and love of my life, my And nally, a very sincere and special acknowledg- husband, Larry; my sister, Dianne Elodia, and her hus- ment to my husband, Laurent (Larry) W. Valliere, for band, Lawrence; my brother, Lawrence Peter, and my his contribution to this publication, for teaching in my sister-in-law, Mary Elizabeth; my cousin Paula; and my review courses for the NCLEX-RN examination, and for nieces and nephews, Angela, Katie, Gina, Karen, Bri- his commitment and dedication in assisting my nursing anna, Gabby, and Nicholas, who were continuously students to prepare for the examination from a nonaca- supportive, giving, and helpful during my research and demic point of view. I thank him for all of his continu- preparation of this publication. They were always there ous support; he was so loyal and loving to me each and and by my side whenever I needed them. every moment as I worked to achieve my professional I want to thank my nursing students at the Com- goals. Larry, you are my “rock of support!” Thank you munity College of Rhode Island who approached me so much! in 1991 and persuaded me to assist them in preparing to take the NCLEX-RN examination. Their enthusi- asm and inspiration led to the commencement of my professional endeavors in conducting review courses A Few Words From Angela for the NCLEX-RN examination for nursing students. There are many people who contributed to my success I also thank the numerous nursing students who have in my work on this product. I am very grateful for their attended my review courses for their willingness to continued support in all of my endeavors. share their needs and ideas. Their input has certainly First and foremost, I would like to thank my hus- added a special uniqueness to all of the publications in band, Brent, for his lighthearted and positive attitude. the Pyramid to Success. He always knows how to make me laugh, especially I also wish to acknowledge all of the nursing faculty when I’m stressed. All of this would not be possible who taught in my review courses for the NCLEX-RN exam- without him! ination. Their commitment, dedication, and expertise have I would also like to thank my parents, Mary and certainly assisted nursing students in achieving success Larry, for their continued support throughout the years. with the NCLEX-RN examination. I also want to extend a Their words of encouragement and wisdom have been very special thank-you to my niece, Angela, for joining me tremendously important to my success. I also don’t in preparing and authoring these NCLEX resources. Angela xv xvi Acknowledgments know what I would do without their support in caring clinical judgment in nursing students. Her case studies for my kids! present real-world situations that nursing graduates are I would like to thank my sister Katie, who is a won- likely to encounter in the clinical settings. Thank you derful nurse. Her ambitions as a nursing student were so Donna! inspiring and reminded me about why I’m so passion- We sincerely acknowledge and thank some very ate about being an educator. Thank you to my brother, important and special people from Elsevier. We thank Nick, who always is positive and encouraging about my Heather Bays-Petrovic, Content Strategist, for her con- work. His wit and sarcasm are always a great way to lift tinuous support, enthusiasm, and expert professional your mood at the end of the day. guidance throughout the preparation of this edition. Finally, I want to extend a special thank you to Linda Heather, thank you so much—you are awesome! We for her collaboration, guidance, and expertise. Without also thank Laurie Gower, Director of Development, for her, I would not be where I am today. Thank you, Linda! always supporting our ideas and projects. Thank you, Laurie! A very special thank-you goes to Laura Goodrich, Senior Content Development Specialist, for her tremen- A Few Words From Both Linda and Angela dous amount of support and assistance, for prioritizing for us to keep us on track, for her ideas for the product, First and foremost, we want to thank our associate edi- and for her professional and expert skills in organizing tor, Jessica Grimm, for all of her dedicated and hard and maintaining an enormous amount of manuscript work in editing and preparing manuscript for this edi- for production. And we thank Senior Content Develop- tion. Her expertise and close attention to details have ment Specialist Rebecca Leenhouts for her expertise in certainly added to the quality of this resource. assisting us to complete this book. Thank you, Becky! We also want to acknowledge and thank Laurent W. We could not have completed this project without Laura Valliere for writing a chapter addressing those important or Becky! self-efcacy and nonacademic test-preparation issues. We want to