Skip to content
Certification Guides

HESI Comprehensive Review for the NCLEX-RN Examination 6th Edition (2019)

HESI Comprehensive Review for the NCLEX-RN Examination 6th Edition (2019) is the ultimate study tool to help you pass your exam on the first try.

Preview 31 of 842 pages

See the first 31 pages exactly as they appear in the document.

  1. Page 1
  2. Page 2
  3. Page 3
    Read page 3 as text

    HESI Comprehensive Review for the NCLEX-RN® Examination SIXTH EDITION E. Tina Cuellar, PhD, WHNP, PMHCNS, BC Director of Live Review, Elsevier/HESI, Houston, Texas 2

  4. Page 4
    Read page 4 as text

    Table of Contents Cover image Title page Copyright Contributing Authors Preface 1. Introduction to Test-Taking Strategies and the NCLEX-RN® Test-Taking Strategies The NCLEX-RN Job Analysis Studies The NCLEX-RN Computer Adaptive Testing Gentle Reminders of General Principles 2. Leadership and Management: Legal Aspects of Nursing Legal Aspects of Nursing Prescriptions and Health Care Providers Review of Legal Aspects of Nursing Leadership and Management Maintaining a Safe Work Environment Communication Skills 3

  5. Page 5
    Read page 5 as text

    Review of Leadership and Management Disaster Nursing Ebola Review of Disaster Nursing 3. Advanced Clinical Concepts Respiratory Failure Respiratory Failure in Children Review of Respiratory Failure Shock Disseminated Intravascular Coagulation (DIC) Review of Shock and DIC Resuscitation Management of Foreign Body Airway Obstruction (FBAO) Review of Resuscitation Fluid and Electrolyte Balance Review of Fluid and Electrolyte Balance Electrocardiogram (ECG) Review of Electrocardiogram (ECG) Perioperative Care Review of Perioperative Care HIV Infection Pediatric HIV Infection Review of HIV Infection Pain: Fifth Vital Sign Review of Pain 4

  6. Page 6
    Read page 6 as text

    Death and Grief Review of Death and Grief 4. Medical-Surgical Nursing Communication Health Promotion and Disease Prevention Teaching/Learning Spiritual Assessment Cultural Diversity Complementary and Alternative Interventions Respiratory System Review of Respiratory System Renal System Review of Renal System Cardiovascular System Review of Cardiovascular System Gastrointestinal (GI) System Review of Gastrointestinal System Endocrine System Review of Endocrine System Musculoskeletal System Review of Musculoskeletal System Neurologic System Review of Neurologic System Hematology and Oncology Review of Hematology and Oncology 5

  7. Page 7
    Read page 7 as text

    Reproductive System Review of Reproductive System Burns Review of Burns 5. Pediatric Nursing Growth and Development Pain Assessment and Management in the Pediatric Client Review of Child Health Promotion Respiratory Disorders Review of Respiratory Disorders Cardiovascular Disorders Review of Cardiovascular Disorders Neuromuscular Disorders Review of Neuromuscular Disorders Renal Disorders Review of Renal Disorders Gastrointestinal Disorders Review of Gastrointestinal Disorders Hematologic Disorders Review of Hematologic Disorders Metabolic and Endocrine Disorders Review of Metabolic and Endocrine Disorders Skeletal Disorders Review of Skeletal Disorders 6. Maternity Nursing 6

  8. Page 8
    Read page 8 as text

    Anatomy and Physiology of Reproduction Antepartum Nursing Care Review of Anatomy and Physiology of Reproduction and Antepartum Nursing Care Fetal and Maternal Assessment Techniques Review of Fetal and Maternal Assessment Techniques Intrapartum Nursing Care Review of Intrapartum Nursing Care Normal Puerperium (Postpartum) Review of Normal Puerperium (Postpartum) The Normal Newborn Review of the Normal Newborn High-Risk Disorders Review of High-Risk Disorders Postpartum High-Risk Disorders Review of Postpartum High-Risk Disorders Newborn High-Risk Disorders Effects on the Neonate of Substance Abuse 7. Psychiatric Nursing Therapeutic Communication Coping Styles (Defense Mechanisms) Treatment Modalities Review of Therapeutic Communication and Treatment Modalities Anxiety and Related Disorders Anxiety Disorders, Obsessive-Compulsive and Related Disorders, and Traumatic and Stressor Related Disorders Review of Anxiety Disorders, Obsessive-Compulsive and Related Disorders, and 7

