Saunders Comprehensive Review for the NCLEX-RN® Examination (2022)
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) simplifies exam prep with well-structured content and practice questions.
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COMPREHENSIVE REVIEW for the EXAM I NATION EDITION
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YOU’VE JUST PURCHASED MORE THAN A TEXTBOOK! REGISTER TODAY! Place Sticker Here You can now purchase Elsevier products on Evolve! Go to evolve.elsevier.com/shop to search and browse for products. 2019v1.0 Enhance your learning with Evolve Student Resources. These online study tools and exercises can help deepen your understanding of textbook content so you can be more prepared for class, perform better on exams, and succeed in your course. Activate the complete learning experience that comes with each http://evolve.elsevier.com/Silvestri/comprehensiveRN/ If your school uses its own Learning Management System, your resources may be delivered on that platform. Consult with your instructor. has already been revealed, the code may have been used and cannot be re-used for registration. To purchase a new code to access these valuable study resources, simply follow the link above.
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Linda Anne Silvestri, PhD, RN, FAAN Nursing Instructor University of Nevada, Las Vegas Las Vegas, Nevada President and Owner Nursing Reviews, Inc. Henderson, Nevada Director and Owner Professional Nursing Seminars, Inc. Henderson, Nevada Elsevier Next Generation NCLEX® (NGN) Consultant and Subject Matter Expert Angela E. Silvestri, PhD, APRN, FNP-BC, CNE Associate Professor and BSN Program Director University of Nevada, Las Vegas Las Vegas, Nevada President Clinical Judgment Test-Taking Strategy Creator Nurse Prep, LLC Henderson, Nevada Elsevier Next Generation NCLEX® (NGN) 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 NCLEX-RN ® examination S A U N D E R S COMPREHENSIVE REVIEW for the E D I T I O N 9
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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 verication 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
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iii Unit I NCLEX-RN ® Exam Preparation, 1 1 Clinical Judgment and the Next Generation NCLEX (NGN)-RN® Examination, 2 2 Self-Efcacy and Pathways to Success, 17 3 The NCLEX-RN® Examination from a Graduate’s Perspective, 22 4 Clinical Judgment and Test-Taking Strategies, 24 Unit II Professional Standards in Nursing, 38 5 Population Health Nursing, 40 6 Ethical and Legal Issues, 53 7 Prioritizing Client Care: Leadership, Delegation, and Emergency Response Planning, 68 Unit III Foundations of Care, 85 8 Fluids and Electrolytes, 88 9 Acid-Base Balance, 106 Vital Signs and Laboratory Reference Intervals, 116 11 Nutrition, 132 12 Health and Physical Assessment of the Adult Client, 143 13 Safety and Infection Control, 166 14 Medication Administration and Intravenous Therapies, 178 15 Perioperative Nursing Care, 189 16 Hygiene, Mobility, and Skin Integrity, 204 17 Urinary and Bowel Elimination, 218 Unit IV Growth and Development Across the Life Span, 234 18 Theories of Growth and Development, 236 19 Growth, Development, and Stages of Life, 244 20 Care of the Older Client, 266 Unit V Maternity Nursing, 275 21 Reproductive System, 277 22 Prenatal Period, 285 23 Risk Conditions Related to Pregnancy, 300 24 Labor and Birth, 323 25 Problems with Labor and Birth, 336 26 Postpartum Period, 343 27 Postpartum Complications, 350 28 Care of the Newborn, 358 29 Maternity and Newborn Medications, 380 Unit VI Pediatric Nursing, 391 30 Integumentary Problems, 392 31 Hematological Problems, 399 32 Oncological Problems, 406 33 Metabolic and Endocrine Problems, 416 34 Gastrointestinal Problems, 425 35 Eye, Ear, and Throat Problems, 444 36 Respiratory Problems, 451 37 Cardiovascular Problems, 467 38 Renal and Genitourinary Problems, 479 39 Neurological and Cognitive Problems, 487 40 Musculoskeletal Problems, 498 41 Immune Problems and Infectious Diseases, 507 42 Pediatric Medication Administration and Calculations, 520 Contents
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Contents iv Unit VII Integumentary Problems of the Adult Client, 527 43 Integumentary Problems, 528 44 Integumentary Medications, 538 Unit VIII Oncological and Hematological Problems of the Adult Client, 547 45 Oncological and Hematological Problems, 549 46 Oncological and Hematological Medications, 587 Unit IX Endocrine Problems of the Adult Client, 598 47 Endocrine Problems, 599 48 Endocrine Medications, 626 Unit X Gastrointestinal Problems of the Adult Client, 641 49 Gastrointestinal Problems, 643 50 Gastrointestinal Medications, 671 Unit XI Respiratory Problems of the Adult Client, 679 51 Respiratory Problems, 680 52 Respiratory Medications, 701 Unit XII Cardiovascular Problems of the Adult Client, 719 53 Cardiovascular Problems, 720 54 Cardiovascular Medications, 760 Unit XIII Renal and Urinary Problems of the Adult Client, 778 55 Renal and Urinary Problems, 779 56 Renal and Urinary Medications, 811 Unit XIV Eye and Ear Problems of the Adult Client, 821 57 Eye and Ear Problems, 822 58 Eye and Ear Medications, 842 Unit XV Neurological Problems of the Adult Client, 852 59 Neurological Problems, 853 60 Neurological Medications, 877 Unit XVI Musculoskeletal Problems of the Adult Client, 888 61 Musculoskeletal Problems, 889 62 Musculoskeletal Medications, 910 Unit XVII Immune Problems of the Adult Client, 918 63 Immune Problems, 919 64 Immune Medications, 933 Unit XVIII Mental Health Problems of the Adult Client, 940 65 Foundations of Psychiatric Mental Health Nursing, 941 66 Mental Health Problems, 954 67 Addictions, 975 68 Crisis Theory and Intervention, 987 69 Psychotherapeutic Medications, 1001 Unit XIX Complex Care, 1015 70 Complex Care, 1017 References, 1088 Index, 1090
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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 seless, 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
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vi 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, specic 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
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vii Linda Anne Silvestri, PhD, RN, FAAN L inda is a well-known nurse educator, entre- preneur, and philanthro- pist whose professional aspirations focus on assisting nursing students to become successful. She has been teaching at all levels of nursing education for many years. Linda is cur- rently a nursing instructor at the University of Nevada, Las Vegas (UNLV). She earned her PhD in nursing from UNLV and conducted research on self-efcacy and the predictors of NCLEX® success. Her research ndings are published in the Journal of Nursing Education and Prac- tice. Dr. Silvestri has received several awards and honors. In 2019, she was inducted as a Fellow in the American Academy of Nursing. In 2012, she received the UNLV School of Nursing Alumna of the Year Award. And in 2010, she received the School of Nursing’s Certicate of Recognition for Outstanding PhD Student. Linda is a member of several national nursing organizations, including the Honor Society of Nursing, Sigma Theta Tau International, the National League for Nursing, the American Nurses Association, and the American Acad- emy of Nursing. Dr. Silvestri is a successful Elsevier author of numerous best-selling NCLEX® preparation resources on the national and international levels. She also serves as an Elsevier Subject Matter Expert for the Next Generation NCLEX® (NGN), and has presented numerous webinars on NCLEX® preparation and suc- cess. Dr. Silvestri is the President and Owner of Nursing Reviews, Inc., and the Director and Owner of Profes- sional Nursing Seminars, Inc. Both companies are dedi- cated to helping nursing graduates achieve their goals of becoming licensed nurses. Angela E. Silvestri, PhD, APRN, FNP-BC, CNE A ngela Silvestri is a well-known nurse educator, researcher, and author. She has been teaching and working in university administrative roles for the last 10 years at all levels of nursing education. She has experience teach- ing in both classroom and clinical settings and in working with graduate students on their culminating projects and research dissertations. She currently serves as the Program Director for the undergraduate BSN program at the Uni- versity of Nevada, Las Vegas (UNLV). Dr. Silvestri is a suc- cessful Elsevier author of numerous best-selling NCLEX® preparation resources on the national and international levels. She also serves as an Elsevier Subject Matter Expert for the Next Generation NCLEX® (NGN). Angela earned a bachelor’s in Nursing and in Sociology from Salve Regina University in Newport, Rhode Island; she earned her master’s degree with a focus in nursing education and her PhD from the University of Nevada, Las Vegas. She also has a post-master’s graduate certicate in advanced practice and is a board-certied Family Nurse Practitio- ner. She is a Scholar in Sigma Theta Tau’s New Academic Leadership Academy. She works with faculty, staff, and students on managing primary and episodic health care needs at UNLV’s Student Wellness Center and Faculty and Staff Treatment Center as a Family Nurse Practitioner. Dr. Silvestri is passionate about college students’ success. She is an expert in creating clinical judgment test-taking strat- egies for NGN items. This passion also comes through in her work at UNLV, where she teaches leadership and licensure exam preparation, and in the publication of her research and best-selling licensure exam review resources. About the Authors