acknowledge all of the staff at Elsevier A very special thank-you goes to all of the review- for their tremendous help throughout the preparation ers, contributors, and item writers who updated and and production of this publication. A special thanks provided many of the practice questions, and to all of to all of them. We want to thank and acknowledge the previous contributors to this book. You were all Tamara Myers, Director, Traditional Nursing Program, awesome! for reviewing our Population Health Nursing chap- Additionally, we want to thank Paula Richards for ter. Thank you Tamara! We thank Julie Eddy, Publish- her expertise and input in reviewing our chapter titled ing Services Manager, and Margaret Reid, Senior Book Population Health Nursing. Thank you, Paula! Designer. You have all played such signicant roles in We thank Dianne E. Fiorentino for her continuous nalizing this publication. And we need to especially support and dedication to our work and in her research acknowledge Cindy Thoms, Senior Project Manager, and reference support and other administrative assistant who so expertly managed all of our copyedited manu- responsibilities for the ninth edition of this book. We script and pages for review for this book. Cindy, you thank Karen Machnacz for her help with reference sup- were so organized, supportive, and so awesome to work port, Jimmy Guilbault for providing medication research with. Your attention to the many details to ensure and support, and Mary and Larry Silvestri for their assistance maintain the quality of this book was so greatly appreci- with getting through all of the tasks and projects we ated. We thank you so much! needed completed. A special thank-you to all of you! Lastly, a very special thank-you to all our nursing We also want to thank Donna Ignatavicius who cre- students: past, present, and future. All of you light up ated the unfolding case studies for the Evolve site for our lives! Your love and dedication to the profession of this book. She has been passionate about creating teach- nursing and your commitment to provide expert and ing and learning strategies that promote thinking and quality health care will bring never-ending rewards! uploaded by medbooksvn  UNIT I Preparation NCLEX-RN® Exam Preparation   CHAPTER 1 Preparation Clinical Judgment and the Next Generation NCLEX (NGN)-RN® Examination Linda A. Silvestri, PhD, RN, FAAN Angela E. Silvestri, PhD, APRN, FNP-BC, CNE This resource provides you with nursing content The Pyramid to Success review, including the content identied in the current Saunders Comprehensive Review for the NCLEX-RN ® NCLEX test plan, and practice questions of all types, Examination each chapter, you will nd Pyramid Point bullets About This Resource and the NCLEX-RN ® Examination NCLEX-RN examination and Pyramid Alert bullets Welcome to the Pyramid to Success and Saunders Com- in red text throughout the chapter that alert you to prehensive Review for the NCLEX-RN® Examination. This important information about nursing concepts. Each resource is specially designed to help you begin your chapter includes Clinical Judgment: Cognitive Skill client successful journey to the peak of the pyramid, becoming scenarios that focus on one of the cognitive skills. a registered nurse. As you begin your journey, you will The book contains 854 NCLEX-style questions. The be introduced to all of the important points regarding Evolve site accompanying this book contains all of the the NCLEX-RN examination and the process of testing, questions from the book plus additional Evolve ques- and to unique and special tips regarding how to prepare tions for a total of more than 6,000 practice questions. yourself for this important examination, both academi- The types of practice questions include multiple choice; cally and nonacademically. You will read what a nursing ll-in-the-blank; multiple-response (select all that graduate who recently passed the NCLEX-RN exami- apply); ordered-response; questions that contain a g- nation has to say about the test. Important test-taking ure, chart/exhibit, or a graphic option item; and audio strategies are detailed. These details will guide you in item formats. Examples of some question types can be selecting the correct option or assist you in making an located throughout this chapter. In addition, the NGN educated guess if you are not entirely sure about the cor- item types are provided on the accompanying Evolve rect answer; they will also guide you in ways to answer site. the NGN test items. Each unit in this book begins with As you read each chapter, identify your strengths and the Pyramid to Success. The Pyramid to Success addresses areas that are in need of further review. specic points related to the NCLEX-RN examination. Test your strengths and abilities by