  9. Page 9
    Read page 9 as text

    Traumatic and Stressor Related Disorders Somatic Symptom Disorder and Related Disorders Review of Somatic Symptom Disorder and Related Disorders Dissociative Disorders Review of Dissociative Disorders Personality Disorders (DSM-5 Criteria) Review of Personality Disorders Eating Disorders Review of Eating Disorders Mood Disorders Review of Mood Disorders Schizophrenia Spectrum and Other Psychotic Disorders Review of Thought Disorders Substance Abuse Disorder Substance Use Disorder Review of Substance Abuse Disorder Abuse Review of Abuse Neurocognitive Disorder (DSM-5) Review of Neurocognitive Disorders Childhood and Adolescent Disorders Review of Childhood and Adolescent Disorders 8. Gerontologic Nursing Theories of Aging Neurocognitive Disorder (NCD): Dementia 8

  10. Page 10
    Read page 10 as text

    Psychosocial Changes Health Maintenance and Preventive Care Review of Gerontologic Nursing Answer Key to Review Questions APPENDIX. Common Laboratory Tests Index 9

  11. Page 11
    Read page 11 as text

    Contributing Authors Safa’a Al-Arabi, PhD, RN, MSN, MPH , Associate Professor and Master’s Track Administrator, University of Texas Medical Branch, Galveston, Texas Karen Alexander, PhD, RN , Program Director at University of Houston Clear Lake, Pearland, Texas Joanna Cain, BSN, BA, RN , President and Founder, Auctorial Pursuits, Inc., Austin, Texas Lucindra Campbell-Law, PhD, ANP, PMHNP, BC , Professor, Carol and Odis Peavy School of Nursing, University of St. Thomas, Houston, Texas E. Tina Cuellar, PhD, WHNP, PMHCNS, BC , Director of Live Review, Elsevier/Education/HESI, Houston, Texas Claudine Dufrene, PhD, RN-BC, GNP-BC, CNE , Assistant Professor, Carol and Odis Peavy School of Nursing, University of St. Thomas, Houston, Texas Sandra Jenkins, PhD, RN , Visiting Professor, University of Houston Clear Lake, Pearland, Texas Shatoi King, MSN, RN , Instructor, University of Houston Clear Lake, Pearland, Texas Necole Leland, MSN, RN, PNP, CPN , Instructor, School of Nursing, University of Nevada, Las Vegas, Las Vegas, Nevada Katherine Ralph, EdD, RN , Nurse Manager Curriculum, Review and Testing, Elsevier/Education/HESI, Houston, Texas 12

  12. Page 12
    Read page 12 as text

    Preface Welcome to HESI Comprehensive Review for the NCLEX-RN ® Examination with online study exams by HESI. Congratulations! This outstanding review manual with online study exams is designed to prepare nursing students for what is very likely the most important examination they will ever take—the NCLEX-RN Licensing Examination. HESI Comprehensive Review for the NCLEX-RN ® Examination allows the nursing student to prepare for the NCLEX-RN licensure examination in a structured way. • Organize previously learned basic nursing knowledge. • Review content learned during basic nursing curriculum. • Identify deficits in content knowledge so that study effort can be focused appropriately. • Develop test-taking skills to demonstrate application of safe nursing practice. • Reduce anxiety level by increasing predictability of ability to correctly answer NCLEX-type questions. • Boost test-taking confidence by being well prepared and knowing what to expect. 13