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viii Rossybel Aberle, RN, BSN Graduate University of Nevada, Las Vegas Las Vegas, Nevada Sarah R. Jean Baptiste, MS, PA-C Physician Assistant Oregon Health Science University Portland, Oregon Esmeralda Araceli Clark, MSN, APRN, FNP-BC Lecturer School of Nursing University of Nevada, Las Vegas Las Vegas, Nevada Eileen H. Gray, RN, DNP, CPNP Nursing Instructor School of Nursing University of Nevada, Las Vegas Las Vegas, Nevada 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 James Guilbault, PharmD, BS, RPh Pharmacy Manager and Clinical Staff Pharmacist Walgreens Pharmacy, Mercy Medical Center, MCPHS University Springeld, Massachusetts Debra Hagler, PhD, RN, aCNS-BC, cNE, CHSE, ANEF, FAAN Clinical Professor Edson College of Nursing and Health Innovation Arizona State University Phoenix, Arizona Diana Rabbani Hagler, MSN-Ed, RN, CCRN TeleHealth ICU RN Banner Health, Grand Canyon University, Maricopa Community Colleges Adjunct Faculty Phoenix, Arizona Donna D. Ignatavicius, MS, RN, CNE, CNEcl, ANEF, FAADN Speaker and Curriculum Consultant for Academic Nursing Programs Founder Boot Camp for Nurse Educators; President DI Associates, Inc. Littleton, Colorado; Next Generation NCLEX®(NGN) Consultant and Subject Matter Expert Elsevier Inc. Michael Johnson, PhD, RN, PMH-BC, CNE Director of Clinical Affairs and Associate Professor School of Nursing Nevada State College Henderson, Nevada Erica Shae Lee, MSN-Ed, RN Associate Program Director Prelicensure Nursing Arizona State University Phoenix, Arizona Necole Leland, DNP, RN, PNP, CPN Assistant Professor School of Nursing University of Nevada, Las Vegas Las Vegas, Nevada Lisa Nicholas, MSN, RN Lecturer, Clinical Instructor School of Nursing University of Nevada, Las Vegas Las Vegas, Nevada Contributors
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Contributors ix Karen L. Petersen, MSN-L, RN, MNN Nursing Faculty Paradise Valley Community College Phoenix, Arizona David Petersen, MSN-Ed, RN Visiting Professor School of Nursing Chamberlain University Phoenix, Arizona 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 Laurent W. Valliere, BS, DD Vice President Marketing Nursing Reviews, Inc. Henderson, Nevada Janelle Willis, MSN, APRN, CNE Lecturer, Clinical Instructor School of Nursing University of Nevada, Las Vegas Las Vegas, Nevada
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x Emily Brown, MSN, APRN, FNP-BC Family Nurse Practitioner University Medical Center Las Vegas, Nevada Alena Grewal, MSN, APRN, FNP-BC Assistant Professor of Nursing University of Nevada, Las Vegas Las Vegas, Nevada 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 James Guilbault, PharmD, BS, RPh Pharmacy Manager and Clinical Staff Pharmacist Walgreens Pharmacy, Mercy Medical Center, MCPHS University Springeld, Massachusetts Debra Hagler, PhD, RN, aCNS-BC, cNE, CHSE, ANEF, FAAN Clinical Professor Edson College of Nursing and Health Innovation Arizona State University Phoenix, Arizona Diana Hagler, MSN-Ed, RN, CCRN TeleHealth ICU RN, Adjunct Faculty Banner Health, Grand Canyon University, Maricopa Community Colleges Phoenix, Arizona Hope Hinchman, MSN, RN Clinical Instructor University of Nevada, Las Vegas Las Vegas, Nevada Sarah R. Jean Baptiste, MS-PA Physician Assistant Oregon Health Science University Portland, Oregon Michael Johnson, PhD, RN, PMH-BC, CNE Director of Clinical Affairs and Associate Professor School of Nursing Nevada State College Henderson, Nevada Lisa M. Nicholas, MSN, RN Lecturer, Clinical Instructor University of Nevada, Las Vegas Las Vegas, Nevada Karen L. Petersen, MSN-L, RN, MNN Nursing Faculty Paradise Valley Community College Phoenix, Arizona Paula Richards, BA Trauma Informed Care Interventionist Dialectical Behavior Therapy Trained Clinical Counselor Baystate Medical Center Springeld, Massachusetts Kelly Rybacki, MSN, RN Instructor of Nursing Paradise Valley Community College Phoenix, Arizona Dieu-My Thi Tran, PhD, RN, CNE Associate Professor of Nursing University of Nevada, Las Vegas Las Vegas, Nevada Janelle Willis, MSN, APRN, CNE Lecturer, Clinical Instructor School of Nursing University of Nevada, Las Vegas Las Vegas, Nevada Reviewers
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xi Linda Anne Silvestri, PhD, RN “To laugh often and much, to appreciate beauty, to nd the best in others, to leave the world a bit better, to know that even one life has breathed easier because you have lived, this is to have succeeded.” —Ralph Waldo Emerson Angela Elizabeth Silvestri, PhD, APRN, FNP-BC, CNE “The climb to the top is arduous and steep. People become exhausted, frustrated, and disenchanted, and are often tempted to give up. Genuine acts of caring draw people for- ward.” -James M. Kouzes Welcome to Saunders Pyramid to Success! An Essential Resource for Test Success Saunders Comprehensive Review for the NCLEX-RN® Exami- nation is one in a series of products designed to assist you in achieving your goal of becoming a registered nurse. This text will provide you with a comprehensive review of all nursing content areas specically related to the cur- rent test plan for the Next Generation NCLEX-RN exami- nation, which is implemented by the National Council of State Boards of Nursing. This resource will help you achieve success on your nursing examinations during nursing school and on the NCLEX-RN examination. Organization This book contains 19 units and 70 chapters. The chap- ters are designed to identify specic components of nursing content. They contain practice questions, both multiple-choice and alternate item formats, that reect the chapter content and the current test plan for the NCLEX-RN examination. All questions in the book and on the Evolve site are presented in NCLEX-style format. The NCLEX test plan identies a framework based on Client Needs . These Client Needs categories include Safe and Effective Care Environment, Health Promotion and Maintenance, Psychosocial Integrity, and Physi- ological Integrity. Integrated Processes are also identied as a component of the test plan. These include Caring, Communication and Documentation, Culture and Spirituality, Nursing Process, and Teaching and Learn- ing. All chapters address the components of the test plan framework. Special Features of the Book Pyramid Terms 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. Denitions can be reviewed in the Audio Glossary on the Evolve site. Pyramid to Success The Pyramid to Success, a featured part of each unit intro- duction, provides you with an overview, guidance, and direction regarding the focus of review in the particular content area, as well as the content area’s relative impor- tance to the test plan for the NCLEX-RN examination. The Pyramid to Success reviews the Client Needs and pro- vides learning outcomes as they pertain to the content in that unit. These learning outcomes identify the spe- cic components and cognitive skills to keep in mind as you review each chapter. Priority Concepts Each chapter identies two Priority Concepts reective of its content. These Priority Concepts will assist you to focus on the important aspects of the content and asso- ciated nursing interventions. These Priority Concepts are also helpful for those students who are learning in a concept-based curriculum. Pyramid Points Pyramid Points ( ) are placed next to specic content throughout the chapters. The Pyramid Points highlight content that is important for preparing for the NCLEX- RN examination and identify content that is likely to appear on the NCLEX-RN examination. Preface
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Preface xii Pyramid Alerts Pyramid Alerts are the red text found throughout the chapters that alert you to important information about nursing concepts. These alerts identify concepts that are important to remember and relate to content that typi- cally appears on the NCLEX-RN examination. Clinical Judgment Boxes Clinical Judgment (CJ) Boxes are located in every chap- ter in the book. These boxes present a clinical scenario that relates to one of the six cognitive skills ( recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action, evaluate outcomes ) that will be measured in the Next Generation NCLEX (NGN) exam. These CJ boxes provide the thinking process needed and neces- sary information to make a clinical decision. Special Features Found on Evolve Pretest and Study Calendar The accompanying Evolve site contains a 75-question pretest and a 75-question posttest that provide you with feedback on your strengths and areas in need of improvement. The results of your pretest will generate an individualized study calendar to guide you in your preparation for the NCLEX examination. Once you have completed your review of the practice questions in this resource, you can take the posttest to evaluate your improvement and need for any additional review in preparation for the NCLEX. After completion of each test you are provided with the opportunity to review the answers, rationales, and strategies, and we highly encourage you to do this. Audio Questions The accompanying Evolve site contains Audio Questions representative of content addressed in the current test plan for the NCLEX-RN examination. These questions are in NCLEX-style format, and each question presents an audio sound, such as lung sounds, as a component of the question. Next Generation NCLEX ® (NGN) Case Studies and NGN Test Questions The accompanying Evolve site contains stand-alone items and unfolding case studies. The clinical judgment stand-alone items provide a clinical scenario and are accompanied by one NGN test question in either a Bow- tie or a Trend item format. These stand-alone items can measure up to all of the cognitive skills of the NCSBN Clinical Judgment Measurement Model (NCJMM). These cognitive skills include Recognize Cues, Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take Action, and Evaluate Outcomes. Each unfolding case study is accompanied by six NGN test items, each mea- suring one of the cognitive skills in sequential order. Audio Review Summaries The companion Evolve site includes three Audio Review Summaries that cover challenging subject areas addressed in the test plan for the NCLEX-RN examination, including Pharmacology , Acid-Base Balance , and Fluids and Electrolytes . Practice Questions While preparing for the NCLEX-RN examination, it is crucial for students to practice answering test questions. This