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

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HESI Comprehensive Review for theNCLEX-RN® ExaminationSIXTH EDITIONE. Tina Cuellar, PhD, WHNP, PMHCNS, BCDirector of Live Review, Elsevier/HESI, Houston, Texas2

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Table of ContentsCover imageTitle pageCopyrightContributing AuthorsPreface1. Introduction to Test-Taking Strategies and the NCLEX-RN®Test-Taking StrategiesThe NCLEX-RNJob Analysis StudiesThe NCLEX-RN Computer Adaptive TestingGentle Reminders of General Principles2. Leadership and Management: Legal Aspects of NursingLegal Aspects of NursingPrescriptions and Health Care ProvidersReview of Legal Aspects of NursingLeadership and ManagementMaintaining a Safe Work EnvironmentCommunication Skills3

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Review of Leadership and ManagementDisaster NursingEbolaReview of Disaster Nursing3. Advanced Clinical ConceptsRespiratory FailureRespiratory Failure in ChildrenReview of Respiratory FailureShockDisseminated Intravascular Coagulation (DIC)Review of Shock and DICResuscitationManagement of Foreign Body Airway Obstruction (FBAO)Review of ResuscitationFluid and Electrolyte BalanceReview of Fluid and Electrolyte BalanceElectrocardiogram (ECG)Review of Electrocardiogram (ECG)Perioperative CareReview of Perioperative CareHIV InfectionPediatric HIV InfectionReview of HIV InfectionPain: Fifth Vital SignReview of Pain4

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Death and GriefReview of Death and Grief4. Medical-Surgical NursingCommunicationHealth Promotion and Disease PreventionTeaching/LearningSpiritual AssessmentCultural DiversityComplementary and Alternative InterventionsRespiratory SystemReview of Respiratory SystemRenal SystemReview of Renal SystemCardiovascular SystemReview of Cardiovascular SystemGastrointestinal (GI) SystemReview of Gastrointestinal SystemEndocrine SystemReview of Endocrine SystemMusculoskeletal SystemReview of Musculoskeletal SystemNeurologic SystemReview of Neurologic SystemHematology and OncologyReview of Hematology and Oncology5

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Reproductive SystemReview of Reproductive SystemBurnsReview of Burns5. Pediatric NursingGrowth and DevelopmentPain Assessment and Management in the Pediatric ClientReview of Child Health PromotionRespiratory DisordersReview of Respiratory DisordersCardiovascular DisordersReview of Cardiovascular DisordersNeuromuscular DisordersReview of Neuromuscular DisordersRenal DisordersReview of Renal DisordersGastrointestinal DisordersReview of Gastrointestinal DisordersHematologic DisordersReview of Hematologic DisordersMetabolic and Endocrine DisordersReview of Metabolic and Endocrine DisordersSkeletal DisordersReview of Skeletal Disorders6. Maternity Nursing6

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Anatomy and Physiology of ReproductionAntepartum Nursing CareReview of Anatomy and Physiology of Reproduction and Antepartum Nursing CareFetal and Maternal Assessment TechniquesReview of Fetal and Maternal Assessment TechniquesIntrapartum Nursing CareReview of Intrapartum Nursing CareNormal Puerperium (Postpartum)Review of Normal Puerperium (Postpartum)The Normal NewbornReview of the Normal NewbornHigh-Risk DisordersReview of High-Risk DisordersPostpartum High-Risk DisordersReview of Postpartum High-Risk DisordersNewborn High-Risk DisordersEffects on the Neonate of Substance Abuse7. Psychiatric NursingTherapeutic CommunicationCoping Styles (Defense Mechanisms)Treatment ModalitiesReview of Therapeutic Communication and Treatment ModalitiesAnxiety and Related DisordersAnxiety Disorders, Obsessive-Compulsive and Related Disorders, and Traumatic andStressor Related DisordersReview of Anxiety Disorders, Obsessive-Compulsive and Related Disorders, and7

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Traumatic and Stressor Related DisordersSomatic Symptom Disorder and Related DisordersReview of Somatic Symptom Disorder and Related DisordersDissociative DisordersReview of Dissociative DisordersPersonality Disorders (DSM-5 Criteria)Review of Personality DisordersEating DisordersReview of Eating DisordersMood DisordersReview of Mood DisordersSchizophrenia Spectrum and Other Psychotic DisordersReview of Thought DisordersSubstance Abuse DisorderSubstance Use DisorderReview of Substance Abuse DisorderAbuseReview of AbuseNeurocognitive Disorder (DSM-5)Review of Neurocognitive DisordersChildhood and Adolescent DisordersReview of Childhood and Adolescent Disorders8. Gerontologic NursingTheories of AgingNeurocognitive Disorder (NCD): Dementia8