  13. Page 13
    Read page 13 as text

    Organization AND PREPARING TO TAKE TESTS Chapter 1 , Introduction to Test-Taking Strategies and the NCLEX-RN ® , gives an overview of the NCLEX-RN Licensing Examination history and test plan for the examination. Reviews of the nursing process, client needs, and strategies for employing clinical judgement to prioritize nursing care are also presented. Chapter 2 , Leadership and Management , reviews the legal aspects of nursing, leadership and management, and disaster nursing. Chapter 3 , Advanced Clinical Concepts , presents nursing assessment, analysis, and planning and intervention, using clinical judgment at the highest level of practice. Topics reviewed include respiratory failure, shock, disseminated intravascular coagulation, resuscitation, fluid and electrolyte balance, intravenous therapy, acid–base balance, electrocardiogram, perioperative care, HIV, pain, and death and grief. Chapters 4 through 8 , Medical-Surgical Nursing, Pediatric Nursing, Maternity Nursing, Psychiatric Nursing, and Gerontologic Nursing , are presented in traditional clinical areas. Each clinical area is divided into physiologic components, with essential knowledge about basic anatomy, growth and development, pharmacology and medication calculation, nutrition, communication, client and family education, acute and chronic care, leadership and management, complementary and alternative interventions, cultural and spiritual diversity, and clinical decision making threaded throughout the different components. Open-ended questions with the answers appear at the end of each chapter, which encourage the student to think in depth about the content that is presented throughout the particular chapter. When a variety of learning mechanisms are used, students have the opportunity to comprehensively prepare for the NCLEX exam; these strategies include: • Reading the manual • Discussing content with others • Answering open-ended questions • Practicing with study exams that simulate the licensure examination These learning experiences are all different ways that students should use to prepare for the NCLEX-RN exam. The purpose of the open-ended questions appearing at the end of the chapter is not a focused practice session on managing NCLEX-style questions, but rather a learning approach that allows for more in-depth thinking about specific topics in the chapter. Practice with multiple-choice questions alone cannot provide the depth of critical thinking and analysis that is made possible by the short-answer questions at the end of the chapter. In addition, the open-ended questions presented at the end of the chapter provide a summary experience that helps students focus on the main topics that were covered in the chapter. Teachers use open-ended questions to stimulate the critical-thinking process, and HESI Comprehensive Review for the NCLEX-RN ® Examination facilitates the critical-thinking process by posing the same type of questions the teacher might ask. When students need to practice multiple-choice questions, the online study exams on 14

  14. Page 14
    Read page 14 as text

    Evolve offer extensive opportunities for practice and skill building to improve their test- taking abilities. The online study exams include six content-specific exams (Medical- Surgical Nursing, Pharmacology, Pediatrics, Fundamentals, Maternity, and Psychiatric- Mental Health Nursing) and two comprehensive exams patterned after categories on the NCLEX-RN exam. The online study exams on Evolve can be accessed as many times as necessary, and the questions from one study exam are not contained on another study exam. For instance, the Medical-Surgical study exam does not contain questions that are on the Pediatrics study exam. The purpose of the study exams is to provide practice and exposure to the critical thinking–style questions that students will encounter on the NCLEX-RN exam. However, the study exams should not be used to predict performance on the actual NCLEX-RN exam. Only the HESI Exit Exam, a secure, computerized exam that simulates the NCLEX-RN test plan and has evidence-based results from numerous research studies indicating a high level of accuracy in predicting NCLEX success, is offered as a true predictor exam. Students are allowed unlimited practice on each online study exam so that they can be sure to have the opportunity to review all of the rationales for the questions. Here is a plan for a student to use with the online study exams: • Step 1: Take the RN study exam without studying for it to see where your strengths and weaknesses are. • Step 2: After going over the content that relates to the study questions in a particular clinical area (e.g., Pediatrics, Medical-Surgical, or Maternity), review that section of the manual and take the test again to determine whether you have been able to improve your scores. • Step 3: Purposely miss every question on the exam so that you can view the rationales for every question. • Step 4: Take the exam again under timed conditions at the pace that you would have to progress in order to complete the NCLEX-RN exam in the time allowed (approximately 1 minute per question). See if being placed under time constraints affects your performance. • Step 5: Put the exam away for a while and continue review and remediation with other textbooks, resources, and results of any HESI secure exams that you have taken at your school. Then, take the study exams again to see if your performance improves after in-depth study and following a few weeks’ break from these questions. Step 5 represents a good activity in preparation for the HESI Exit Exam presented in your final semester of the nursing program, especially if you have not used the online study exams for several weeks. Repeated exposure to the questions, however, will make them less useful over time because students tend to memorize the answers. For this reason, these tests are useful only for practice and not for prediction of NCLEX-RN success. The tendency to memorize the questions after viewing them multiple times falsely elevates a student’s score on the study exams. Additional assistance for students studying for the NCLEX-RN Licensing Examination can be obtained from a variety of online products in the Elsevier family. Many nursing schools have also adopted the following: 15