book contains multiple-choice and alternate item format questions. The accompanying software includes all the questions from the book, plus additional new Evolve questions for a total of more than 5700 ques- tions. The alternate item format questions in the book and on the accompanying Evolve site may be presented as one of the following: ◼ Fill-in-the-blank question ◼ Multiple-response question ◼ Prioritizing (ordered response) question ◼ Figure/illustration question ◼ Graphic options question, in which each option con- tains a gure or illustration ◼ Chart/exhibit question ◼ Audio question ◼ NGN stand-alone items and unfolding case studies The NGN stand-alone items and unfolding case studies provide you with practice in prioritizing, decision- making, and critical thinking, and strengthen your clinical judgment skills. Multiple-Choice and Alternate Item Format Questions Starting with Unit II, each chapter is followed by a practice test. Each practice test contains several ques- tions reective of the content in the chapter and those presented on the NCLEX-RN examination. These ques- tions provide you with practice in prioritizing, decision- making, critical thinking, and clinical judgment skills. Chapter 1 of this book provides a description of each question type. The Next Generation NCLEX (NGN) is also discussed in this chapter. The answer section for each practice question through- out the chapters and on the Evolve site provides the cor- rect answer, the rationale for the correct and incorrect options, and a test-taking strategy that will assist you in answering the question correctly. The test-taking strategy is highlighted in bold blue type. This highlighting will provide you with guidance and direction for further reme- diation in the Saunders Clinical Judgment and Test-Taking Strategies: Passing Nursing School and the NCLEX® Exam . The categories identied in each practice question on the Evolve site include Level of Cognitive Ability, Client Needs, Integrated Process, Clinical Judgment/Cognitive Skill, the nursing Content Area, the Health Problem, and Priority Concepts. Every question on the accompanying
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Preface xiii Evolve site is organized by these question codes, so you can customize your study session to be as specic or as generic as you need. Additionally, a link to view nor- mal laboratory reference intervals is provided with each practice question. Pharmacology and Medication Calculations Review Students consistently state that pharmacology is an area with which they need assistance. The NCLEX-RN test plan continues to incorporate pharmacology in the examination, but only the generic drug names will be included. Therefore, pharmacology chapters have been included for your review and practice. This book includes 13 pharmacology chapters, a medication and intravenous prescriptions calculation chapter, and a pediatric medication administration and calculation chapter. Each of these chapters is followed by a practice test that uses the same question format described earlier. This book contains numerous pharmacology questions. Additionally, more than 1000 pharmacology questions can be found on the accompanying Evolve site. Next Generation NCLEX (NGN) Questions As described above, the accompanying Evolve site con- tains stand-alone items and unfolding case studies. The NCSBN has conducted rigorous research over the past several years to develop NGN case studies and test items that will effectively measure clinical judgment. The NCSBN will launch the NGN questions on the exami- nation starting in April 2023, and these item types are designed to test the candidate’s ability to make safe and competent clinical judgments. The information in this book about the NGN reects the most up-to-date infor- mation at the time of the printing of this book. Since the NCSBN continues to research and collect data on the NGN items, additional and continuous changes could be made. We encourage you to access the NCSBN website at www.ncsbn.org for these latest updates. The Evolve site for this resource provides you with NGN stand-alone items and unfolding case studies with accompanying test items that are reective of the item types that NCSBN has indicated (as of the time of this publication) will be presented. How to Use This Book Saunders Comprehensive Review for the NCLEX-RN® Exam- ination is especially designed to help you with your suc- cessful journey to the peak of the Saunders Pyramid to Success : becoming a registered nurse! As you begin your journey through this book, you will be introduced to all of the important points regarding the current NCLEX- RN examination, the process of testing, and unique and special tips regarding how to prepare yourself for 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. You should begin your process through the Saun- ders Pyramid to Success by reading all of Unit I in this book and becoming familiar with the central points regarding the NCLEX-RN examination, including the NGN. Chapter 2 describes self-efcacy and the unique and special tips regarding how to prepare yourself both academically and nonacademically for this important examination. Be sure to read Chapter 3, written by a nursing graduate who recently passed the examination, and note what the graduate has to say about the testing experience. Chapter 4 will provide you with the critical testing strategies that will guide you in selecting the cor- rect option or assist you in selecting an answer to a ques- tion if you must guess. Keep these strategies in mind as you proceed through this book. Continue by studying the specic content areas addressed in Units II through XIX. Review the denitions of the Pyramid Terms, located in each chapter, and the Pyramid to Success notes and the Client Needs and Learning Outcomes, located in each unit introduction. Read through the chapters and focus on the Pyramid Points and Pyramid Alerts, which iden- tify the areas most likely to be tested on the NCLEX- RN examination. Pay particular attention to the Clinical Judgment boxes because they provide information about the cognitive skills in the NCSBN Clinical Judgment Measurement Model and the thinking processes in mak- ing an interpretation or decision. As you read each chapter, identify your areas of strength and those in need of further review. Highlight these areas, and test your abilities by taking all prac- tice tests provided at the end of the chapters. Be sure to review all rationales and test-taking strategies. After reviewing all chapters in the book, reect and identify any areas requiring further review; then take the time to review those areas in both the book and the companion Evolve site. In preparation for the NCLEX- RN examination, be sure to take the pretest on the Evolve site and generate your study calendar. Follow the calendar for your review because the calendar represents your pretest results and the best study path to follow based on your strong areas and content areas in need of 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. Climbing the Pyramid to Success The purpose of this book is to provide a comprehensive review of the nursing content you will be tested on during
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Preface xiv the NCLEX-RN examination. However, Saunders Compre- hensive Review for the NCLEX-RN® Examination is intended to do more than simply prepare you for the rigors of the NCLEX-RN examination; this book is also meant to serve as a valuable study tool that you can refer to throughout your nursing program, with specic customizable Evolve site selections, including a selection for NGN cases and test items, to help identify and reinforce key content areas and prepare you for your nursing exams. After using this book for comprehensive content review, your next step in the Pyramid to Success is to get additional practice with the Q & A review product. Saun- ders Q&A Review for the NCLEX-RN® Examination offers more than 6000 unique practice questions in the book and on the companion Evolve site. The questions are focused on the Client Needs and Integrated Processes of the NCLEX-RN test plan, making it easy to access your study area of choice. The Evolve site for this book also provides you with NGN cases and test items. For on-the-go Q&A review, you can pick up Saunders Q&A Review Cards for the NCLEX-RN® Examination . Your nal step on the Pyramid to Success is to mas- ter the online review . The HESI/Saunders Online Review for the NCLEX-RN® Examination provides an interactive and individualized platform to get you ready for your NCLEX exam. This online course provides 10 high-level content modules, supplemented with instructional vid- eos, animations, audio, illustrations, case studies, and several subject matter exams. End-of-module practice tests are provided, along with several Crossing the Finish Line practice tests. In addition, you can assess your prog- ress with a Pretest, Test Yourself quizzes , and a Comprehen- sive Exam in a computerized environment that prepares you for the actual NCLEX-RN examination. NGN cases and test items are also provided. At the base of the Pyramid to Success are our test - taking strategies , which provide a foundation for under- standing and unpacking the complexities of NCLEX-RN examination questions, including alternate item formats, NGN stand-alone items, and unfolding case studies with accompanying NGN items. Saunders Clinical Judgment and Test-Taking Strategies: Passing Nursing School and the NCLEX ® Exam takes a detailed look at clinical judgment and all of the test-taking strategies you will need to know in order to pass any nursing examination, including the Next Generation NCLEX-RN. Special tips are integrated for nursing students, and more than 1200 practice ques- tions are included so that you can apply the testing strate- gies. NGN questions are included on the Evolve site. Good luck with your journey through the Saun- ders Pyramid to Success . We wish you continued success throughout your new career as a registered nurse!
