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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Document preview page 1

Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 1

Document preview content for Saunders Comprehensive Review for the NCLEX-RN® Examination (2022)

Saunders Comprehensive Review for the NCLEX-RN® Examination (2022)

Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) simplifies exam prep with well-structured content and practice questions.

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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 1 preview imageCOMPREHENSIVE REVIEWfor theEXAM INATIONEDITION
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 2 preview image
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 3 preview imageYOU’VE JUST PURCHASEDMORE THANA TEXTBOOK!REGISTER TODAY!PlaceStickerHereYou can now purchase Elsevier products on Evolve!Go to evolve.elsevier.com/shop to search and browse for products.2019v1.0Enhance your learning with Evolve Student Resources.These online study tools and exercises can help deepen yourunderstanding of textbook content so you can be moreprepared for class, perform better on exams, and succeedin your course.Activate the complete learning experience that comes with eachhttp://evolve.elsevier.com/Silvestri/comprehensiveRN/If your school uses its own Learning Management System, your resources may bedelivered on that platform. Consult with your instructor.has already been revealed, the code may have been used and cannotbe re-used for registration. To purchase a new code to access thesevaluable study resources, simply follow the link above.
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 4 preview imageLinda Anne Silvestri,PhD, RN, FAANNursing InstructorUniversity of Nevada, Las VegasLas Vegas, NevadaPresident and OwnerNursing Reviews, Inc.Henderson, NevadaDirector and OwnerProfessional Nursing Seminars, Inc.Henderson, NevadaElsevierNext Generation NCLEX® (NGN) Consultant andSubject Matter ExpertAngela E. Silvestri,PhD, APRN, FNP-BC,CNEAssociate Professor and BSN Program DirectorUniversity of Nevada, Las VegasLas Vegas, NevadaPresidentClinical Judgment Test-Taking Strategy CreatorNurse Prep, LLCHenderson, NevadaElsevierNext Generation NCLEX® (NGN) Subject Matter ExpertAssociate EditorJessica Grimm,DNP, APRN, ACNP-BC,CNEAssociate Professor of NursingTouro University NevadaHenderson, NevadaAssistant Professor of Anesthesia andPerioperative MedicineOregon Health State UniversityPortland, OregonNCLEX-RN®examinationS A U N D E R SCOMPREHENSIVE REVIEWfor theE D I T I O N9
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 5 preview imageElsevier3251 Riverport LaneSt. Louis, Missouri 63043SAUNDERS COMPREHENSIVE REVIEW FOR THE NCLEX-RN® EXAMINATION,NINTH EDITIONISBN: 978-0-323-79530-2Copyright © 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 ormechanical, including photocopying, recording, or any information storage and retrieval system, withoutpermission in writing from the publisher. Details on how to seek permission, further information about thePublisher’s permissions policies and our arrangements with organizations such as the Copyright ClearanceCenter and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissionsThis book and the individual contributions contained in it are protected under copyright by the Publisher(other than as may be noted herein).NoticePractitioners and researchers must always rely on their own experience and knowledge in evaluatingand using any information, methods, compounds or experiments described herein. Because of rapidadvances in the medical sciences, in particular, independent verication of diagnoses and drug dosagesshould be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editorsor 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 ideascontained in the material herein.NCLEX®, NCLEX-RN®, and NCLEX-PN® are registered trademarks of the National Council of StateBoards of Nursing, Inc.Previous editions copyrighted 2020, 2017, 2014, 2012, and 2009.Content Strategist:Heather Bays-PetrovicSenior Content Development Specialists:Laura Goodrich and Rebecca LeenhoutsPublishing Services Manager:Julie EddySenior Project Manager:Cindy ThomsSenior Book Designer:Margaret ReidPrinted in CanadaLast digit is the print number:987654321