  15. Page 15
    Read page 15 as text

    • HESI Examinations —A comprehensive set of examinations designed to prepare nursing students for the NCLEX exam. They include customized electronic remediation from current Elsevier textbooks and multimedia, as well as additional practice questions. Each student is given an individualized report detailing exam results and is allowed to view questions and rationales for items that were answered incorrectly. The electronic remediation, a complementary feature of the specialty and exit exams, can be filed by the student for later study. • HESI Practice Test —This is the ideal way to practice for the NCLEX exam. With more than 1200 practice questions included in this online test bank, nursing students can access practice exams 24 hours a day, 7 days a week. HESI Practice Test questions are written at the critical-thinking level so that students are tested not for memorization but for their skills in clinical application. Students select a test option (either a clinical specialty or a comprehensive exam), and HESI Practice Test automatically supplies a series of critical-thinking practice questions. NCLEX exam–style questions include multiple-choice and alternate-item formats and are accompanied by correct answers and rationales. • HESI RN Case Studies —These prepare students to manage complex patient conditions and make sound clinical judgments. These online case studies cover a broad range of physiologic and psychosocial alterations, plus related management, pharmacology, and therapeutic concepts. • HESI Patient Reviews —These are designed to teach and assess students’ retention of core nursing content. These online interactive reviews provide a firsthand look at safe and effective nursing care. • HESI Live Review —A live review course is presented by an expert faculty member who has additional instruction in working with students who are preparing to take the NCLEX exam. Students are presented with a workbook and practice NCLEX-style questions that are used during the course. • Evolve eBooks —Online versions of all of the Mosby, Saunders, and Elsevier textbooks used in the student’s nursing curriculum are presented. Search across titles, highlight, make notes, and more—all on your computer. • Elsevier Simulations —Virtual versions simulate the clinical environment. These multilayered, complex, supplemental simulations enable students to experience clinical assignments without the need for actual clinical space. • Elsevier Courses —These are created by experts using instructional design principles. This interactive content engages students with reading, animation, video, audio, interactive exercises, and assessments. 16

  16. Page 16
    Read page 16 as text

    Next Generation NCLEX and Clinical Judgment Starting in July of 2017, the National Council of State Boards of Nursing (NCSBN) began including a special research section to select candidates after they complete the exam. The data collected from this section is used to help determine new item types that may be included in a future version of the NCLEX, known as Next Generation NCLEX (NGN). (More information can be found at ( http://www.ncsbn.org/next-generation- nclex.htm. ) An important piece of the NGN is the clinical judgment model. Clinical judgment is important for all nurses, and this book helps nursing students by reviewing information and skills that nurses must master to practice clinical judgment. Additionally, NCLEX practice questions on the Evolve website written at higher levels of Bloom’s taxonomy help students practice applying their clinical judgment knowledge. Finally, a Clinical Judgment Scenario with practice NGN questions is included in Chapter 4 to familiarize students with these types of questions . 17