answering all Client Needs and activities as identied in the test plan practice questions provided in this book and on the framework for the examination are listed, as are learn- accompanying Evolve site. Be sure to read all rationales ing outcomes and competencies for the unit. Cognitive and test-taking strategies. The rationale provides you Skills identied in the National Council of State Boards with signicant information regarding the correct and of Nursing (NCSBN) Clinical Judgment Measurement incorrect options. The test-taking strategy provides you Model (NCJMM) are a focus in chapters and practice with the logical path to selecting the correct option. A questions. Pyramid Terms are key words that are dened reference source and page number are provided so that in the glossary on the accompanying Evolve site and set you can easily nd information you need to review in in a green color throughout each chapter to direct your another Elsevier text. Each practice question on the  attention to signicant points for the examination. accompanying Evolve site is coded on the basis of the uploaded by medbooksvn  CHAPTER 1 Clinical Judgment and the Next Generation NCLEX (NGN)-RN ® Examination 3 Level of Cognitive Ability, the Client Needs category, TABLE 1.1 Cognitive Skills/Processes and Descriptions Clinical Judgment/Cognitive Skill, the Integrated Pro- cess, the Content Area, the Health Problem if applica- Cognitive Skill/Process Description ble, and Priority Concepts. The Health Problem code is Recognize cues Identifying signicant data; data can be Preparation a unique and helpful feature that allows you to lter and from many sources (assessment) select questions based on a disease process when you Analyze cues Connecting data to the client's clinical are practicing questions on Evolve. For example, if heart presentation—determining if the data is failure is your area of interest, you can select “Adult expected? Unexpected? (analysis) Health, Cardiovascular, Heart Failure” on the Evolve Prioritize hypotheses Ranking hypotheses; what are the site, and all questions on this content will be gener- concerns or client needs/problems and ated for practice. In addition, two Priority Concepts that their priority? (analysis) relate to the content of the question are identied. This Generate solutions Using hypotheses or client needs to code is especially helpful for students whose curriculum determine interventions for an expected is concept-based. Additionally, information about all outcome (planning) of the special features of this resource and the question Take action Implementing the generated solutions types is located in the preface of this book. addressing the highest priorities or hypotheses (implementation) Other Resources in the Saunders Pyramid to Success Evaluate outcomes Comparing observed outcomes with There are several other resources in the Saunders Pyra- expected ones (evaluation) mid to Success program. These include the following: From Dickison, P., Haerling, K.A., & Lasater, K. (2019). Integrating the The Saunders Q&A Review for the NCLEX-RN® Examina- National Council of State Boards of Nursing Clinical Judgment Model tion, The HESI/Saunders Online Review for the NCLEX-RN® into Nursing Educational Frameworks. Journal of Nursing Education, Examination, Saunders Clinical Judgment and Test-Taking 58(2), 72–78. Strategies: Passing Nursing School and the NCLEX® Exam, Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items, Saunders Q&A Review Cards analyzing cues; (3) prioritizing hypotheses; (4) gener- for the NCLEX-RN® Exam, and Saunders RNtertainment ating solutions; (5) taking action; and (6) evaluating for the NCLEX-RN® Exam. The HESI® CompassTM Course outcomes (Dickison et al., 2019). Table 1.1 provides a is also a resource for NCLEX preparation and provides description of these six cognitive skills/processes identi- you with an individual coach to guide you in your prep- ed in the NCJMM. The NCJMM also serves as a guide aration. Ask your nursing instructors about institutional for the NCSBN to create NGN® questions. The NCJMM access to this course. continues to evolve as may the NGN® item types that The resources in the Saunders Pyramid to Success will be presented in the exam. All of the current NCLEX are described in the preface of this book and can be item types known as stand-alone items, the new clinical obtained online by visiting elsevierhealth.com or by judgment stand-alone items (bow-tie and trend), and calling 800-545-2522. unfolding case studies that include six NGN items will Let’s begin our journey through the Pyramid to be presented in the NGN. Some of these new NGN® Success. item types can be found on the Evolve site accompany- ing this book, and an example of a highlight-in-table NGN item can be located in