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 6 preview imageiiiUnit INCLEX-RN®Exam Preparation,11Clinical Judgment and the Next GenerationNCLEX (NGN)-RN® Examination,22Self-Efcacy and Pathways to Success,173The NCLEX-RN® Examination from a Graduate’sPerspective,224Clinical Judgment and Test-TakingStrategies,24Unit IIProfessional Standards in Nursing,385Population Health Nursing,406Ethical and Legal Issues,537Prioritizing Client Care: Leadership, Delegation,and Emergency Response Planning,68Unit IIIFoundations of Care,858Fluids and Electrolytes,889Acid-Base Balance,106Vital Signs and Laboratory ReferenceIntervals,11611Nutrition,13212Health and Physical Assessment of the AdultClient,14313Safety and Infection Control,16614Medication Administration and IntravenousTherapies,17815Perioperative Nursing Care,18916Hygiene, Mobility, and Skin Integrity,20417Urinary and Bowel Elimination,218Unit IVGrowth and Development Acrossthe Life Span,23418Theories of Growth and Development,23619Growth, Development, and Stages of Life,24420Care of the Older Client,266Unit VMaternity Nursing,27521Reproductive System,27722Prenatal Period,28523Risk Conditions Related to Pregnancy,30024Labor and Birth,32325Problems with Labor and Birth,33626Postpartum Period,34327Postpartum Complications,35028Care of the Newborn,35829Maternity and Newborn Medications,380Unit VIPediatric Nursing,39130Integumentary Problems,39231Hematological Problems,39932Oncological Problems,40633Metabolic and Endocrine Problems,41634Gastrointestinal Problems,42535Eye, Ear, and Throat Problems,44436Respiratory Problems,45137Cardiovascular Problems,46738Renal and Genitourinary Problems,47939Neurological and Cognitive Problems,48740Musculoskeletal Problems,49841Immune Problems and Infectious Diseases,50742Pediatric Medication Administration andCalculations,520Contents
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 7 preview imageContentsivUnit VIIIntegumentary Problems of the AdultClient,52743Integumentary Problems,52844Integumentary Medications,538Unit VIIIOncological and HematologicalProblems of the Adult Client,54745Oncological and Hematological Problems,54946Oncological and HematologicalMedications,587Unit IXEndocrine Problems of the Adult Client,59847Endocrine Problems,59948Endocrine Medications,626Unit XGastrointestinal Problems of the AdultClient,64149Gastrointestinal Problems,64350Gastrointestinal Medications,671Unit XIRespiratory Problems of the AdultClient,67951Respiratory Problems,68052Respiratory Medications,701Unit XIICardiovascular Problems of the AdultClient,71953Cardiovascular Problems,72054Cardiovascular Medications,760Unit XIIIRenal and Urinary Problems of the AdultClient,77855Renal and Urinary Problems,77956Renal and Urinary Medications,811Unit XIVEye and Ear Problems of the AdultClient,82157Eye and Ear Problems,82258Eye and Ear Medications,842Unit XVNeurological Problems of the AdultClient,85259Neurological Problems,85360Neurological Medications,877Unit XVIMusculoskeletal Problems of the AdultClient,88861Musculoskeletal Problems,88962Musculoskeletal Medications,910Unit XVIIImmune Problems of the AdultClient,91863Immune Problems,91964Immune Medications,933Unit XVIIIMental Health Problems of the AdultClient,94065Foundations of Psychiatric Mental HealthNursing,94166Mental Health Problems,95467Addictions,97568Crisis Theory and Intervention,98769Psychotherapeutic Medications,1001Unit XIXComplex Care,101570Complex Care,1017References,1088Index,1090
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 8 preview imageIn 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 SilvestriTo my parents,Mary ElizabethandLawrence Peter,who have instilled in me the values of working hard and being seless,and who have been my support system as I pursue my professional goalsand 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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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 9 preview imageviTo 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 aregistered 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 yourgoals.In our opinion, you are about to enter the most wonderful and rewardingprofession that exists. Your willingness, desire, and ability to assist those whoneed nursing care will bring great satisfaction to your life. In the professionof nursing, your learning will be a lifelong process. This aspect of the profes-sion makes it stimulating and dynamic. Your learning process will continue toexpand and grow as