  17. Page 17
    Read page 17 as text

    Introduction to Test-Taking Strategies and the NCLEX-RN ® Congratulations! You have made the wise decision to prepare, in a structured way, for the NCLEX-RN ® . A. Since you have successfully completed a basic nursing program and are well acquainted with your test-taking skills and ability to apply your clinical knowledge, you already have the basic knowledge required to pass the licensing examination. B. However, following these general guidelines will help ensure your success. 1. Organize your knowledge. 2. Identify weaknesses in content knowledge to help focus your study time appropriately. 3. Review the need-to-know content learned in nursing school. 4. Develop strong test-taking skills to demonstrate your knowledge. 5. Reduce your level of anxiety by dissecting test questions and using your foundational knowledge to arrive at the correct answer. 6. Know what to expect. Remember that knowledge is power. You are powerful when you are well prepared and know what to expect. 18

  18. Page 18
    Read page 18 as text

    Test-Taking Strategies These test-taking strategies help you focus your study so that you can concentrate on what the exam questions are asking instead of being distracted by extraneous information that is not needed to answer the questions. A. The NCLEX-RN tests your knowledge about several core concepts and the ability to synthesize information to effectively apply, analyze, or evaluate a client’s needs to provide safe and effective care. For example, a question may appear to be a medical-surgical or pediatric question, but the question can also cover such topics as communication, nutrition, growth and development, medication, client and family education, and safety. HESI Hint The most essential element of nursing care is client safety. B. Understand the question. 1. Determine whether the question is written in a positive or negative style. a. A positive style question may ask what the nurse should do or ask for the best or first nursing intervention to implement. H E S I H i n t Most questions are written in a positive style. b. A negative style question may ask what the nurse should avoid, which prescription the nurse should question, or which behavior indicates the need for reteaching the client. HESI Hint Negative style questions contain key words that denote the negative style. Examples 1. “Which response indicates to the nurse a need to reteach the client about heart disease?” (Which information or understanding by the client is incorrect?) 2. “Which medication order should the nurse question ?” (Which prescription is unsafe, not beneficial, inappropriate to this client situation?) C. Identify key words. 19

  19. Page 19
    Read page 19 as text

    1. Ask yourself which words or phrases provide the critical information. 2. This information may include the age of the client, the setting, the timing, a set of symptoms or behaviors, or any number of other factors. a. For example, the nursing actions for a 10-year-old postop client are different from those for a 70-year-old postop client. D. Rephrase the question. 1. Rephrasing the question helps eliminate nonessential information in the question to help you determine the correct answer. a. Ask yourself, “What is this question really asking?” b. While keeping the options covered, rephrase the question in your own words. 2. Rule out options. a. Based on your knowledge, you can most likely identify one or two options that are clearly incorrect. b. Physically mark through those options on the test booklet if allowed. Mentally mark through those options in your head if using a computer. c. Differentiate between the remaining options, considering your knowledge of the subject and related nursing principles, such as roles of the nurse, nursing process, ABCs (airway, breathing, circulation), CAB (circulation, airway, breathing for cardiopulmonary resuscitation [CPR]), and Maslow’s hierarchy of needs. E. Implement these guidelines. 1. Consider the content of the question and what specifically the question is asking. 2. Generally, an assessment of the client occurs before an action is taken, except in the case of an emergency, for example, if a client is bleeding profusely, stop the bleeding. Or, if a client is having difficulty breathing, open the airway then assess the client. 3. Identify the least invasive intervention before taking action. 4. Gather all of the necessary information and complete the necessary assessments before calling the healthcare provider. 5. Determine which client to assess first (e.g., most at risk, most physiologically unstable). 6. Identify opposites in the answers. a. Example: prone versus supine; elevated versus decreased. b. Read VERY carefully; one opposite is likely to be the answer, but not always. c. If you do not know the answer, choose the most likely of the “opposites” and move on. 7. Take into account a client’s lifestyle, culture, and spiritual beliefs when answering a question. F. Use your critical thinking skills. 1. Respond to questions based on a. Client safety 20