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xv A Few Words From Linda There are many individuals who in their own ways have contributed to my success in making my professional dreams become a reality. My sincere appreciation and warmest thanks are extended to all of them. First, I want to acknowledge my parents, who opened my door of opportunity in education. I thank my mother, Frances Mary, for all of her love, support, and assistance as I continuously worked to achieve my pro- fessional goals. I thank my father, Arnold Lawrence, who always provided insightful words of encouragement. My memories of their love and support will always remain in my heart. I am certain that they are very proud of my professional accomplishments. I also thank my best friend and love of my life, my husband, Larry; my sister, Dianne Elodia, and her hus- band, Lawrence; my brother, Lawrence Peter, and my sister-in-law, Mary Elizabeth; my cousin Paula; and my nieces and nephews, Angela, Katie, Gina, Karen, Bri- anna, Gabby, and Nicholas, who were continuously supportive, giving, and helpful during my research and preparation of this publication. They were always there and by my side whenever I needed them. I want to thank my nursing students at the Com- munity College of Rhode Island who approached me 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 for the NCLEX-RN examination for nursing students. I also thank the numerous nursing students who have attended my review courses for their willingness to share their needs and ideas. Their input has certainly added a special uniqueness to all of the publications in the Pyramid to Success. I also wish to acknowledge all of the nursing faculty who taught in my review courses for the NCLEX-RN exam- ination. Their commitment, dedication, and expertise have certainly assisted nursing students in achieving success with the NCLEX-RN examination. I also want to extend a very special thank-you to my niece, Angela, for joining me in preparing and authoring these NCLEX resources. Angela is wonderful to work with. Her tremendous theoretical and clinical knowledge and expertise and her consistently out- standing ideas and work in creating clinical judgment test- taking strategies certainly added to the excellent quality of this product and all of the other products in the Pyramid to Success. She is very dedicated to promoting and ensuring student success. Thank you, Angela! A special thank-you goes to Loren Wilson, former Senior Vice President, for her years of expert guidance and continuous support for all of the products in the Pyramid to Success . I would also like to acknowledge Patricia Mieg and Jeff Price, former educational sales representatives, who encouraged me to submit my ideas and initial work for the rst edition of this book to the W.B. Saunders Company. And nally, a very sincere and special acknowledg- ment to my husband, Laurent (Larry) W. Valliere, for his contribution to this publication, for teaching in my review courses for the NCLEX-RN examination, and for his commitment and dedication in assisting my nursing students to prepare for the examination from a nonaca- demic point of view. I thank him for all of his continu- ous support; he was so loyal and loving to me each and every moment as I worked to achieve my professional goals. Larry, you are my “rock of support!” Thank you so much! A Few Words From Angela There are many people who contributed to my success in my work on this product. I am very grateful for their continued support in all of my endeavors. First and foremost, I would like to thank my hus- band, Brent, for his lighthearted and positive attitude. He always knows how to make me laugh, especially when I’m stressed. All of this would not be possible without him! I would also like to thank my parents, Mary and Larry, for their continued support throughout the years. Their words of encouragement and wisdom have been tremendously important to my success. I also don’t Acknowledgments
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Acknowledgments xvi know what I would do without their support in caring for my kids! I would like to thank my sister Katie, who is a won- derful nurse. Her ambitions as a nursing student were so inspiring and reminded me about why I’m so passion- ate about being an educator. Thank you to my brother, Nick, who always is positive and encouraging about my work. His wit and sarcasm are always a great way to lift your mood at the end of the day. Finally, I want to extend a special thank you to Linda for her collaboration, guidance, and expertise. Without her, I would not be where I am today. Thank you, Linda! A Few Words From Both Linda and Angela First and foremost, we want to thank our associate edi- tor, Jessica Grimm, for all of her dedicated and hard work in editing and preparing manuscript for this edi- tion. Her expertise and close attention to details have certainly added to the quality of this resource. We also want to acknowledge and thank Laurent W. Valliere for writing a chapter addressing those important self-efcacy and nonacademic test-preparation issues. A very special thank-you goes to all of the review- ers, contributors, and item writers who updated and provided many of the practice questions, and to all of the previous contributors to this book. You were all awesome! Additionally, we want to thank Paula Richards for her expertise and input in reviewing our chapter titled Population Health Nursing. Thank you, Paula! We thank Dianne E. Fiorentino for her continuous support and dedication to our work and in her research and reference support and other administrative assistant responsibilities for the ninth edition of this book. We thank Karen Machnacz for her help with reference sup- port, Jimmy Guilbault for providing medication research support, and Mary and Larry Silvestri for their assistance with getting through all of the tasks and projects we needed completed. A special thank-you to all of you! We also want to thank Donna Ignatavicius who cre- ated the unfolding case studies for the Evolve site for this book. She has been passionate about creating teach- ing and learning strategies that promote thinking and clinical judgment in nursing students. Her case studies present real-world situations that nursing graduates are likely to encounter in the clinical settings. Thank you Donna! We sincerely acknowledge and thank some very important and special people from Elsevier. We thank Heather Bays-Petrovic, Content Strategist, for her con- tinuous support, enthusiasm, and expert professional guidance throughout the preparation of this edition. Heather, thank you so much—you are awesome! We also thank Laurie Gower, Director of Development, for 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- dous amount of support and assistance, for prioritizing for us to keep us on track, for her ideas for the product, and for her professional and expert skills in organizing and maintaining an enormous amount of manuscript for production. And we thank Senior Content Develop- ment Specialist Rebecca Leenhouts for her expertise in assisting us to complete this book. Thank you, Becky! We could not have completed this project without Laura or Becky! We want to acknowledge all of the staff at Elsevier for their tremendous help throughout the preparation and production of this publication. A special thanks to all of them. We want to thank and acknowledge Tamara Myers, Director, Traditional Nursing Program, for reviewing our Population Health Nursing chap- ter. Thank you Tamara! We thank Julie Eddy, Publish- ing Services Manager, and Margaret Reid, Senior Book Designer. You have all played such signicant roles in nalizing this publication. And we need to especially acknowledge Cindy Thoms, Senior Project Manager, who so expertly managed all of our copyedited manu- script and pages for review for this book. Cindy, you were so organized, supportive, and so awesome to work with. Your attention to the many details to ensure and maintain the quality of this book was so greatly appreci- ated. We thank you so much! Lastly, a very special thank-you to all our nursing students: past, present, and future. All of you light up our lives! Your love and dedication to the profession of nursing and your commitment to provide expert and quality health care will bring never-ending rewards!
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Preparation UNIT I NCLEX-RN ® Exam Preparation
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Preparation The Pyramid to Success Saunders Comprehensive Review for the NCLEX-RN ® Examination About This Resource and the NCLEX-RN ® Examination Welcome to the Pyramid to Success and Saunders Com- prehensive Review for the NCLEX-RN® Examination. This resource is specially designed to help you begin your successful journey to the peak of the pyramid, becoming a registered nurse. As you begin your journey, you will be introduced to all of the important points regarding the NCLEX-RN examination and the process of testing, and to unique and special tips regarding how to prepare yourself for this important examination, both academi- cally and nonacademically. You will read what a nursing graduate who recently passed the NCLEX-RN exami- nation has to say about the test. Important test-taking strategies are detailed. These details will guide you in selecting the correct option or assist you in making an educated guess if you are not entirely sure about the cor- rect answer; they will also guide you in ways to answer the NGN test items. Each unit in this book begins with the Pyramid to Success. The Pyramid to Success addresses specic points related to the NCLEX-RN examination. Client Needs and activities as identied in the test plan framework for the examination are listed, as are learn- ing outcomes and competencies for the unit. Cognitive Skills identied in the National Council of State Boards of Nursing (NCSBN) Clinical Judgment Measurement Model (NCJMM) are a focus in chapters and practice questions. Pyramid Terms are key words that are dened in the glossary on the accompanying Evolve site and set in a green color throughout each chapter to direct your attention to signicant points for the examination. This resource provides you with nursing content review, including the content identied in the current NCLEX test plan, and practice questions of all types, each chapter, you will nd Pyramid Point bullets NCLEX-RN examination and Pyramid Alert bullets in red text throughout the chapter that alert you to important information about nursing concepts. Each chapter includes Clinical Judgment: Cognitive Skill client scenarios that focus on one of the cognitive skills. The book contains 854 NCLEX-style questions. The Evolve site accompanying this book contains all of the questions from the book plus additional Evolve ques- tions for a total of more than 6,000 practice questions. The types of practice questions include multiple choice; ll-in-the-blank; multiple-response (select all that apply); ordered-response; questions that contain a g- ure, chart/exhibit, or a graphic option item; and audio item formats. Examples of some question types can be located throughout this chapter. In addition, the NGN item types are provided on the accompanying Evolve site. As you read each chapter, identify your strengths and areas that are in need of further review. Test your strengths and abilities by answering all practice questions provided in this book and on the accompanying Evolve site. Be sure to read all rationales and test-taking strategies. The rationale provides you with signicant information regarding the correct and incorrect options. The test-taking strategy provides you with the logical path to selecting the correct option. A reference source and page number are provided so that you can easily nd information you need to review in another Elsevier text. Each practice question on the accompanying Evolve site is coded on the basis of the Clinical Judgment and the Next Generation NCLEX (NGN)-RN ® Examination Linda A. Silvestri, PhD, RN, FAAN Angela E. Silvestri, PhD, APRN, FNP-BC, CNE C H A P T E R 1