the profession continues to evolve. Your next very impor-tant endeavor will be the learning process involved to achieve success in yourexamination to become a registered nurse.We are excited and pleased to be able to provide you with theSaunders Pyramidto Successproducts, which will help you prepare for your next important pro-fessional goal, becoming a registered nurse. We want to thank all of our formerand current nursing students whom we have assisted in their studies for theNCLEX-RN® examination for their willingness to offer ideas regarding theirneeds in preparing for licensure. Student ideas have certainly added a specialuniqueness to all of the products available in theSaunders Pyramid to Success.Saunders Pyramid to Successproducts provide you with everything that youneed to ready yourself for the NCLEX-RN examination. These products includematerial that is required for the NCLEX-RN examination for all nursing stu-dents regardless of educational background, specic strengths, areas in need ofimprovement, or clinical experience during the nursing program.So let’s get started and begin our journey through theSaunders Pyramid toSuccess, and welcome to the wonderful profession of nursing!Sincerely,Dr. Linda Anne Silvestri and Dr. Angela Elizabeth Silvestri
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 10 preview imageviiLinda Anne Silvestri,PhD, RN, FAANLinda is a well-knownnurse educator, entre-preneur, and philanthro-pistwhoseprofessionalaspirationsfocusonassisting nursing studentsto become successful. Shehas been teaching at alllevels 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 fromUNLV and conducted research on self-efcacy and thepredictors of NCLEX® success. Her research ndings arepublished in theJournal of Nursing Education and Prac-tice.Dr. Silvestri has received several awards and honors.In 2019, she was inducted as a Fellow in the AmericanAcademy of Nursing. In 2012, she received the UNLVSchool of Nursing Alumna of the Year Award. And in2010, she received the School of Nursing’s Certicateof Recognition for Outstanding PhD Student. Linda isa member of several national nursing organizations,including the Honor Society of Nursing, Sigma ThetaTau International, the National League for Nursing, theAmerican Nurses Association, and the American Acad-emy of Nursing. Dr. Silvestri is a successful Elsevierauthor of numerous best-selling NCLEX® preparationresources on the national and international levels. Shealso serves as an Elsevier Subject Matter Expert for theNext Generation NCLEX® (NGN), and has presentednumerous webinars on NCLEX® preparation and suc-cess. Dr. Silvestri is the President and Owner of NursingReviews, Inc., and the Director and Owner of Profes-sional Nursing Seminars, Inc. Both companies are dedi-cated to helping nursing graduates achieve their goals ofbecoming licensed nurses.Angela E. Silvestri,PhD, APRN, FNP-BC,CNEAngelaSilvestriisawell-knownnurseeducator, researcher, andauthor.Shehasbeenteaching and working inuniversityadministrativeroles for the last 10 years atall levels of nursing education. She has experience teach-ing in both classroom and clinical settings and in workingwith graduate students on their culminating projects andresearch dissertations. She currently serves as the ProgramDirector 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 internationallevels. She also serves as an Elsevier Subject Matter Expertfor the Next Generation NCLEX® (NGN). Angela earneda bachelor’s in Nursing and in Sociology from SalveRegina University in Newport, Rhode Island; she earnedher master’s degree with a focus in nursing education andher PhD from the University of Nevada, Las Vegas. Shealso has a post-master’s graduate certicate in advancedpractice and is a board-certied Family Nurse Practitio-ner. She is a Scholar in Sigma Theta Tau’s New AcademicLeadership Academy. She works with faculty, staff, andstudents on managing primary and episodic health careneeds at UNLV’s Student Wellness Center and Faculty andStaff Treatment Center as a Family Nurse Practitioner. Dr.Silvestri is passionate about college students’ success. Sheis an expert in creating clinical judgment test-taking strat-egies for NGN items. This passion also comes throughin her work at UNLV, where she teaches leadership andlicensure exam preparation, and in the publication of herresearch and best-selling licensure exam review resources.About the Authors