  20. Page 20
    Read page 20 as text

    b. ABCs c. CAB for CPR d. Caring e. Incorporation of culture and spiritual practices f. Scientific, behavioral, and sociologic principles g. Communication (spoken and written [documentation]) with client, family, colleagues, and other members of the healthcare team h. Principles of teaching and learning i. Maslow’s hierarchy of needs j. Nursing process k. Focus on what information is in the stem. Do not focus on information not included in the question. Do not read more into the question than is already there. 1. NCLEX-RN ideal hospital 2. Basic anatomy and physiology 2. Do not respond to questions based on a. YOUR past client care experiences or your employer’s policies b. A familiar phrase or term c. “Of course, I would have already” d. What you think is realistic; perceptions of realism are subjective e. Your children, pregnancies, parents, personal response to a drug, etc. f. The “what-ifs” H E S I H i n t As soon as you are seated in the testing area, use the erasable noteboard to write down information you’ve memorized (a brain dump). That’s a resource you may use while testing if you become too stressed to recall information you memorized. G. Keep memorization to a minimum. 1. Don’t try to memorize all of the material found in your textbooks because it isn’t possible. Only memorize core concepts. a. Growth and developmental milestones b. Death and dying stages c. Crisis intervention d. Immunization schedules e. Principles of teaching and learning f. Stages of pregnancy and fetal growth g. Nurse Practice Act: Standards of Practice and Delegation h. Ethical practices and standards i. Commonly used laboratory test values: 1. Review Appendix A. 2. Hemoglobin and hematocrit (H&H) 21

  21. Page 21
    Read page 21 as text

    3. White blood cells (WBCs), red blood cells (RBCs), platelets 4. Electrolytes: K + , Na + , Ca ++ , Mg ++ , Cl − , 5. Blood urea nitrogen (BUN) and creatinine 6. Relationship of Ca ++ and 7. Arterial blood gases (ABGs) 8. SED rate, erythrocyte sedimentation rate (ESR), prothrombin time (PT), international normalized ratio (INR), partial thromboplastin time (PTT), activated partial thromboplastin time (aPTT) H E S I H i n t Remember not to confuse PT, PTT, and aPTT. j. Nutrition 1. High or low Na + 2. High or low K + 3. High 4. Iron 5. Vitamin K 6. Proteins 7. Carbohydrates 8. Fats k. Foods and diets related to 1. Body system disturbances (cardiac, endocrine, gastrointestinal) 2. Chemotherapy, radiation, surgery 3. Pregnancy and fetal growth needs 4. Dialysis 5. Burns l. Nutrition concepts 1. Introduce one food at a time for infants and clients with allergies. 2. Progression to “as tolerated” foods and diets H. Understand medication administration. 1. Safe medication administration requires more than knowing the name, classification, and action of the medication. a. The Six Rights, including techniques of skill execution b. Drug interactions c. Vulnerable organs to medication effects 1. Know what to assess (kidney function, vital signs). 22

  22. Page 22
    Read page 22 as text

    2. Know which laboratory values relate to specific organs and their functions. d. Client allergies e. Presence of infections and superinfections f. Concepts of peak and trough levels g. How you would know if 1. The drug is working. 2. There is a problem. h. Nursing actions i. Client education 1. Safety 2. Empowerment 3. Compliance 23

  23. Page 23
    Read page 23 as text

    The NCLEX-RN A. The main purpose of the NCLEX-RN is to protect the public. B. The NCLEX-RN 1. Was developed by the National Council of State Boards of Nursing (referred to as “the Council” throughout this book) 2. Is administered by the State Board of Nurse Examiners 3. Is designed to test candidates’ a. Capabilities for safe and effective nursing practice b. Essential entry-level nursing knowledge c. Ability to problem solve by applying critical thinking skills 24