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Preparation CHAPTER 1 Clinical Judgment and the Next Generation NCLEX (NGN)-RN ® Examination 3 Level of Cognitive Ability, the Client Needs category, Clinical Judgment/Cognitive Skill, the Integrated Pro- cess, the Content Area, the Health Problem if applica- ble, and Priority Concepts. The Health Problem code is a unique and helpful feature that allows you to lter and select questions based on a disease process when you are practicing questions on Evolve. For example, if heart failure is your area of interest, you can select “Adult Health, Cardiovascular, Heart Failure” on the Evolve site, and all questions on this content will be gener- ated for practice. In addition, two Priority Concepts that relate to the content of the question are identied. This code is especially helpful for students whose curriculum is concept-based. Additionally, information about all of the special features of this resource and the question types is located in the preface of this book. Other Resources in the Saunders Pyramid to Success There are several other resources in the Saunders Pyra- mid to Success program. These include the following: The Saunders Q&A Review for the NCLEX-RN® Examina- tion, The HESI/Saunders Online Review for the NCLEX-RN® Examination, Saunders Clinical Judgment and Test-Taking 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 for the NCLEX-RN® Exam, and Saunders RNtertainment for the NCLEX-RN® Exam. The HESI ® Compass TM Course is also a resource for NCLEX preparation and provides you with an individual coach to guide you in your prep- aration. Ask your nursing instructors about institutional access to this course. The resources in the Saunders Pyramid to Success are described in the preface of this book and can be obtained online by visiting elsevierhealth.com or by calling 800-545-2522. Let’s begin our journey through the Pyramid to Success. Clinical Judgment and Next Generation NCLEX ® Items Clinical judgment is the observed outcome of critical thinking and decision-making (Dickison, Haerling, & Lasater, 2019). In recent years, heightened atten- tion has been paid to clinical judgment as a means of teaching, learning, and assessment and testing. The Next Generation NCLEX-RN ® examination requires candidates to demonstrate a higher level of ability in applying clinical judgment in the delivery of client care. Clinical judgment can also be used as a test-taking strat- egy to answer test questions (refer to Chapter 4). The National Council of State Boards of Nursing (NCSBN) has created a Clinical Judgment Measurement Model (NCJMM) that consists of applying six cognitive skills or processes. These include: (1) recognizing cues; (2) analyzing cues; (3) prioritizing hypotheses; (4) gener- ating solutions; (5) taking action; and (6) evaluating outcomes (Dickison et al., 2019). Table 1.1 provides a description of these six cognitive skills/processes identi- ed in the NCJMM. The NCJMM also serves as a guide for the NCSBN to create NGN ® questions. The NCJMM continues to evolve as may the NGN ® item types that will be presented in the exam. All of the current NCLEX item types known as stand-alone items, the new clinical judgment stand-alone items (bow-tie and trend), and unfolding case studies that include six NGN items will be presented in the NGN. Some of these new NGN ® 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 NCSBN conducts ongoing research on the NGN test design and NGN items. The information in this chapter reects what is currently published by the NCSBN. The NGN will be implemented in April 2023 and because some additional changes in item types may occur, we encourage you to frequently access the NCSBN website at www.ncsbn.org for updates about the NGN design, items, and test plan updates. Examination Process An important step in the Pyramid to Success is to become as familiar as possible with the examination process. Candidates facing the challenge of this exami- nation can experience signicant anxiety. Knowing what the examination is all about and knowing what you will TABLE 1.1 Cognitive Skills/Processes and Descriptions Cognitive Skill/Process Description Recognize cues Identifying signicant data; data can be from many sources (assessment) Analyze cues Connecting data to the client's clinical presentation—determining if the data is expected? Unexpected? (analysis) Prioritize hypotheses Ranking hypotheses; what are the concerns or client needs/problems and their priority? (analysis) Generate solutions Using hypotheses or client needs to determine interventions for an expected outcome (planning) Take action Implementing the generated solutions addressing the highest priorities or hypotheses (implementation) Evaluate outcomes Comparing observed outcomes with expected ones (evaluation) From Dickison, P., Haerling, K.A., & Lasater, K. (2019). Integrating the National Council of State Boards of Nursing Clinical Judgment Model into Nursing Educational Frameworks. Journal of Nursing Education, 58 (2), 72–78.
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Preparation UNIT I NCLEX-RN ® Exam Preparation 4 encounter during the process of testing will assist in alleviating fear and anxiety. The information contained in this chapter was obtained from the NCSBN website (www.ncsbn.org) and from the current NCSBN test plan for the NCLEX-RN and includes some procedures related to registering for the exam, testing procedures, and the answers to the questions most commonly asked by nursing students and graduates preparing to take the NCLEX. You can obtain additional information regard- ing the test and its development by accessing the NCSBN website and clicking on the NCLEX Examination tab or by writing to the National Council of State Boards of Nursing, 111 East Wacker Drive, Suite 2900, Chicago, IL 60601. You are encouraged to access the NCSBN web- site, because this site provides you with the most up- to-date and valuable information about the NCLEX and other resources available to an NCLEX candidate. You are also encouraged to access the most up-to-date Can- didate Bulletin. This document provides you with every- thing you need to know about registration procedures and scheduling a test date. Computer Adaptive Testing The acronym CAT stands for computer adaptive test. The exam is delivered as a variable length CAT, which allows for the exam to select stand-alone items and item sets (unfolding case studies) that are optimal for each test- taker. The stand-alone items are selected and balanced on the basis of the percentages of each of the test plan categories and subcategories. Each item is selected to target the candidate’s ability level. Once all test plan requirements are met, a stopping rule is triggered in which a reliable pass-or-fail decision is made. When taking a CAT, once an answer is recorded, all subsequent questions administered depend, to an extent, on the answer selected for that question. Skip- ping questions or returning to earlier questions is incompatible with the logical methodology of a CAT. The inability to skip questions or go back to change pre- vious answers will not be a disadvantage to you; you will not fall into that “trap” of changing a correct answer to an incorrect one with the CAT system. If you are faced with a question that contains unfa- miliar content, you may need to guess at the answer. There is no penalty for guessing, but you need to make an educated guess. With most of the questions, the answer will be right there in front of you. If you need to guess, use your nursing knowledge and clinical experi- ences and clinical judgment skills to their fullest extent and all of the test-taking strategies you have practiced in this review program. You do not need any computer experience to take this examination. A keyboard tutorial is provided on the NCSBN website, and you are encouraged to view the online tutorial when you are preparing for the NCLEX examination. The tutorial will instruct you on the use of the on-screen optional calculator, the use of the mouse, and how to record an answer. The tutorial also provides instructions on how to respond to the different ques- tion types on this examination. NCSBN also provides an online tutorial about the new item types that allows you to interact with these items as much as you need to before taking the exam. In addition, at the testing site, a test administrator is present to assist in explaining the use of the computer to ensure your full understanding of how to proceed. The new NGN item types will not be scored as either all correct or all incorrect. Instead, new scoring models will be applied for new NGN items that allow partial credit scoring for most items. For specic information on the scoring models, refer to the NCSBN website at www.ncsbn.org and the National Council of State Boards of Nursing’s Next Generation NCLEX News (2021) at https://www.ncsbn.org/NGN_Summer21_Eng.pdf. Development of the Test Plan The test plan for the NCLEX-RN examination is devel- oped by the NCSBN. The examination is a national examination; the NCSBN considers the legal scope of nursing practice as governed by state laws and regula- tions, including the nurse practice act, and uses these laws to dene the areas on the examination that will assess the competence of the test-taker for licensure. The NCSBN also conducts an important study every 3 years, known as a practice analysis study, to link the examination to nursing practice. The results of this study determine the framework for the test plan for the examination. The participants in this study include newly licensed registered nurses from all types of gen- eralist nursing education programs. Participants of this study provide valuable information about work settings. From a list of nursing care activities (activity statements) provided, the participants are asked about the applica- bility, frequency, and importance of performing these activities in relation to client safety. A panel of content experts at the NCSBN analyzes the results of the study and makes decisions regarding the test plan framework. The NCSBN also conducted extensive research and experimentation and sought out subject matter expert feedback from educators, researchers, and practicing clin- ical nurses about clinical experiences and health prob- lems commonly encountered by a new graduate nurse. Findings supported the need for developing a model for measuring clinical judgment in the test plan design. This led to the development of new NGN test items and con- tinuous research to test item reliability and validity.