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 11 preview imageviiiRossybel Aberle, RN, BSNGraduateUniversity of Nevada, Las VegasLas Vegas, NevadaSarah R. Jean Baptiste, MS, PA-CPhysician AssistantOregon Health Science UniversityPortland, OregonEsmeralda Araceli Clark, MSN, APRN, FNP-BCLecturerSchool of NursingUniversity of Nevada, Las VegasLas Vegas, NevadaEileen H. Gray, RN, DNP, CPNPNursing InstructorSchool of NursingUniversity of Nevada, Las VegasLas Vegas, NevadaJessica Grimm, DNP, APRN, ACNP-BC, CNEAssociate Professor of NursingTouro University NevadaHenderson, Nevada;Assistant Professor of Anesthesia and Perioperative MedicineOregon Health State UniversityPortland, OregonJames Guilbault, PharmD, BS, RPhPharmacy Manager and Clinical StaffPharmacistWalgreens Pharmacy, Mercy MedicalCenter, MCPHS UniversitySpringeld, MassachusettsDebra Hagler, PhD, RN, aCNS-BC, cNE, CHSE,ANEF, FAANClinical ProfessorEdson College of Nursing and Health InnovationArizona State UniversityPhoenix, ArizonaDiana Rabbani Hagler, MSN-Ed, RN, CCRNTeleHealth ICU RNBanner Health, Grand Canyon University,Maricopa Community CollegesAdjunct FacultyPhoenix, ArizonaDonna D. Ignatavicius, MS, RN, CNE, CNEcl, ANEF,FAADNSpeaker and Curriculum Consultant for Academic NursingProgramsFounderBoot Camp for Nurse Educators;PresidentDI Associates, Inc. Littleton, Colorado;Next Generation NCLEX®(NGN) Consultant and SubjectMatter ExpertElsevier Inc.Michael Johnson, PhD, RN, PMH-BC, CNEDirector of Clinical Affairs and Associate ProfessorSchool of NursingNevada State CollegeHenderson, NevadaErica Shae Lee, MSN-Ed, RNAssociate Program DirectorPrelicensure NursingArizona State UniversityPhoenix, ArizonaNecole Leland, DNP, RN, PNP, CPNAssistant ProfessorSchool of NursingUniversity of Nevada, Las VegasLas Vegas, NevadaLisa Nicholas, MSN, RNLecturer, Clinical InstructorSchool of NursingUniversity of Nevada, Las VegasLas Vegas, NevadaContributors
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 12 preview imageContributorsixKaren L. Petersen, MSN-L, RN, MNNNursing FacultyParadise Valley Community CollegePhoenix, ArizonaDavid Petersen, MSN-Ed, RNVisiting ProfessorSchool of NursingChamberlain UniversityPhoenix, ArizonaKatherine M. Silvestri, MSN, APRN, FNP-BCEditorial and Reviewer ConsultantNursing Reviews, Inc.Henderson, NevadaMargaret Trnka, MSN, RNLecturer, Clinical InstructorSchool of NursingUniversity of Nevada, Las VegasLas Vegas, NevadaLaurent W. Valliere, BS, DDVice PresidentMarketingNursing Reviews, Inc.Henderson, NevadaJanelle Willis, MSN, APRN, CNELecturer, Clinical InstructorSchool of NursingUniversity of Nevada, Las VegasLas Vegas, Nevada
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 13 preview imagexEmily Brown, MSN, APRN, FNP-BCFamily Nurse PractitionerUniversity Medical CenterLas Vegas, NevadaAlena Grewal, MSN, APRN, FNP-BCAssistant Professor of NursingUniversity of Nevada, Las VegasLas Vegas, NevadaJessica Grimm, DNP, APRN, ACNP-BC, CNEAssociate Professor of NursingTouro University NevadaHenderson, Nevada;Assistant Professor of Anesthesia and Perioperative MedicineOregon Health State UniversityPortland, OregonJames Guilbault, PharmD, BS, RPhPharmacy Manager and Clinical Staff PharmacistWalgreens Pharmacy, Mercy Medical Center,MCPHS UniversitySpringeld, MassachusettsDebra Hagler, PhD, RN, aCNS-BC, cNE, CHSE, ANEF,FAANClinical ProfessorEdson College of Nursing and Health InnovationArizona State UniversityPhoenix, ArizonaDiana Hagler, MSN-Ed, RN, CCRNTeleHealth ICU RN, Adjunct FacultyBanner Health, Grand Canyon University,Maricopa Community CollegesPhoenix, ArizonaHope Hinchman, MSN, RNClinical InstructorUniversity of Nevada, Las VegasLas Vegas, NevadaSarah R. Jean Baptiste, MS-PAPhysician AssistantOregon Health Science UniversityPortland, OregonMichael Johnson, PhD, RN, PMH-BC, CNEDirector of Clinical Affairs and Associate ProfessorSchool of NursingNevada State CollegeHenderson, NevadaLisa M. Nicholas, MSN, RNLecturer, Clinical InstructorUniversity of Nevada, Las VegasLas Vegas, NevadaKaren L. Petersen, MSN-L, RN, MNNNursing FacultyParadise Valley Community CollegePhoenix, ArizonaPaula Richards, BATrauma Informed Care InterventionistDialectical Behavior Therapy TrainedClinical CounselorBaystate Medical CenterSpringeld, MassachusettsKelly Rybacki, MSN, RNInstructor of NursingParadise Valley Community CollegePhoenix, ArizonaDieu-My Thi Tran, PhD, RN, CNEAssociate Professor of NursingUniversity of Nevada, Las VegasLas Vegas, NevadaJanelle Willis, MSN, APRN, CNELecturer, Clinical InstructorSchool of NursingUniversity of Nevada, Las VegasLas Vegas, NevadaReviewers