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Psychosocial ChangesHealth Maintenance and Preventive CareReview of Gerontologic NursingAnswer Key to Review QuestionsAPPENDIX. Common Laboratory TestsIndex9

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Contributing AuthorsSafa’a Al-Arabi, PhD, RN, MSN, MPH,Associate Professor and Master’s TrackAdministrator, University of Texas Medical Branch, Galveston, TexasKaren Alexander, PhD, RN,Program Director at University of Houston Clear Lake,Pearland, TexasJoanna Cain, BSN, BA, RN,President and Founder, Auctorial Pursuits, Inc., Austin,TexasLucindra Campbell-Law, PhD, ANP, PMHNP, BC,Professor, Carol and Odis PeavySchool of Nursing, University of St. Thomas, Houston, TexasE. Tina Cuellar, PhD, WHNP, PMHCNS, BC,Director of Live Review,Elsevier/Education/HESI, Houston, TexasClaudine Dufrene, PhD, RN-BC, GNP-BC, CNE,Assistant Professor, Carol and OdisPeavy School of Nursing, University of St. Thomas, Houston, TexasSandra Jenkins, PhD, RN,Visiting Professor, University of Houston Clear Lake,Pearland, TexasShatoi King, MSN, RN,Instructor, University of Houston Clear Lake, Pearland, TexasNecole Leland, MSN, RN, PNP, CPN,Instructor, School of Nursing, University ofNevada, Las Vegas, Las Vegas, NevadaKatherine Ralph, EdD, RN,Nurse Manager Curriculum, Review and Testing,Elsevier/Education/HESI, Houston, Texas12

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PrefaceWelcome toHESI Comprehensive Review for the NCLEX-RN®Examinationwith online studyexams by HESI.Congratulations! This outstanding review manual with online study exams is designed toprepare nursing students for what is very likely the most important examination they willever take—the NCLEX-RN Licensing Examination.HESI Comprehensive Review for theNCLEX-RN®Examinationallows the nursing student to prepare for the NCLEX-RNlicensure 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 focusedappropriately.• Develop test-taking skills to demonstrate application of safe nursing practice.• Reduce anxiety level by increasing predictability of ability to correctly answerNCLEX-type questions.• Boost test-taking confidence by being well prepared and knowing what to expect.13

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Organization AND PREPARING TO TAKE TESTSChapter 1, Introduction to Test-Taking Strategies and the NCLEX-RN®, gives anoverview of the NCLEX-RN Licensing Examination history and test plan for theexamination. Reviews of the nursing process, client needs, and strategies for employingclinical 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, andplanning and intervention, using clinical judgment at the highest level of practice. Topicsreviewed 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, MaternityNursing, Psychiatric Nursing, and Gerontologic Nursing, are presented in traditionalclinical areas. Each clinical area is divided into physiologic components, with essentialknowledge about basic anatomy, growth and development, pharmacology and medicationcalculation, nutrition, communication, client and family education, acute and chronic care,leadership and management, complementary and alternative interventions, cultural andspiritual diversity, and clinical decision making threaded throughout the differentcomponents.Open-ended questions with the answers appear at the end of each chapter, whichencourage the student to think in depth about the content that is presented throughout theparticular chapter. When a variety of learning mechanisms are used, students have theopportunity 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 examinationThese learning experiences are all different ways that students should use to prepare forthe NCLEX-RN exam. The purpose of the open-ended questions appearing at the end of thechapter is not a focused practice session on managing NCLEX-style questions, but rather alearning approach that allows for more in-depth thinking about specific topics in thechapter. Practice with multiple-choice questions alone cannot provide the depth of criticalthinking and analysis that is made possible by the short-answer questions at the end of thechapter. In addition, the open-ended questions presented at the end of the chapter providea summary experience that helps students focus on the main topics that were covered in thechapter. Teachers use open-ended questions to stimulate the critical-thinking process, andHESI Comprehensive Review for the NCLEX-RN®Examinationfacilitates the critical-thinkingprocess by posing the same type of questions the teacher might ask.When students need to practice multiple-choice questions, the online study exams on14