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Preparation CHAPTER 1 Clinical Judgment and the Next Generation NCLEX (NGN)-RN ® Examination 5 Test Plan The questions are written to address Level of Cognitive Ability, Client Needs, and Integrated Processes, includ- ing Clinical Judgment and Cognitive Skills, as identied in the test plan developed by the NCSBN. The content of the NCLEX-RN examination reects the activities identied in the practice analysis study conducted by the NCSBN. Exam items are written based on the test plan framework and these activities rather than on content areas such as adult health, maternity, pediatrics, or mental health. Level of Cognitive Ability Levels of cognitive ability include remembering, under- standing, applying, analyzing, evaluating, and creating. The practice of nursing requires complex thought pro- cessing and critical thinking in decision making and in making clinical judgments. Therefore, you will not encounter any remembering or understanding questions on the NCLEX. Questions on this examination are writ- ten at the applying level or higher in terms of cognitive ability. Table 1.2 provides descriptions and examples of each level of cognitive ability. Box 1.1 presents an exam- ple of a question that requires you to apply data. Client Needs The NCSBN identies a test plan framework based on Client Needs, which includes four major categories. Some of these categories are divided further into sub- categories. The Client Needs categories are Safe and Effective Care Environment, Health Promotion and Maintenance, Psychosocial Integrity, and Physiological Integrity (Table 1.3). Safe and Effective Care Environment The Safe and Effective Care Environment category includes two subcategories: Management of Care, and Safety and Infection Control. According to the NCSBN, Management of Care addresses prioritizing care and providing and directing nursing care that will ensure a safe care delivery setting to protect cli- ents and health care personnel. The NCSBN indicates that Safety and Infection Control addresses content that will protect clients and health care personnel from health and environmental hazards within health care facilities and in community settings. Box 1.2 presents examples of questions that address these two subcategories. Health Promotion and Maintenance The Health Promotion and Maintenance category addresses the principles related to growth and devel- opment. According to the NCSBN, this Client Needs category also addresses content required to assist the individual to prevent health problems; to recognize alterations in health; and to develop health practices that promote and support optimal wellness. See Box 1.3 for an example of a question in this Client Needs category. Psychosocial Integrity The Psychosocial Integrity category addresses content required to promote and support the ability of the cli- ent to cope, adapt, and problem-solve during stressful events. The NCSBN also indicates that this Client Needs category addresses the emotional, mental, and social well-being of the client experiencing stressful events and care for the client with an acute or chronic mental ill- ness. See Box 1.4 for an example of a question in this Client Needs category. TABLE 1.2 Levels of Cognitive Ability: Level and Descriptions and Examples Level Description and Example Remembering Recalling, retrieving information from memoriza- tion, previous learning, or long-term memory. Example: A normal blood glucose level is 70-99 mg/dL (3.9-5.5 mmol/L). Understanding Determining the meaning of information. Example: A blood glucose level of 60 mg/dL (3.34 mmol/L) is lower than the normal reference range. Applying Carrying out an appropriate action based on information. Example: Administering 10–15 g of carbohydrate such as a ½ glass of fruit juice to treat mild hypo- glycemia. Analyzing Examining concepts or data and interpreting how the concepts or data connect or relate to one another. Example: The concept is mild hypoglycemia and the connecting data are the signs and symptoms of mild hypoglycemia, such as hunger, irritability, weakness, headache, blood glucose level lower than 60 mg/dL (3.34 mmol/L). Evaluating Making judgments, conclusions, or validations based on evidence. Example: Determining that treatment for mild hypoglycemia was eective if the blood glucose level returned to a normal level between 70-99 mg/dL (3.9-5.5 mmol/L) and signs and symptoms resolved. Creating Generating or producing a new outcome or plan of care by putting parts of information together. Example: Designing a safe and individualized plan of care with the interprofessional health care team for a client with diabetes mellitus that meets the client’s physiological, psychosocial, and health maintenance needs. Adapted from Understanding Bloom’s (and Anderson and Krathwohl’s) Taxonomy, 2015, ProEdit, Inc. http://www.proedit.com/understanding- blooms-and-anderson-and-krathwohls-taxonomy/
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Preparation UNIT I NCLEX-RN ® Exam Preparation 6 Physiological Integrity The Physiological Integrity category includes four sub- categories: Basic Care and Comfort, Pharmacological and Parenteral Therapies, Reduction of Risk Potential, and Physiological Adaptation. The NCSBN describes 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- ing. Pharmacological and Parenteral Therapies addresses content for administering medications and parenteral therapies, such as intravenous therapies and parenteral nutrition, and administering blood and blood prod- ucts. Reduction of Risk Potential addresses content for The nurse notes blanching, coolness, and edema at the peripheral intravenous (IV) site. On the basis of these nd- ings, the nurse would implement which action rst ? 1. Remove the IV. 2. Apply a warm compress. 3. Check for a blood return. 4. Measure the area of inltration. Answer: 1 This question requires that you focus on the data in the ques- tion and analyze that data to determine that the client is expe- riencing an inltration. Note the strategic word, rst. Next, you need to consider the harmful effects of inltration and deter- mine the action to implement rst. Because inltration can be damaging to the surrounding tissue, the appropriate rst action is to remove the IV to prevent further damage. Once the IV is removed, further action would be taken, depend- ing on the medication infusing at the time of inltration and based on agency protocol. Further action may include aspira- tion of the uid from the site, injection of an antidote, applica- tion of warm or cool compresses for specied time intervals, or elevation of the extremity. BOX 1.1 Level of Cognitive Ability: Applying TABLE 1.3 The Client Needs Categories and Subcategories and Percentage of Questions on the NCLEX-RN Examination Client Needs Category and Subcategory Percentage of Questions Safe and Eective Care Environment Management of Care 17-23 Safety and Infection Control 9-15 Health Promotion and Maintenance 6-12 Psychosocial Integrity 6-12 Physiological Integrity Basic Care and Comfort 6-12 Pharmacological and Parenteral Therapies 12-18 Reduction of Risk Potential 9-15 Physiological Adaptation 11-17 From National Council of State Boards of Nursing: 2019 NCLEX-RN ® examination: Test plan for the National Council Licensure Examination for Registered Nurses . Chicago, 2018, National Council of State Boards of Nursing. Management of Care The nurse has received the client assignment for the day. Which client would the nurse assess first ? 1. The client who has a nasogastric tube attached to inter- mittent suction 2. The client who needs to receive subcutaneous insulin before breakfast 3. The client who is 2 days postoperative and is complain- ing of incisional pain 4. The client who has a blood glucose level of 50 mg/dL (2.8 mmol/L) and complains of blurred vision Answer: 4 This question addresses the subcategory Management of Care in the Client Needs category Safe and Effective Care Environment. Note the strategic word, rst, so you need to establish priorities by comparing the needs of each client and deciding which need is urgent. The client described in the correct option has a low blood glucose level and symptoms reective of hypoglycemia. This client should be assessed rst 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. Safety and Infection Control The nurse prepares to care for a client on contact precau- tions who has a hospital-acquired infection caused by methicillin-resistant Staphylococcus aureus (MRSA). The client has an abdominal wound that requires irrigation and has a tracheostomy attached to a mechanical ventila- tor, which requires frequent suctioning. The nurse would assemble which necessary protective items before entering the client’s room? 1. Gloves and gown 2. Gloves and face shield 3. Gloves, gown, and face shield 4. Gloves, gown, and shoe protectors Answer: 3 This question addresses the subcategory Safety and Infec- tion Control in the Client Needs category Safe and Effective Care Environment. It addresses content related to protecting oneself from contracting an infection and requires that you consider the methods of possible transmission of infection, based on the client’s condition. Note the data in the ques- tion. Because of the potential for splashes of infective mate- rial occurring during the wound irrigation or suctioning of the tracheostomy, option 3 is correct. BOX 1.2 Safe and Effective Care Environment
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Preparation CHAPTER 1 Clinical Judgment and the Next Generation NCLEX (NGN)-RN ® Examination 7 preventing complications or health problems related to the client’s condition or any prescribed treatments or procedures. Physiological Adaptation addresses content for managing and providing care to clients with acute, chronic, or life-threatening conditions. See Box 1.5 for examples of questions in this Client Needs category. Integrated Processes The NCSBN identies ve processes in the test plan that are fundamental to the practice of nursing. These pro- cesses are incorporated throughout the major categories of Client Needs. The Integrated Process subcategories are Caring, Communication and Documentation, Nursing Process (Assessment, Analysis, Planning, Implementa- tion, and Evaluation), Culture and Spirituality, and Teach- ing and Learning. See Box 1.6 for an example of a question that incorporates the Integrated Process of Caring. Types of Questions on the Examination and Scoring The types of questions on the current NCLEX include multiple-choice; ll-in-the-blank; multiple-response; ordered-response (prioritizing); image (hot spot) ques- tions; gure, chart/exhibit, or graphic option items; and audio formats. These question types will continue to be a part of the NCLEX examination, and each of these question types will be scored as either correct or incor- rect, known as dichotomous scoring. Currently, no partial credit is given. Thus, the possible points for these ques- tion types will be 0 or 1 point. Examples of these ques- tion types follow. The NGN question types will also be on the exam, starting in April 2023, and will use a case study approach as stand-alone items and unfolding case studies. The stand-alone items will be accompanied by a question that tests more than one cognitive skill. Each unfolding case study will be accompanied by six NGN item type ques- tions, and each cognitive skill will be tested. Every can- didate will be administered three unfolding case studies, each with six accompanying items. These three unfold- ing case studies will be administered within the rst 85 questions on the exam (minimum length exam). After the minimum-length exam, if a stopping rule is not trig- gered, then the exam will continue and stand-alone items (bow-tie and trend) will be administered as part of the exam. Examples of both stand-alone items and unfold- ing case studies and NGN items can be located on the Evolve site accompanying this book. These are specially designed to simulate the NCLEX experience of testing for these NGN item