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 14 preview imagexiLinda Anne Silvestri, PhD, RN“To laugh often and much, to appreciate beauty, to nd thebest in others, to leave the world a bit better, to know thateven one life has breathed easier because you have lived, thisis to have succeeded.”—Ralph Waldo EmersonAngela Elizabeth Silvestri, PhD, APRN,FNP-BC, CNE“The climb to the top is arduous and steep. People becomeexhausted, frustrated, and disenchanted, and are oftentempted to give up. Genuine acts of caring draw people for-ward.”-James M. KouzesWelcome to SaundersPyramid toSuccess!An Essential Resource for Test SuccessSaunders Comprehensive Review for the NCLEX-RN® Exami-nationis one in a series of products designed to assist youin achieving your goal of becoming a registered nurse.This text will provide you with a comprehensive reviewof all nursing content areas specically related to the cur-rent test plan for the Next Generation NCLEX-RN exami-nation, which is implemented by the National Councilof State Boards of Nursing. This resource will help youachieve success on your nursing examinations duringnursing school and on the NCLEX-RN examination.OrganizationThis book contains 19 units and 70 chapters. The chap-ters are designed to identify specic components ofnursing content. They contain practice questions, bothmultiple-choice and alternate item formats, that reectthe chapter content and the current test plan for theNCLEX-RN examination. All questions in the book andon the Evolve site are presented in NCLEX-style format.The NCLEX test plan identies a framework basedonClient Needs. These Client Needs categories includeSafe and Effective Care Environment, Health Promotionand Maintenance, Psychosocial Integrity, and Physi-ological Integrity.Integrated Processesare also identiedas a component of the test plan. These include Caring,CommunicationandDocumentation,CultureandSpirituality, Nursing Process, and Teaching and Learn-ing. All chapters address the components of the testplan framework.Special Features of the BookPyramid TermsPyramid Termsare important to the discussion of thecontent in the chapters in each unit. Therefore, they arein boldgreentype throughout the content section ofeach chapter. Denitions can be reviewed in the AudioGlossary on the Evolve site.Pyramid to SuccessThePyramid to Success,a featured part of each unit intro-duction, provides you with an overview, guidance, anddirection regarding the focus of review in the particularcontent area, as well as the content area’s relative impor-tance to the test plan for the NCLEX-RN examination.ThePyramid to Successreviews the Client Needs and pro-vides learning outcomes as they pertain to the contentin that unit. These learning outcomes identify the spe-cic components and cognitive skills to keep in mind asyou review each chapter.Priority ConceptsEach chapter identies twoPriority Conceptsreectiveof its content. ThesePriority Conceptswill assist you tofocus on the important aspects of the content and asso-ciated nursing interventions. These Priority Conceptsare also helpful for those students who are learning in aconcept-based curriculum.Pyramid PointsPyramid Points() are placed next to specic contentthroughout the chapters. ThePyramid Pointshighlightcontent that is important for preparing for the NCLEX-RN examination and identify content that is likely toappear on the NCLEX-RN examination.Preface
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 15 preview imagePrefacexiiPyramid AlertsPyramid Alertsare theredtext found throughout thechapters that alert you to important information aboutnursing concepts. These alerts identify concepts that areimportant to remember and relate to content that typi-cally appears on the NCLEX-RN examination.Clinical Judgment BoxesClinical Judgment (CJ) Boxes are located in every chap-ter in the book. These boxes present a clinical scenariothat relates to one of the six cognitive skills (recognizecues, analyze cues, prioritize hypotheses, generate solutions,take action, evaluate outcomes) that will be measured inthe Next Generation NCLEX (NGN) exam. These CJboxes provide the thinking process needed and neces-sary information to make a