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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 theNCLEX-RN exam. The online study exams on Evolve can be accessed as many times asnecessary, and the questions from one study exam are not contained on another studyexam. For instance, the Medical-Surgical study exam does not contain questions that are onthe Pediatrics study exam. The purpose of the study exams is to provide practice andexposure to the critical thinking–style questions that students will encounter on theNCLEX-RN exam. However, the study exams should not be used to predict performanceon the actual NCLEX-RN exam. Only the HESI Exit Exam, a secure, computerized examthat simulates the NCLEX-RN test plan and has evidence-based results from numerousresearch studies indicating a high level of accuracy in predicting NCLEX success, is offeredas a true predictor exam. Students are allowed unlimited practice on each online studyexam so that they can be sure to have the opportunity to review all of the rationales for thequestions.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 yourstrengths and weaknesses are.• Step 2: After going over the content that relates to the study questions in aparticular clinical area (e.g., Pediatrics, Medical-Surgical, or Maternity), reviewthat section of the manual and take the test again to determine whether you havebeen able to improve your scores.• Step 3: Purposely miss every question on the exam so that you can view therationales for every question.• Step 4: Take the exam again under timed conditions at the pace that you wouldhave 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 constraintsaffects your performance.• Step 5: Put the exam away for a while and continue review and remediation withother textbooks, resources, and results of any HESI secure exams that you havetaken at your school. Then, take the study exams again to see if your performanceimproves after in-depth study and following a few weeks’ break from thesequestions.Step 5 represents a good activity in preparation for the HESI Exit Exam presented in yourfinal semester of the nursing program, especially if you have not used the online studyexams for several weeks. Repeated exposure to the questions, however, will make them lessuseful over time because students tend to memorize the answers. For this reason, these testsare useful only for practice and not for prediction of NCLEX-RN success. The tendency tomemorize the questions after viewing them multiple times falsely elevates a student’s scoreon the study exams.Additional assistance for students studying for the NCLEX-RN Licensing Examinationcan be obtained from a variety of online products in the Elsevier family. Many nursingschools have also adopted the following:15

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•HESI Examinations—A comprehensive set of examinations designed to preparenursing students for the NCLEX exam. They include customized electronicremediation from current Elsevier textbooks and multimedia, as well as additionalpractice questions. Each student is given an individualized report detailing examresults and is allowed to view questions and rationales for items that wereanswered incorrectly. The electronic remediation, a complementary feature of thespecialty 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. Withmore than 1200 practice questions included in this online test bank, nursingstudents can access practice exams 24 hours a day, 7 days a week.HESI PracticeTestquestions are written at the critical-thinking level so that students are testednot for memorization but for their skills in clinical application. Students select atest option (either a clinical specialty or a comprehensive exam), andHESI PracticeTestautomatically supplies a series of critical-thinking practice questions. NCLEXexam–style questions include multiple-choice and alternate-item formats and areaccompanied by correct answers and rationales.•HESI RN Case Studies—These prepare students to manage complex patientconditions and make sound clinical judgments. These online case studies cover abroad range of physiologic and psychosocial alterations, plus relatedmanagement, pharmacology, and therapeutic concepts.•HESI Patient Reviews—These are designed to teach and assess students’ retentionof core nursing content. These online interactive reviews provide a firsthand lookat safe and effective nursing care.•HESI Live Review—A live review course is presented by an expert faculty memberwho has additional instruction in working with students who are preparing totake the NCLEX exam. Students are presented with a workbook and practiceNCLEX-style questions that are used during the course.•Evolve eBooks—Online versions of all of the Mosby, Saunders, and Elseviertextbooks used in the student’s nursing curriculum are presented. Search acrosstitles, highlight, make notes, and more—all on your computer.•Elsevier Simulations—Virtual versions simulate the clinical environment. Thesemultilayered, complex, supplemental simulations enable students to experienceclinical assignments without the need for actual clinical space.•Elsevier Courses—These are created by experts using instructional designprinciples. This interactive content engages students with reading, animation,video, audio, interactive exercises, and assessments.16