types. Both NGN stand-alone items (cur- rently known as bow-tie and trend) and unfolding cases with accompanying NGN items are included. Refer to the Evolve site for practice with these question types. Addi- tionally, the unique test-taking strategies used to answer NGN items are illustrated with each bow-tie and trend item and with items accompanying the unfolding case studies. Chapter 4, Box 4.5 provides an example of one type of NGN question and its unique test-taking strategy. In addition to the stand-alone items (bow-tie and trend), according to the NCSBN, other NGN item types will be used. Table 1.4 provides a list of the NGN ques- tion types. The NCSBN also identies three scoring methods for NGN items. These scoring methods are described in Table 1.5 The NCSBN provides specic directions for you to follow with all question types on the NCLEX to guide you through the testing process. Be sure to read these directions as they appear on the computer screen. The nurse is choosing age-appropriate toys for a toddler. Which toy is the best choice for this age? 1. Puzzle 2. Toy soldiers 3. Large stacking blocks 4. A card game with large pictures Answer: 3 This question addresses the Client Needs category Health Promotion and Maintenance and specically relates to the principles of growth and development of a toddler. Note the strategic word, best. Toddlers like to master activities inde- pendently, such as stacking blocks. Because toddlers do not have the developmental ability to determine what could be harmful, toys that are safe need to be provided. A puzzle and toy soldiers provide objects that can be placed in the mouth and may be harmful for a toddler. A card game with large pic- tures may require cooperative play, which is more appropriate for a school-age child. BOX 1.3 Health Promotion and Maintenance A client with end-stage chronic obstructive pulmonary disease has selected guided imagery to help cope with psychological stress. Which client statement indicates the best understand- ing of this stress-reduction measure? 1. “This will help only if I play music at the same time.” 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.” 4. “The best thing about this is that I can use it anywhere, anytime.” Answer: 4 This question addresses the Client Needs category Psychoso- cial Integrity, and the content addresses coping mechanisms. Note the strategic word, best. Focus on the subject, a charac- teristic of guided imagery. Guided imagery involves the client creating an image in the mind, concentrating on the image, and gradually becoming less aware of the offending stimulus. It can be done anytime and anywhere; some clients may use other relaxation techniques or play music with it. BOX 1.4 Psychosocial Integrity
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Preparation UNIT I NCLEX-RN ® Exam Preparation 8 Examples of some of these types of questions are noted in this chapter and in this book, and all types, including the NGN items, are on the accompanying Evolve site. Multiple-Choice Questions Some of the questions that you will be asked to answer will be in the multiple-choice format. These questions provide you with data about a client situ- ation and four answers, or options. Only one answer is correct. Fill-in-the-Blank Questions Fill-in-the-blank questions will ask you to perform a medication calculation, determine an intravenous ow rate, or calculate an intake or output record on a client. You will need to type only a number (your answer) in the answer box. If the question requires rounding the answer, this needs to be performed at the end of the cal- culation. The rules for rounding an answer are described in the tutorial provided by the NCSBN and are also pro- vided in the specic question on the computer screen. Basic Care and Comfort A client with Parkinson’s disease develops akinesia while ambu- lating, increasing the risk for falls. Which suggestion would the nurse provide to the client to alleviate this problem? 1. Use a wheelchair to move around. 2. Stand erect and use a cane to ambulate. 3. Keep the feet close together while ambulating and use a walker. 4. Consciously think about walking over imaginary lines on the oor. Answer: 4 This question addresses the subcategory Basic Care and Com- fort in the Client Needs category Physiological Integrity and addresses client mobility and promoting assistance in an activ- ity of daily living to maintain safety. Focus on the subject, akine- sia. Clients with Parkinson’s disease can develop bradykinesia (slow movement) or akinesia (freezing or no movement). Hav- ing these clients imagine lines on the oor to walk over can keep them moving forward while remaining safe. Pharmacological and Parenteral Therapies The nurse monitors a client receiving digoxin for which early manifestation of digoxin toxicity? 1. Anorexia 2. Facial pain 3. Photophobia 4. Yellow color perception Answer: 1 This question addresses the subcategory Pharmacological and Parenteral Therapies in the Client Needs category Physiologi- cal Integrity. Note the strategic word , early. Digoxin is a cardiac glycoside that is used to manage and treat heart failure in some clients and to control ventricular rates in some clients with atrial brillation. The most common early manifestations of toxicity include gastrointestinal disturbances such as anorexia, nau- sea, and vomiting. Neurological abnormalities can also occur early and include fatigue, headache, weakness, depression, drowsiness, confusion, and nightmares. Facial pain, personal- ity changes, and ocular disturbances (photophobia, diplopia, light ashes, halos around bright objects, yellow or green color perception) are also signs of toxicity, but are not early signs. Reduction of Risk Potential A magnetic resonance imaging (MRI) study is prescribed for a client with a suspected brain tumor. The nurse would imple- ment which action to prepare the client for this test? 1. Shave the groin for insertion of a femoral catheter. 2. Remove all metal-containing objects from the client. 3. Keep the client NPO (nothing by mouth) for 6 hours be- fore the test. 4. Instruct the client in inhalation techniques for the admin- istration of a radioisotope. Answer: 2 This question addresses the subcategory Reduction of Risk Potential in the Client Needs category Physiological Integrity, and the nurse’s responsibilities in preparing the client for the diagnostic test to prevent risks associated with the test. Focus on the subject, preparing a client for an MRI. In an MRI study, radiofrequency pulses in a magnetic eld are converted into pictures. All metal objects, such as rings, bracelets, hairpins, and watches, should be removed. In addition, a history should be taken to ascertain whether the client has any internal metal- lic devices, such as orthopedic hardware, pacemakers, or shrapnel. An intravenous (IV) catheter may be inserted if a con- trast agent is prescribed. A femoral catheter is not used for this diagnostic test. Additionally, shaving is not a common practice because of the risk for microabrasions and infection. If needed, hair may be clipped away from an insertion site. NPO status is not necessary for an MRI study of the head. Inhalation of a radioisotope may be prescribed with other types of scans, but it is not a part of the procedures for an MRI. Physiological Adaptation A client with renal insufciency has a magnesium level of 3.5 mEq/L (1.44 mmol/L). On the basis of this laboratory result, the nurse interprets which sign as signicant? 1. Hyperpnea 2. Drowsiness 3. Hypertension 4. Physical hyperactivity Answer: 2 This question addresses the subcategory Physiological Adap- tation in the Client Needs category Physiological Integrity. It addresses an alteration in body systems. Focus on the data in the question. The normal magnesium level is 1.8 to 2.6 mEq/L (0.74 to 1.07 mmol/L). A magnesium level of 3.5 mEq/L (1.44 mmol/L) indicates hypermagnesemia. Neurological manifesta- tions begin to occur when magnesium levels are elevated and are noted as symptoms of neurological depression, such as drowsiness, sedation, lethargy, respiratory depression, muscle weakness, and areexia. Bradycardia and hypotension also occur. BOX 1.5 Physiological Integrity
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Preparation CHAPTER 1 Clinical Judgment and the Next Generation NCLEX (NGN)-RN ® Examination 9 A client is scheduled for angioplasty. The client says to the nurse, “I’m so afraid that it will hurt and will make me worse off than I am.” Which response by the nurse is therapeutic? 1. “Can you tell me what you understand about the proce- dure?” 2. “Your fears are a sign that you really should have this procedure.” 3. “Those are very normal fears, but please be assured that everything will be okay.” 4. “Try not to worry. This is a well-known and easy proce- dure for the cardiologist.” Answer: 1 This question addresses the subcategory Caring in the cat- egory of Integrated Processes. It also addresses the concept of communication. The correct option utilizes a therapeutic communication technique that explores the client’s feelings, determines the level of client understanding about the proce- dure, and displays caring. Option 2 demeans the client and does not encourage further sharing by the client. Option 3 does not address the client’s fears, provides false reassur- ance, and puts the client’s feelings on hold. Option 4 dimin- ishes the client’s feelings by directing attention away from the client and toward the cardiologist’s importance. BOX 1.6 Integrated Processes TABLE 1.4 NGN Item Types Type of Item/Case Scenario Description Item Types Stand-alone Item A stand-alone item will include a short scenario about a client and will be accompa- nied by one question that tests more than one cognitive skill. Bow-tie Trend Unfolding Case An unfolding case study will include phases as the story about the client un- folds and changes. This will be accom- panied by six NGN item type questions, and each of the six cognitive skills will be tested. Highlight in Text Highlight in Table Matrix Multiple Choice Matrix Multiple Response Multiple Response Select N Multiple Response Select All That Apply Multiple Response Group- ing Drag and Drop Cloze Drag and Drop Rationale Drop Down Cloze Drop Down Rationale Drop Down in Table From Betts, J., Muntean, W., Kim, D, Kao, S. (Winter 2022). Next Genera- tion NCLEX ® : Test design . Chicago, NCSBN; National Council of State Boards of Nursing. (2022). Next Generation NCLEX News . Retrieved from NGN_Winter22_English_Final.pdf (ncsbn.org). TABLE 1.5 NGN Scoring Methods Method Description Plus-Minus (+/-) Scoring One point is given for each correct response. One point is subtracted for each incorrect re- sponse. No negative scores; if the sum is negative, a zero is assigned. Used when the test-taker can select any number of options, such as a highlight in text, highlight in table, multiple response (select all that apply), multiple response grouping, or a matrix multiple response Zero-One- (0/1) Scoring One point is given for each correct response. Zero points given for incorrect responses. Points are NOT subtracted for incorrect responses. Used for items such as drag and drop cloze, drop down cloze, drop down-in-table, matrix multiple choice, multiple response select N or bow-tie Rationale Scoring One point is given for each correct grouping of re- sponse elements; both parts of the paired informa- tion must be correct to earn a point. Used when elements of a response are linked, such as drop down rationale or drag and drop rationale items From National Council of State Boards of Nursing. (2021). Next Genera- tion NCLEX News . Retrieved from https://www.ncsbn.org/NGN_Sum mer21_Eng.pdf; National Council of State Boards of Nursing. (2021). Braving new pathways: Leading the way for regulatory transformation , 2021 NCSBN annual meeting. A prescription reads: acetaminophen liquid, 650 mg orally every 4 hours PRN for pain. The medication label reads: 500 mg/15 mL. The nurse prepares how many milliliters to admin- ister one dose? Fill in the blank. Record your answer using one decimal place. Answer: 19.5 mL Formula: Desired Available × Volume = mL 650 500 15 = 19.5 mg mg mL mL × In this question, you need to focus on the subject, mL per dose, and use the formula for calculating a medication dose. When the dose is determined, you will need to type your numeric answer in the answer box. Always follow the specic directions noted on the computer screen. Also, remember that there will be an on-screen calculator on the computer for your use. BOX 1.7 Fill-in-the-Blank Question In addition, you must type in a decimal point if neces- sary. See Box 1.7 for an example. Multiple-Response Question For a multiple-response question, also known as a “select all that apply (SATA)” question, you will be asked