clinical decision.Special Features Found on EvolvePretest and Study CalendarThe accompanying Evolve site contains a 75-questionpretest and a 75-question posttest that provide youwith feedback on your strengths and areas in need ofimprovement. The results of your pretest will generatean individualized study calendar to guide you in yourpreparation for the NCLEX examination. Once youhave completed your review of the practice questionsin this resource, you can take the posttest to evaluateyour improvement and need for any additional reviewin preparation for the NCLEX. After completion of eachtest you are provided with the opportunity to reviewthe answers, rationales, and strategies, and we highlyencourage you to do this.Audio QuestionsThe accompanying Evolve site containsAudio Questionsrepresentative of content addressed in the current testplan for the NCLEX-RN examination. These questionsare in NCLEX-style format, and each question presentsan audio sound, such as lung sounds, as a componentof the question.Next Generation NCLEX®(NGN) Case Studies andNGN Test QuestionsTheaccompanyingEvolvesitecontainsstand-aloneitems and unfolding case studies. The clinical judgmentstand-alone items provide a clinical scenario and areaccompanied by one NGN test question in either a Bow-tie or a Trend item format. These stand-alone items canmeasure up to all of the cognitive skills of the NCSBNClinicalJudgmentMeasurementModel(NCJMM).These cognitive skills include Recognize Cues, AnalyzeCues, Prioritize Hypotheses, Generate Solutions, TakeAction, and Evaluate Outcomes. Each unfolding casestudy is accompanied by six NGN test items, each mea-suring one of the cognitive skills in sequential order.Audio Review SummariesThe companion Evolve site includes threeAudio ReviewSummariesthat cover challenging subject areas addressedin the test plan for the NCLEX-RN examination, includingPharmacology,Acid-Base Balance, andFluids and Electrolytes.Practice QuestionsWhile preparing for the NCLEX-RN examination, it iscrucial for students to practice answering test questions.This book contains multiple-choice and alternate itemformat questions. The accompanying software includesall the questions from the book, plus additional newEvolve questions for a total of more than 5700 ques-tions. The alternate item format questions in the bookand on the accompanying Evolve site may be presentedas 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 studiesThe NGN stand-alone items and unfolding case studiesprovide you with practice in prioritizing, decision-making, and critical thinking, and strengthen yourclinical judgment skills.Multiple-Choice and Alternate Item Format QuestionsStarting with Unit II, each chapter is followed by apractice test. Each practice test contains several ques-tions reective of the content in the chapter and thosepresented 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 eachquestion type. The Next Generation NCLEX (NGN) isalso 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 incorrectoptions, and a test-taking strategy that will assist you inanswering the question correctly. The test-taking strategyis highlighted in boldbluetype. This highlighting willprovide you with guidance and direction for further reme-diation in theSaunders Clinical Judgment and Test-TakingStrategies: Passing Nursing School and the NCLEX® Exam.The categories identied in each practice question onthe Evolve site include Level of Cognitive Ability, ClientNeeds, Integrated Process, Clinical Judgment/CognitiveSkill, the nursing Content Area, the Health Problem, andPriority Concepts. Every question on the accompanying
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 16 preview imagePrefacexiiiEvolve site is organized by these question codes, so youcan customize your study session to be as specic or asgeneric as you need. Additionally, a link to view nor-mal laboratory reference intervals is provided with eachpractice question.Pharmacology and MedicationCalculations ReviewStudents consistently state that pharmacology is anarea with which they need assistance. The NCLEX-RNtest plan continues to incorporate pharmacology inthe examination, but only the generic drug names willbe included. Therefore, pharmacology chapters havebeen included for your review and practice. This bookincludes 13 pharmacology chapters, a medication andintravenousprescriptionscalculationchapter,andapediatricmedicationadministrationandcalculationchapter. Each