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Next Generation NCLEX and Clinical JudgmentStarting in July of 2017, the National Council of State Boards of Nursing (NCSBN) beganincluding 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 maybe 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. Clinicaljudgment is important for all nurses, and this book helps nursing students by reviewinginformation and skills that nurses must master to practice clinical judgment.Additionally, NCLEX practice questions on the Evolve website written at higher levels ofBloom’s taxonomy help students practice applying their clinical judgment knowledge.Finally, a Clinical Judgment Scenario with practice NGN questions is included inChapter 4 to familiarize students with these types of questions.17

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Introduction to Test-Taking Strategies andthe NCLEX-RN®Congratulations! You have made the wise decision to prepare, in a structured way, for theNCLEX-RN®.A. Since you have successfully completed a basic nursing program and are wellacquainted with your test-taking skills and ability to apply your clinicalknowledge, you already have the basic knowledge required to pass the licensingexamination.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 studytime 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 usingyour foundational knowledge to arrive at the correct answer.6. Know what to expect. Remember that knowledge is power. You arepowerful when you are well prepared and know what to expect.18

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Test-Taking StrategiesThese test-taking strategies help you focus your study so that you can concentrate on whatthe exam questions are asking instead of being distracted by extraneous information that isnot needed to answer the questions.A. The NCLEX-RN tests your knowledge about several core concepts and the abilityto synthesize information to effectively apply, analyze, or evaluate a client’s needsto provide safe and effective care. For example, a question may appear to be amedical-surgical or pediatric question, but the question can also cover such topicsas communication, nutrition, growth and development, medication, client andfamily education, and safety.HESI HintThe most essential element of nursing care is client safety.B. Understand the question.1. Determine whether the question is written in a positive or negativestyle.a. Apositivestyle question may ask what the nurse shoulddo or ask for the best or first nursing intervention toimplement.H E S I H i n tMost questions are written in a positive style.b. Anegativestyle question may ask what the nurse shouldavoid, which prescription the nurse should question, orwhich behavior indicates the need for reteaching theclient.HESI HintNegative style questions contain key words that denote the negative style.Examples1. “Which response indicates to the nurse a need toreteachthe client about heartdisease?” (Which information or understanding by the client is incorrect?)2. “Which medication order should the nursequestion?” (Which prescription is unsafe,not beneficial, inappropriate to this client situation?)C. Identify key words.19

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1. Ask yourself which words or phrases provide the critical information.2. This information may include the age of the client, the setting, thetiming, a set of symptoms or behaviors, or any number of other factors.a. For example, the nursing actions for a 10-year-old postopclient are different from those for a 70-year-old postopclient.D. Rephrase the question.1. Rephrasing the question helps eliminate nonessential information inthe question to help you determine the correct answer.a. Ask yourself, “What is this questionreallyasking?”b. While keeping the options covered, rephrase the questionin your own words.2. Rule out options.a. Based on your knowledge, you can most likely identifyone or two options that are clearly incorrect.b. Physically mark through those options on the test bookletif allowed. Mentally mark through those options in yourhead if using a computer.c. Differentiate between the remaining options, consideringyour knowledge of the subject and related nursingprinciples, 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 questionis 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 bleedingprofusely, stop the bleeding. Or, if a client is having difficultybreathing, 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 necessaryassessments before calling the healthcare provider.5. Determine which client to assess first (e.g., most at risk, mostphysiologically unstable).6. Identify opposites in the answers.a. Example: prone versus supine; elevated versus decreased.b. ReadVERYcarefully; one opposite is likely to be theanswer, but not always.c. If you do not know the answer, choose the most likely ofthe “opposites” and move on.7. Take into account a client’s lifestyle, culture, and spiritual beliefs whenanswering a question.F. Use your critical thinking skills.1. Respond to questions based ona. Client safety20

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b. ABCsc. CAB for CPRd. Caringe. Incorporation of culture and spiritual practicesf. Scientific, behavioral, and sociologic principlesg. Communication (spoken and written [documentation])with client, family, colleagues, and other members of thehealthcare teamh. Principles of teaching and learningi. Maslow’s hierarchy of needsj. Nursing processk. Focus on what information is in the stem. Do not focus oninformation not included in the question. Do not readmore into the question than is already there.1. NCLEX-RN ideal hospital2. Basic anatomy and physiology2. Do not respond to questions based ona. YOUR past client care experiences or your employer’spoliciesb. A familiar phrase or termc. “Of course, I would have already”d. What you think is realistic; perceptions of realism aresubjectivee. Your children, pregnancies, parents, personal response toa drug, etc.f. The “what-ifs”H E S I H i n tAs soon as you are seated in the testing area, use the erasable noteboard to writedown information you’ve memorized (a brain dump). That’s a resource youmay use while testing if you become too stressed to recall information youmemorized.G. Keep memorization to a minimum.1. Don’t try to memorize all of the material found in your textbooksbecause it isn’t possible. Only memorize core concepts.a. Growth and developmental milestonesb. Death and dying stagesc. Crisis interventiond. Immunization schedulese. Principles of teaching and learningf. Stages of pregnancy and fetal growthg. Nurse Practice Act: Standards of Practice and Delegationh. Ethical practices and standardsi. Commonly used laboratory test values:1. Review Appendix A.2. Hemoglobin and hematocrit (H&H)21