Chapter 4, Box 4.5. The Clinical Judgment and Next Generation NCSBN conducts ongoing research on the NGN test NCLEX® Items design and NGN items. The information in this chapter reects what is currently published by the NCSBN. The Clinical judgment is the observed outcome of critical NGN will be implemented in April 2023 and because thinking and decision-making (Dickison, Haerling, some additional changes in item types may occur, we & Lasater, 2019). In recent years, heightened atten- encourage you to frequently access the NCSBN website tion has been paid to clinical judgment as a means of at www.ncsbn.org for updates about the NGN design, teaching, learning, and assessment and testing. The items, and test plan updates. Next Generation NCLEX-RN® examination requires candidates to demonstrate a higher level of ability in applying clinical judgment in the delivery of client care. Examination Process Clinical judgment can also be used as a test-taking strat- egy to answer test questions (refer to Chapter 4). The An important step in the Pyramid to Success is to National Council of State Boards of Nursing (NCSBN) become as familiar as possible with the examination has created a Clinical Judgment Measurement Model process. Candidates facing the challenge of this exami- (NCJMM) that consists of applying six cognitive skills nation can experience signicant anxiety. Knowing what or processes. These include: (1) recognizing cues; (2) the examination is all about and knowing what you will  4 UNIT I NCLEX-RN® Exam Preparation encounter during the process of testing will assist in online tutorial when you are preparing for the NCLEX alleviating fear and anxiety. The information contained examination. The tutorial will instruct you on the use of in this chapter was obtained from the NCSBN website the on-screen optional calculator, the use of the mouse, (www.ncsbn.org) and from the current NCSBN test and how to record an answer. The tutorial also provides Preparation plan for the NCLEX-RN and includes some procedures instructions on how to respond to the different ques- related to registering for the exam, testing procedures, tion types on this examination. NCSBN also provides and the answers to the questions most commonly asked an online tutorial about the new item types that allows by nursing students and graduates preparing to take the you to interact with these items as much as you need to NCLEX. You can obtain additional information regard- before taking the exam. In addition, at the testing site, ing the test and its development by accessing the NCSBN a test administrator is present to assist in explaining the website and clicking on the NCLEX Examination tab or use of the computer to ensure your full understanding by writing to the National Council of State Boards of of how to proceed. Nursing, 111 East Wacker Drive, Suite 2900, Chicago, IL 60601. You are encouraged to access the NCSBN web- The new NGN item types will not be scored as either site, because this site provides you with the most up- all correct or all incorrect. Instead, new scoring models to-date and valuable information about the NCLEX and will be applied for new NGN items that allow partial other resources available to an NCLEX candidate. You credit scoring for most items. For specic information are also encouraged to access the most up-to-date Can- on the scoring models, refer to the NCSBN website at didate Bulletin. This document provides you with every- www.ncsbn.org and the National Council of State Boards thing you need to know about registration procedures of Nursing’s Next Generation NCLEX News (2021) at and scheduling a test date. https://www.ncsbn.org/NGN_Summer21_Eng.pdf. Computer Adaptive Testing Development of the Test Plan The acronym CAT stands for computer adaptive test. The exam is delivered as a variable length CAT, which allows The test plan for the NCLEX-RN examination is devel- for the exam to select stand-alone items and item sets oped by the NCSBN. The examination is a national (unfolding case studies) that are optimal for each test- examination; the NCSBN considers the legal scope of taker. The stand-alone items are selected and balanced nursing practice as governed by state laws and regula- on the basis of the percentages of each of the test plan tions, including the nurse practice act, and uses these categories and subcategories. Each item is selected to laws to dene the areas on the examination that will target the candidate’s ability level. Once all test plan assess the competence of the test-taker for licensure. requirements are met, a stopping rule is triggered in The NCSBN also conducts an important study every which a reliable pass-or-fail decision is made. 3 years, known as a practice analysis study, to link the When taking a CAT, once an answer is