of these chapters is followed by a practicetest that uses the same question format described earlier.This book contains numerous pharmacology questions.Additionally, more than 1000 pharmacology questionscan be found on the accompanying Evolve site.Next Generation NCLEX (NGN)QuestionsAs described above, the accompanying Evolve site con-tains stand-alone items and unfolding case studies. TheNCSBN has conducted rigorous research over the pastseveral years to develop NGN case studies and test itemsthatwilleffectivelymeasureclinicaljudgment.TheNCSBN will launch the NGN questions on the exami-nation starting in April 2023, and these item types aredesigned to test the candidate’s ability to make safe andcompetent clinical judgments. The information in thisbook about the NGN reects the most up-to-date infor-mation at the time of the printing of this book. Sincethe NCSBN continues to research and collect data onthe NGN items, additional and continuous changescould be made. We encourage you to access the NCSBNwebsite at www.ncsbn.org for these latest updates. TheEvolve site for this resource provides you with NGNstand-aloneitemsandunfoldingcasestudieswithaccompanying test items that are reective of the itemtypes that NCSBN has indicated (as of the time of thispublication) will be presented.How to Use This BookSaunders Comprehensive Review for the NCLEX-RN® Exam-inationis especially designed to help you with your suc-cessful journey to the peak of the SaundersPyramid toSuccess: becoming a registered nurse! As you begin yourjourney through this book, you will be introduced to allof the important points regarding the current NCLEX-RN examination, the process of testing, and uniqueand special tips regarding how to prepare yourself forthis very important examination. You will also be intro-duced to the NGN and the types of case studies and testitems that will be on the NCLEX-RN.You should begin your process through the Saun-dersPyramid to Successby reading all of Unit I in thisbook and becoming familiar with the central pointsregarding the NCLEX-RN examination, including theNGN. Chapter 2 describes self-efcacy and the uniqueand special tips regarding how to prepare yourself bothacademically and nonacademically for this importantexamination. Be sure to read Chapter 3, written by anursing graduate who recently passed the examination,and note what the graduate has to say about the testingexperience. Chapter 4 will provide you with the criticaltesting 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 asyou proceed through this book. Continue by studyingthe specic content areas addressed in Units II throughXIX. Review the denitions of thePyramid Terms,locatedin each chapter, and thePyramid to Successnotes and theClient Needs and Learning Outcomes, located in eachunit introduction. Read through the chapters and focuson thePyramid PointsandPyramid Alerts,which iden-tify the areas most likely to be tested on the NCLEX-RN examination. Pay particular attention to theClinicalJudgmentboxes because they provide information aboutthe cognitive skills in the NCSBN Clinical JudgmentMeasurement Model and the thinking processes in mak-ing an interpretation or decision.As you read each chapter, identify your areas ofstrength and those in need of further review. Highlightthese areas, and test your abilities by taking all prac-tice tests provided at the end of the chapters. Be sure toreview all rationales and test-taking strategies.After reviewing all chapters in the book, reect andidentify any areas requiring further review; then takethe time to review those areas in both the book and thecompanion Evolve site. In preparation for the NCLEX-RN examination, be sure to take the pretest on theEvolve site and generate your study calendar. Follow thecalendar for your review because the calendar representsyour pretest results and the best study path to followbased on your strong areas and content areas in need ofreview. Also, be sure to access theNGN cases and itemsand theAudio Review Summariesas part of your prepara-tion for the NCLEX-RN examination.Climbing the Pyramid to SuccessThe purpose of this book is to provide acomprehensivereviewof the nursing content you will be tested on during