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3. White blood cells (WBCs), red blood cells(RBCs), platelets4. Electrolytes: K+, Na+, Ca++, Mg++, Cl−,5. Blood urea nitrogen (BUN) and creatinine6. Relationship of Ca++and7. 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 tRemember not to confuse PT, PTT, and aPTT.j. Nutrition1. High or low Na+2. High or low K+3. High4. Iron5. Vitamin K6. Proteins7. Carbohydrates8. Fatsk. Foods and diets related to1. Body system disturbances (cardiac,endocrine, gastrointestinal)2. Chemotherapy, radiation, surgery3. Pregnancy and fetal growth needs4. Dialysis5. Burnsl. Nutrition concepts1. Introduce one food at a time for infantsand clients with allergies.2. Progression to “as tolerated” foods anddietsH. 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 executionb. Drug interactionsc. Vulnerable organs to medication effects1. Know what to assess (kidney function,vital signs).22

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2. Know which laboratory values relate tospecific organs and their functions.d. Client allergiese. Presence of infections and superinfectionsf. Concepts of peak and trough levelsg. How you would know if1. The drug is working.2. There is a problem.h. Nursing actionsi. Client education1. Safety2. Empowerment3. Compliance23

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The NCLEX-RNA. The main purpose of the NCLEX-RN is to protect the public.B. The NCLEX-RN1. 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 Examiners3. Is designed to test candidates’a. Capabilities for safe and effective nursing practiceb. Essential entry-level nursing knowledgec. Ability to problem solve by applying critical thinkingskills24

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Job Analysis StudiesA. Essential knowledge that new nurses should know is determined by job analysisstudies.B. Job analysis studies indicate that newly licensed registered nurses are using all fivecategories of the nursing process and that such use is evenly distributedthroughout the nursing process areas. Therefore, equal attention is given to eachpart of the nursing process in selecting NCLEX-RN items (Table 1.1).TABLE 1.1The Nursing ProcessHESI HintThe Council wants to ensure that the licensing examination measures current entry-levelnursing behaviors. For this reason, job analysis studies are conducted every 3 years. Thesestudies determine how frequently various types of nursing activities are performed, howoften they are delegated, and how critical they are to client safety, with criticality givenmore value than frequency.Nursing DiagnosesA. Nursing diagnoses are formulated during the analysis portion of the nursingprocess. They give form and direction to the nursing process, promote prioritysetting, and guide nursing actions (Table 1.2).B. To qualify as a nursing diagnosis, the primary responsibility and accountability forrecognition and treatment rest with the nurse.25

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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 selectan appropriate nursing intervention based on the stated nursingdiagnosis.2. You may be asked to select, from among the choices provided, themost appropriate nursing diagnosis(es) for the described case.3. You may be asked to choose, from four nursing diagnoses, the one thatshould have priority based on the data in the stem.D. For further information about nursing diagnoses, review a fundamentals text, amedical-surgical nursing text, or a nursing diagnosis handbook.HESI HintA nursing diagnosis must be subject to oversight by nursing management. It is not amedical diagnosis. The cause may or may not arise from a medical diagnosis.Client NeedsA. Job analysis studies have identified categories of care provided by nurses calledclient needs.The test plan is structured according to these categories (Table 1.3).Prioritizing Nursing CareA. Many NCLEX-RN items are designed to test your ability to set priorities.1. Identify themost importantclient needs.2. Which nursing intervention ismost important?TABLE 1.2Components of a Nursing DiagnosisTABLE 1.3Components of the NCLEX-RN Test Plan26