recorded, examination to nursing practice. The results of this all subsequent questions administered depend, to an study determine the framework for the test plan for extent, on the answer selected for that question. Skip- the examination. The participants in this study include ping questions or returning to earlier questions is newly licensed registered nurses from all types of gen- incompatible with the logical methodology of a CAT. eralist nursing education programs. Participants of this The inability to skip questions or go back to change pre- study provide valuable information about work settings. vious answers will not be a disadvantage to you; you will From a list of nursing care activities (activity statements) not fall into that “trap” of changing a correct answer to provided, the participants are asked about the applica- an incorrect one with the CAT system. bility, frequency, and importance of performing these If you are faced with a question that contains unfa- activities in relation to client safety. A panel of content miliar content, you may need to guess at the answer. experts at the NCSBN analyzes the results of the study There is no penalty for guessing, but you need to make and makes decisions regarding the test plan framework. an educated guess. With most of the questions, the The NCSBN also conducted extensive research and answer will be right there in front of you. If you need to experimentation and sought out subject matter expert guess, use your nursing knowledge and clinical experi- feedback from educators, researchers, and practicing clin- ences and clinical judgment skills to their fullest extent ical nurses about clinical experiences and health prob- and all of the test-taking strategies you have practiced in lems commonly encountered by a new graduate nurse. this review program. Findings supported the need for developing a model for You do not need any computer experience to take measuring clinical judgment in the test plan design. This this examination. A keyboard tutorial is provided on led to the development of new NGN test items and con- the NCSBN website, and you are encouraged to view the tinuous research to test item reliability and validity. uploaded by medbooksvn  CHAPTER 1 Clinical Judgment and the Next Generation NCLEX (NGN)-RN ® Examination 5 Test Plan TABLE 1.2 Levels of Cognitive Ability: Level and Descriptions and Examples The questions are written to address Level of Cognitive Level Description and Example Ability, Client Needs, and Integrated Processes, includ- Preparation Remembering Recalling, retrieving information from memoriza- ing Clinical Judgment and Cognitive Skills, as identied tion, previous learning, or long-term memory. in the test plan developed by the NCSBN. Example: A normal blood glucose level is 70-99 mg/dL (3.9-5.5 mmol/L). The content of the NCLEX-RN examination reects Understanding Determining the meaning of information. the activities identied in the practice analysis study Example: A blood glucose level of 60 mg/dL (3.34 conducted by the NCSBN. Exam items are written based mmol/L) is lower than the normal reference range. on the test plan framework and these activities rather Applying Carrying out an appropriate action based on than on content areas such as adult health, maternity, information. pediatrics, or mental health. Example: Administering 10–15 g of carbohydrate such as a ½ glass of fruit juice to treat mild hypo- glycemia. Level of Cognitive Ability Analyzing Examining concepts or data and interpreting how Levels of cognitive ability include remembering, under- the concepts or data connect or relate to one standing, applying, analyzing, evaluating, and creating. another. Example: The concept is mild hypoglycemia and The practice of nursing requires complex thought pro- the connecting data are the signs and symptoms cessing and critical thinking in decision making and of mild hypoglycemia, such as hunger, irritability, in making clinical judgments. Therefore, you will not weakness, headache, blood glucose level lower encounter any remembering or understanding questions than 60 mg/dL (3.34 mmol/L). on the NCLEX. Questions on this examination are writ- Evaluating Making judgments, conclusions, or validations ten at the applying level or higher in terms of cognitive based on evidence. ability. Table 1.2 provides descriptions and examples of Example: Determining that treatment for mild hypoglycemia was eective if the blood glucose level each level of cognitive ability. Box 1.1 presents an exam- returned to a normal level between 70-99 mg/dL ple of a question that requires you to apply data. (3.9-5.5 mmol/L) and signs and symptoms resolved. Client Needs Creating Generating or producing a new outcome or plan of care by putting parts of information together. The NCSBN