  24. Page 24
    Read page 24 as text

    Job Analysis Studies A. Essential knowledge that new nurses should know is determined by job analysis studies. B. Job analysis studies indicate that newly licensed registered nurses are using all five categories of the nursing process and that such use is evenly distributed throughout the nursing process areas. Therefore, equal attention is given to each part of the nursing process in selecting NCLEX-RN items (Table 1.1). TABLE 1.1 The Nursing Process HESI Hint The Council wants to ensure that the licensing examination measures current entry-level nursing behaviors. For this reason, job analysis studies are conducted every 3 years. These studies determine how frequently various types of nursing activities are performed, how often they are delegated, and how critical they are to client safety, with criticality given more value than frequency. Nursing Diagnoses A. Nursing diagnoses are formulated during the analysis portion of the nursing process. They give form and direction to the nursing process, promote priority setting, and guide nursing actions (Table 1.2). B. To qualify as a nursing diagnosis, the primary responsibility and accountability for recognition and treatment rest with the nurse. 25

  25. Page 25
    Read page 25 as text

    C. NCLEX-RN questions regarding nursing diagnosis can take several forms. 1. You may be given the nursing diagnosis in the stem and asked to select an appropriate nursing intervention based on the stated nursing diagnosis. 2. You may be asked to select, from among the choices provided, the most appropriate nursing diagnosis(es) for the described case. 3. You may be asked to choose, from four nursing diagnoses, the one that should have priority based on the data in the stem. D. For further information about nursing diagnoses, review a fundamentals text, a medical-surgical nursing text, or a nursing diagnosis handbook. HESI Hint A nursing diagnosis must be subject to oversight by nursing management. It is not a medical diagnosis. The cause may or may not arise from a medical diagnosis. Client Needs A. Job analysis studies have identified categories of care provided by nurses called client needs. The test plan is structured according to these categories (Table 1.3). Prioritizing Nursing Care A. Many NCLEX-RN items are designed to test your ability to set priorities. 1. Identify the most important client needs. 2. Which nursing intervention is most important ? TABLE 1.2 Components of a Nursing Diagnosis TABLE 1.3 Components of the NCLEX-RN Test Plan 26

  26. Page 26
    Read page 26 as text

    27

  27. Page 27
    Read page 27 as text

    28

  28. Page 28
    Read page 28 as text

    3. Which nursing action should be performed first ? 4. Which response is best ? B. Setting priorities 1. Which action should be performed first or next? Remember, client safety is paramount. 2. Remember Maslow (Table 1.4). 3. The Five Rights of Delegation (see Chapter 2, p. 16) HESI Hint Answering NCLEX-RN questions often depends on setting priorities, making judgments about priorities, and analyzing the data and formulating a decision about care based on 29

  29. Page 29
    Read page 29 as text

    priorities. Using Maslow’s hierarchy of needs can help you set nursing priorities. 30