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Preparation UNIT I NCLEX-RN ® Exam Preparation to select or check all of the options, such as nursing interventions, that relate to the information in the ques- tion. In these question types, there may be one correct answer, there may be more than one correct answer, or all answers could be correct. See Box 1.8 for an example. Ordered-Response Question In this type of question, you will be asked to place nurs- ing actions in order of priority. Information will be pre- sented in a question and, based on the data, you need to determine what you will do rst, second, third, and so forth. Specic directions for answering are provided with the question. See Figure 1.1 for an example. Figure or Hot Spot Question A question with a picture or graphic will ask you to answer the question based on the picture or graphic. The question could contain a chart, a table, or a gure or illustration. You also may be asked to use the computer mouse to point and click on a specic area (hot spot) in the visual. A chart, table, gure, or illustration may appear in any type of question, including a multiple- choice question. See Box 1.10 for an example. Chart/Exhibit Question In this type of question, you will be presented with a client situation and a chart, medical record, or exhibit. You will be provided with tabs or buttons that you need to click to obtain the information needed to answer the question. A prompt or message will appear that will indi- cate the need to click on a tab or button. See Box 1.9 for an example. Graphic Item Option Question In this type of question, the option selections will be pictures rather than text. You will select the option that represents your answer choice. See Box 1.11 for an example. Audio Questions Audio questions will require listening to a sound to answer the question. These questions will prompt you to use the headset provided and to click on the sound icon. You will be able to click on the volume button to adjust the volume to your comfort level, and you will be able to listen to the sound as many times as necessary. Con- tent examples include, but are not limited to, various lung sounds, heart sounds, or bowel sounds. Examples of this question type are located on the accompanying Evolve site See Figure 1.2 for an example.. The NCSBN provides a practice test for candidates that is composed of previously used NCLEX questions that are no longer a part of the NCLEX. This exam simu- lates the look of the real exam and provides the candi- date with practice for the NCLEX. This practice test can be purchased through the NCSBN at www.ncsbn.org Registering to Take the Examination It is important to obtain an NCLEX Examination Candidate Bulletin from the NCSBN website at www.ncsbn.org, because this bulletin provides all of the information you need to register for and schedule your examination. It also provides you with website and tele- phone information for NCLEX examination contacts. The initial step in the registration process is to submit an application to the state board of nursing in the state in which you intend to obtain licensure. You need to obtain information from the board of nursing regarding The emergency department nurse is caring for a child suspected of acute epiglottitis. Which interventions apply in the care of the child? Select all that apply. 1. Obtain a throat culture. 2. Auscultate lung sounds. 3. Maintain the child in a supine position. 4. Obtain a pediatric-size tracheostomy tray. 5. Place the child on an oxygen saturation monitor. 6. Prepare the child for a lateral neck and chest x-ray. In a multiple-response question, you will be asked to select or check all of the options, such as interventions, that relate to the information in the question. Focus on the subject, interventions for the child with suspected acute epiglottitis. To answer this question, recall that acute epiglottitis is a serious obstructive inammatory process that requires immediate intervention and that airway patency is a priority. Auscultating lung sounds allows the nurse to obtain information about airway patency without causing further airway compromise, which can happen by examining the throat. Examination of the throat with a tongue depressor or attempting to obtain a throat culture is contraindicated because the examination can precipitate further obstruction. A lateral neck and chest x-ray is obtained to determine the degree of obstruction, if present. To reduce respiratory distress, the child should sit upright. The child is placed on an oxygen saturation monitor to monitor oxygenation status. Tracheostomy and intubation may be necessary if respiratory distress is severe. Remember to follow the specic directions given on the computer screen. BOX 1.8 Multiple-Response Question
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Preparation CHAPTER 1 Clinical Judgment and the Next Generation NCLEX (NGN)-RN ® Examination 11 FIG. 1.1 Example of an ordered-response question. the specic registration process, because the process may vary from state to state. Then, use the NCLEX Examina- tion Candidate Bulletin as your guide to complete the registration process. Following the registration instructions and com- pleting the registration forms precisely and accurately are important. Registration forms not properly com- pleted or not accompanied by the proper fees in the required method of payment will be returned to you and will delay testing. You must pay a fee for taking the examination; you also may have to pay additional fees to the board of nursing in the state in which you are applying. Authorization to Test Form and Scheduling an Appointment Once you are eligible to test, you will receive an Authori- zation to Test (ATT) form. You cannot make an appoint- ment until you receive an ATT form. Note the validity dates on the ATT form, and schedule a testing date and time before the expiration date on the ATT form. The NCLEX Examination Candidate Bulletin provides you with the directions for scheduling an appointment; you do not have to take the examination in the same state in which you are seeking licensure. The ATT form contains important information, including your test authorization number, candidate identication number, and validity date. You need to take your ATT form to the testing center on the day of your examination. You will not be admitted to the examination if you do not have it. Changing Your Appointment If for any reason you need to change your appointment to test, you can make the change on the candidate web- site or by calling candidate services. Refer to the NCLEX Examination Candidate Bulletin for this contact infor- mation and other important procedures for canceling and changing an appointment. If you fail to arrive for the examination or fail to cancel your appointment to test without providing appropriate notice, you will forfeit your examination fee and your ATT form will be invalidated. This information will be reported to the board of nursing in the state in which you have applied for licensure, and you will be required to register and pay the testing fees again.
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Preparation UNIT I NCLEX-RN ® Exam Preparation 12 BOX 1.9 Chart/Exhibit Question A 30-year-old client visits the clinic and requests a prescription for oral contraceptives. The nurse performs an assessment on the client and reviews the history and physical examination documented in the medical record from the client’s previous visit. The nurse determines that oral contraceptives are contra- indicated because of which documented items? Refer to chart. Select all that apply. Client’s Chart History and Physical Medications Diagnostic Results Past medical his- tory: Deep vein throm- bosis with asso- ciated thrombo- phlebitis Hypertension Coronary artery disease Prediabetes Multivitamin 1 orally daily Lisinopril 40 mg orally daily Atorvastatin 10 mg orally daily Metformin 500 mg orally twice daily Renal ultrasound shows no hydrone- phrosis, no renal artery stenosis Complete blood cell count shows white blood cells (WBC) 5,000 mm 3 (5 × 9 /L), hemoglobin (Hgb) 16 g/dL (60 g/L), hematocrit (Hct) 47% (0.47), platelets 590,000 mm 3 (590 × 10 9 /L) 1. Hypertension 2. Prediabetes 3. Coronary artery disease 4. Renal ultrasound results 5. Takes multivitamin orally daily 6. Takes lisinopril 40 mg orally daily 7. Takes atorvastatin 10 mg orally daily 8. Complete blood cell count results 9. Takes metformin 500 mg orally twice daily 10. Past medical history of deep vein thrombosis with associated thrombophlebitis Answer: 1, 3, 8, 10 This chart/exhibit question provides you with data from the client’s medical record. Focus on the subject, the item(s) that are a contraindication to the use of oral contraceptives. Oral contraceptives are contraindicated in women with a history of any of the following: thrombophlebitis and thromboembolic disorders, cardiovascular or cerebrovascular diseases (includ- ing stroke), any estrogen-dependent cancer or breast cancer, benign or malignant liver tumors, impaired liver function, hyper- tension, and diabetes mellitus with vascular involvement. This client has prediabetes, which is not a contraindication. Items 1 and 3 are cardiovascular diseases. The client has hypertension, coronary artery disease, and deep vein thrombosis with associ- ated thrombophlebitis, all contraindications to the use of oral contraceptives. The renal ultrasound result is not signicant. The medications the client is taking are not specic contraindi- cations to oral contraceptives. The normal WBC is 5000-10,000 mm 3 (5-10 × 9 /L). The normal Hgb ranges from 12-18 g/dL (120-180 g/L). The normal Hct ranges from 37-52% (0.37-0.52). The normal platelet count is 150,000-400,000 mm 3 (150-400 × 9 /L). Item 8 has components that indicate a contraindication; of note is that the platelet count is elevated and thus this cli- ent has polycythemia, which is a thromboembolic disorder and therefore a contraindication for the use of oral contraceptives. Option 10 notes that the client has a history of deep vein throm- bosis with associated thrombophlebitis, a contraindication to the use of oral contraceptives. BOX 1.10 Figure Question A client who experienced a myocardial infarction is being monitored via cardiac telemetry. The nurse notes the sudden onset of this cardiac rhythm on the monitor (refer to figure) and immediately takes which action? 1. Takes the client’s blood pressure 2. Initiates cardiopulmonary resuscitation (CPR) 3. Places a nitroglycerin tablet under the client’s tongue 4. Continues to monitor the client and then contacts the cardiologist Answer: 2 This question requires you to identify the cardiac rhythm and then determine the priority nursing action. Note the strategic word , immediately. This cardiac rhythm identies a coarse ven- tricular brillation (VF). The goals of treatment are to termi- nate VF promptly and to convert it to an organized rhythm. The physician, cardiologist, or an Advanced Cardiac Life Support (ACLS)–qualied nurse must immediately debrillate the client. If a debrillator is not readily available, CPR is initiated until the debrillator arrives. Options 1, 3, and 4 are incorrect actions and delay lifesaving treatment.
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