identies a test plan framework based on Example: Designing a safe and individualized plan Client Needs, which includes four major categories. of care with the interprofessional health care team Some of these categories are divided further into sub- for a client with diabetes mellitus that meets the categories. The Client Needs categories are Safe and client’s physiological, psychosocial, and health maintenance needs. Effective Care Environment, Health Promotion and Maintenance, Psychosocial Integrity, and Physiological Adapted from Understanding Bloom’s (and Anderson and Krathwohl’s) Integrity (Table 1.3). Taxonomy, 2015, ProEdit, Inc. http://www.proedit.com/understanding- blooms-and-anderson-and-krathwohls-taxonomy/ Safe and Effective Care Environment The Safe and Effective Care Environment category includes two subcategories: Management of Care, category also addresses content required to assist the and Safety and Infection Control. According to the individual to prevent health problems; to recognize NCSBN, Management of Care addresses prioritizing alterations in health; and to develop health practices care and providing and directing nursing care that that promote and support optimal wellness. See Box will ensure a safe care delivery setting to protect cli- 1.3 for an example of a question in this Client Needs ents and health care personnel. The NCSBN indicates category. that Safety and Infection Control addresses content that will protect clients and health care personnel Psychosocial Integrity from health and environmental hazards within health The Psychosocial Integrity category addresses content care facilities and in community settings. Box 1.2 required to promote and support the ability of the cli- presents examples of questions that address these two ent to cope, adapt, and problem-solve during stressful subcategories. events. The NCSBN also indicates that this Client Needs category addresses the emotional, mental, and social Health Promotion and Maintenance well-being of the client experiencing stressful events and The Health Promotion and Maintenance category care for the client with an acute or chronic mental ill- addresses the principles related to growth and devel- ness. See Box 1.4 for an example of a question in this opment. According to the NCSBN, this Client Needs Client Needs category.  6 UNIT I NCLEX-RN® Exam Preparation BOX 1.1 Level of Cognitive Ability: Applying BOX 1.2 Safe and Effective Care Environment The nurse notes blanching, coolness, and edema at the Management of Care peripheral intravenous (IV) site. On the basis of these nd- The nurse has received the client assignment for the day. Preparation ings, the nurse would implement which action rst? Which client would the nurse assess first? 1. Remove the IV. 2. Apply a warm compress. 1. The client who has a nasogastric tube attached to inter- 3. Check for a blood return. mittent suction 4. Measure the area of inltration. 2. The client who needs to receive subcutaneous insulin before breakfast Answer: 1 3. The client who is 2 days postoperative and is complain- This question requires that you focus on the data in the ques- ing of incisional pain tion and analyze that data to determine that the client is expe- 4. The client who has a blood glucose level of 50 mg/dL riencing an inltration. Note the strategic word, rst. Next, you (2.8 mmol/L) and complains of blurred vision need to consider the harmful effects of inltration and deter- mine the action to implement rst. Because inltration can Answer: 4 be damaging to the surrounding tissue, the appropriate rst This question addresses the subcategory Management of action is to remove the IV to prevent further damage. Once Care in the Client Needs category Safe and Effective Care the IV is removed, further action would be taken, depend- Environment. Note the strategic word, rst, so you need to ing on the medication infusing at the time of inltration and establish priorities by comparing the needs of each client and based on agency protocol. Further action may include aspira- deciding which need is urgent. The client described in the tion of the uid from the site, injection of an antidote, applica- correct option has a low blood glucose level and symptoms tion of warm or cool compresses for specied time intervals, reective of hypoglycemia. This client should be assessed rst or elevation of the extremity. so that treatment can be implemented. Although the clients in options 1, 2, and 3 have needs that require assessment, their assessments can wait until the client in the correct option is stabilized. TABLE 1.3 The Client Needs Categories and Safety and Infection Control Subcategories and Percentage of Questions on the The nurse prepares to care for a client on contact precau- NCLEX-RN Examination tions who has a