  30. Page 30
    Read page 30 as text

    The NCLEX-RN Computer Adaptive Testing A. Computer adaptive testing (CAT) is used for implementation of the NCLEX-RN. B. The CAT is administered at a testing center selected by the Council. C. Pearson VUE is responsible for adapting the NCLEX-RN to the CAT format, processing candidate applications, and transmitting test results to its data center for scoring. D. The testing centers are located throughout the United States. E. The Council generates the NCLEX-RN questions. TABLE 1.4 Maslow’s Hierarchy of Needs Need Definition Nursing Implications Physiologic Biologic needs for food, shelter, water, sleep, oxygen, sexual expression The priority biologic need is breathing (i.e., an open airway). Review Table 1.3, which lists activities associated with physiologic integrity. If asked to identify the most important action, identify needs associated with physiologic integrity (e.g., providing an open airway) as the most important nursing action. Safety Avoiding harm; attaining security, order, and physical safety Review Table 1.3, which lists the activities associated with a safe and effective care environment. Ensuring that the client’s environment is safe is a priority (e.g., teaching an older client to remove throw rugs that pose a safety hazard when ambulating has a greater priority than teaching the client how to use a walker). The first priority is safety, followed by coping skills. Love and Belonging Esteem and Recognition Giving and receiving affection; companionship; identification with a group Self-esteem and respect of others; success in work; prestige Although these needs are important (described in Table 1.3), they are less important than physiologic or safety needs. For example, it is more important for a client to have an open airway and a safe environment for ambulating than it is to assist him or her to become part of a support group. However, assisting the client in becoming a part of a support group has higher priority than assisting in the development of self-esteem. The sense of belonging comes first, and such a sense may help in developing self-esteem. Self- Actualization Aesthetic Fulfillment of unique potentialSearch for beauty and spiritual goals It is important to understand the last two needs in Maslow’s hierarchy. They could deal with client needs associated with health promotion and maintenance, such as continued growth and development and self-care, as well as those associated with psychosocial integrity. However, you will probably not be asked to prioritize needs at this level. Remember, it is the goal of the Council to ensure safe nursing practice, and such practice does not usually deal with the client’s self-actualization or aesthetic needs. How CAT Works A. The NCLEX-RN consists of 75 to 265 multiple-choice or alternative-format questions (15 of which are pilot items) presented on a computer screen. B. The candidate is presented with a test item and possible answers. C. If the candidate answers the question correctly, a slightly more difficult item will 31

  31. Page 31
    Read page 31 as text

    follow, and the level of difficulty will increase with each item until the candidate misses an item. D. If the candidate misses an item, a slightly less difficult item will follow, and the level of difficulty will decrease with each item until the candidate has answered an item correctly. E. This process will continue until the candidate has achieved a definite pass or a definite fail score. There will be no borderline pass or fail scores because the adaptive testing method determines the candidate’s level of performance before she or he has finished the examination. F. The lowest number of items a candidate can answer to complete the examination is 75; 15 of them will be pilot items and will not count toward the pass or fail score; 60 of them will determine the candidate’s score. G. The number of the item the candidate is currently answering will appear on the upper-right area of the screen. H. When the candidate has answered enough items to determine a definite pass or fail score, a message will appear on the screen notifying the candidate that he or she has completed the examination. I. The greatest number of items a candidate can answer is 265, and the longest amount of time the candidate can take to complete the examination is 6 hours. J. Candidates will have up to 6 hours to complete the NCLEX-RN; total examination time includes a short tutorial, two preprogrammed optional breaks, and any unscheduled breaks the candidate may take. The first optional break is offered after 2 hours of testing. The second optional break is offered after 3.5 hours of testing. The computer will automatically tell candidates when these scheduled breaks begin. 1. All breaks count against testing time. 2. When candidates take breaks, they must leave the testing room, and they will be required to provide a palm vein scan before and after the breaks. K. If a candidate has not obtained a pass or fail score at the end of the 6 hours and has not completed all 265 items in the 6-hour limit, but has answered all of the last 60 questions presented correctly, he or she will pass the examination. L. If a candidate has not obtained a pass or fail score at the end of the 6 hours, has not completed all 265 items in the 6-hour limit, and has not answered correctly all of the last 60 questions presented, he or she will fail the examination. M. A specific passing score is recommended by the Council. All states require the same score to pass, so that if you pass in one state, you are eligible to practice nursing in any other state. However, states do differ in their requirements regarding the number of times a candidate can take the NCLEX-RN. N. Although the Council has the ability to determine a candidate’s score at the time of completion of the examination, it has been decided that it would be best for candidates to receive their scores from their individual Board of Nurse Examiners. The Council does not want the testing center to be in a position of having to deal with candidates’ reactions to scores, nor does the Council want those waiting to take their examinations to be influenced by such reactions. O. The candidate must answer each question in order to proceed. You cannot omit a question or return to an item presented earlier. There is no going back; this works 32

811 more pages in the full document

Unlock it once and it stays in your library, ready to chat with or turn into flashcards.

Unlock the full document

More National Council Licensure Examination study materials

See all

Study this document with CramX

Once it is in your library, every tool can work from it.