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3. Which nursing action should be performedfirst?4. Which response isbest?B. Setting priorities1. Which action should be performed first or next? Remember, clientsafety is paramount.2. Remember Maslow (Table 1.4).3. The Five Rights of Delegation (see Chapter 2, p. 16)HESI HintAnswering NCLEX-RN questions often depends on setting priorities, making judgmentsabout priorities, and analyzing the data and formulating a decision about care based on29

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

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The NCLEX-RN Computer Adaptive TestingA. 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 centerfor scoring.D. The testing centers are located throughout the United States.E. The Council generates the NCLEX-RN questions.TABLE 1.4Maslow’s Hierarchy of NeedsNeedDefinitionNursing ImplicationsPhysiologicBiologic needs forfood, shelter, water,sleep, oxygen,sexual expressionThe priority biologic need is breathing (i.e., an open airway). Review Table1.3, which lists activities associated with physiologic integrity. If asked toidentify themost importantaction, identify needs associated withphysiologic integrity (e.g., providing an open airway) as the mostimportant nursing action.SafetyAvoiding harm;attaining security,order, and physicalsafetyReview Table 1.3, which lists the activities associated with a safe andeffective care environment. Ensuring that the client’s environment is safe isa priority (e.g., teaching an older client to remove throw rugs that pose asafety hazard when ambulating has a greater priority than teaching theclient how to use a walker). The first priority is safety, followed by copingskills.Love andBelongingEsteem andRecognitionGiving andreceivingaffection;companionship;identificationwith a groupSelf-esteem andrespect ofothers; successin work;prestigeAlthough these needs are important (described in Table 1.3), they are lessimportant than physiologic or safety needs. For example, it is moreimportant for a client to have an open airway and a safe environment forambulating than it is to assist him or her to become part of a supportgroup. However, assisting the client in becoming a part of a support grouphas higher priority than assisting in the development of self-esteem. Thesense of belonging comes first, and such a sense may help in developingself-esteem.Self-ActualizationAestheticFulfillment ofuniquepotentialSearch forbeauty and spiritualgoalsIt is important to understand the last two needs in Maslow’s hierarchy.They could deal with client needs associated with health promotion andmaintenance, such as continued growth and development and self-care, aswell as those associated with psychosocial integrity. However, you willprobably not be asked to prioritize needs at this level. Remember, it is thegoal of the Council to ensuresafenursing practice, and such practice doesnot usually deal with the client’s self-actualization or aesthetic needs.How CAT WorksA. The NCLEX-RN consists of 75 to 265 multiple-choice or alternative-formatquestions (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 will31

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follow, and the level of difficulty will increase with each item until the candidatemisses an item.D. If the candidate misses an item, a slightly less difficult item will follow, and thelevel of difficulty will decrease with each item until the candidate has answered anitem correctly.E. This process will continue until the candidate has achieved a definite pass or adefinite fail score. There will be no borderline pass or fail scores because theadaptive testing method determines the candidate’s level of performance beforeshe or he has finished the examination.F. The lowest number of items a candidate can answer to complete the examination is75; 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 theupper-right area of the screen.H. When the candidate has answered enough items to determine a definite pass orfail score, a message will appear on the screen notifying the candidate that he orshe has completed the examination.I. The greatest number of items a candidate can answer is 265, and the longestamount 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 examinationtime includes a short tutorial, two preprogrammed optional breaks, and anyunscheduled breaks the candidate may take. The first optional break is offeredafter 2 hours of testing. The second optional break is offered after 3.5 hours oftesting. The computer will automatically tell candidates when these scheduledbreaks begin.1. All breaks count against testing time.2. When candidates take breaks, they must leave the testing room, andthey will be required to provide a palm vein scan before and after thebreaks.K. If a candidate has not obtained a pass or fail score at the end of the 6 hours and hasnot completed all 265 items in the 6-hour limit, but has answered all of the last 60questions 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 notcompleted all 265 items in the 6-hour limit, and has not answered correctly all ofthe last 60 questions presented, he or she will fail the examination.M. A specific passing score is recommended by the Council. All states require thesame score to pass, so that if you pass in one state, you are eligible to practicenursing in any other state. However, states do differ in their requirementsregarding 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 ofcompletion of the examination, it has been decided that it would be best forcandidates 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 dealwith candidates’ reactions to scores, nor does the Council want those waiting totake their examinations to be influenced by such reactions.O. The candidate must answer each question in order to proceed. You cannot omit aquestion or return to an item presented earlier. There is no going back; this works32

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