hospital-acquired infection caused by methicillin-resistant Staphylococcus aureus (MRSA). The Percentage of client has an abdominal wound that requires irrigation Client Needs Category and Subcategory Questions and has a tracheostomy attached to a mechanical ventila- Safe and Eective Care Environment tor, which requires frequent suctioning. The nurse would Management of Care 17-23 assemble which necessary protective items before entering the client’s room? Safety and Infection Control 9-15 1. Gloves and gown Health Promotion and Maintenance 6-12 2. Gloves and face shield 3. Gloves, gown, and face shield Psychosocial Integrity 6-12 4. Gloves, gown, and shoe protectors Answer: 3 This question addresses the subcategory Safety and Infec- Physiological Integrity tion Control in the Client Needs category Safe and Effective Basic Care and Comfort 6-12 Care Environment. It addresses content related to protecting Pharmacological and Parenteral Therapies 12-18 oneself from contracting an infection and requires that you consider the methods of possible transmission of infection, Reduction of Risk Potential 9-15 based on the client’s condition. Note the data in the ques- Physiological Adaptation 11-17 tion. Because of the potential for splashes of infective mate- rial occurring during the wound irrigation or suctioning of the From National Council of State Boards of Nursing: 2019 NCLEX-RN® tracheostomy, option 3 is correct. examination: Test plan for the National Council Licensure Examination for Registered Nurses. Chicago, 2018, National Council of State Boards of Nursing. these subcategories as follows: Basic Care and Comfort addresses content for providing comfort and assistance to the client in the performance of activities of daily liv- Physiological Integrity ing. Pharmacological and Parenteral Therapies addresses The Physiological Integrity category includes four sub- content for administering medications and parenteral categories: Basic Care and Comfort, Pharmacological therapies, such as intravenous therapies and parenteral and Parenteral Therapies, Reduction of Risk Potential, nutrition, and administering blood and blood prod- and Physiological Adaptation. The NCSBN describes ucts. Reduction of Risk Potential addresses content for uploaded by medbooksvn  CHAPTER 1 Clinical Judgment and the Next Generation NCLEX (NGN)-RN ® Examination 7 BOX 1.3 Health Promotion and Maintenance BOX 1.4 Psychosocial Integrity The nurse is choosing age-appropriate toys for a toddler. A client with end-stage chronic obstructive pulmonary disease Which toy is the best choice for this age? has selected guided imagery to help cope with psychological Preparation stress. Which client statement indicates the best understand- 1. Puzzle ing of this stress-reduction measure? 2. Toy soldiers 3. Large stacking blocks 1. “This will help only if I play music at the same time.” 4. A card game with large pictures 2. “This will work for me if I am alone in a quiet area.” 3. “I need to do this when I lie down in case I fall asleep.” Answer: 3 4. “The best thing about this is that I can use it anywhere, This question addresses the Client Needs category Health anytime.” Promotion and Maintenance and specically relates to the principles of growth and development of a toddler. Note the Answer: 4 strategic word, best. Toddlers like to master activities inde- This question addresses the Client Needs category Psychoso- pendently, such as stacking blocks. Because toddlers do not cial Integrity, and the content addresses coping mechanisms. have the developmental ability to determine what could be Note the strategic word, best. Focus on the subject, a charac- harmful, toys that are safe need to be provided. A puzzle and teristic of guided imagery. Guided imagery involves the client toy soldiers provide objects that can be placed in the mouth creating an image in the mind, concentrating on the image, and may be harmful for a toddler. A card game with large pic- and gradually becoming less aware of the offending stimulus. tures may require cooperative play, which is more appropriate It can be done anytime and anywhere; some clients may use for a school-age child. other relaxation techniques or play music with it. preventing complications or health problems related to as stand-alone items and unfolding case studies. The the client’s condition or any prescribed treatments or stand-alone items will be accompanied by a question that procedures. Physiological Adaptation addresses content tests more than one cognitive skill. Each unfolding case for managing and providing care to clients with acute, study will be accompanied by six NGN item type ques- chronic, or life-threatening conditions. See Box 1.5 for tions, and each cognitive skill will be tested. Every can- examples of questions in this Client