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 17 preview imagePrefacexivthe NCLEX-RN examination. However,Saunders Compre-hensive Review for the NCLEX-RN® Examinationis intendedto do more than simply prepare you for the rigors of theNCLEX-RN examination; this book is also meant to serveas a valuable study tool that you can refer to throughoutyour nursing program, with specic customizable Evolvesite selections, including a selection for NGN cases andtest items, to help identify and reinforce key content areasand prepare you for your nursing exams.After using this book for comprehensive contentreview, your next step in thePyramid to Successis to getadditional practice with theQ&A reviewproduct.Saun-ders Q&A Review for the NCLEX-RN® Examinationoffersmore than 6000 unique practice questions in the bookand on the companion Evolve site. The questions arefocused on the Client Needs and Integrated Processesof the NCLEX-RN test plan, making it easy to accessyour study area of choice. The Evolve site for this bookalso provides you with NGN cases and test items. Foron-the-go Q&A review, you can pick upSaunders Q&AReview Cards for the NCLEX-RN® Examination.Your nal step on thePyramid to Successis to mas-ter theonline review. TheHESI/Saunders Online Reviewfor the NCLEX-RN® Examinationprovides an interactiveand individualized platform to get you ready for yourNCLEX exam. This online course provides 10 high-levelcontent modules, supplemented with instructional vid-eos, animations, audio, illustrations, case studies, andseveral subject matter exams. End-of-module practicetests are provided, along with severalCrossing the FinishLinepractice tests. In addition, you can assess your prog-ress with aPretest, Test Yourself quizzes, and aComprehen-sive Examin a computerized environment that preparesyou for the actual NCLEX-RN examination. NGN casesand test items are also provided.At the base of thePyramid to Successare ourtest-taking strategies, which provide a foundation for under-standing and unpacking the complexities of NCLEX-RNexamination questions, including alternate item formats,NGN stand-alone items, and unfolding case studies withaccompanying NGN items.Saunders Clinical Judgmentand Test-Taking Strategies: Passing Nursing School and theNCLEX®Examtakes a detailed look at clinical judgmentand all of the test-taking strategies you will need to knowin order to pass any nursing examination, including theNext Generation NCLEX-RN. Special tips are integratedfor 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-dersPyramid to Success. We wish you continued successthroughout your new career as a registered nurse!
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 18 preview imagexvA Few Words From LindaThere are many individuals who in their own ways havecontributed to my success in making my professionaldreams become a reality. My sincere appreciation andwarmest thanks are extended to all of them.First, I want to acknowledge my parents, who openedmydoorofopportunityineducation.Ithankmymother, Frances Mary, for all of her love, support, andassistance as I continuously worked to achieve my pro-fessional goals. I thank my father, Arnold Lawrence, whoalways provided insightful words of encouragement. Mymemories of their love and support will always remainin my heart. I am certain that they are very proud of myprofessional accomplishments.I also thank my best friend and love of my life, myhusband, Larry; my sister, Dianne Elodia, and her hus-band, Lawrence; my brother, Lawrence Peter, and mysister-in-law, Mary Elizabeth; my cousin Paula; and mynieces and nephews, Angela, Katie, Gina, Karen, Bri-anna, Gabby, and Nicholas, who were continuouslysupportive, giving, and helpful during my research andpreparation of this publication. They were always thereand by my side whenever I needed them.I want to thank my nursing students at the Com-munity College of Rhode Island who approached mein 1991 and persuaded me to assist them in preparingtotaketheNCLEX-RNexamination.Theirenthusi-asm and inspiration led to the commencement of myprofessional endeavors in conducting review coursesfor the NCLEX-RN examination for nursing students.I also thank the numerous nursing students who haveattended my review courses for their willingness toshare their needs and ideas. Their input has certainlyadded a special uniqueness to all of the publications inthePyramid to Success.I also wish to acknowledge all of the nursing facultywho taught in my review courses for the NCLEX-RN exam-ination. Their commitment, dedication, and expertise havecertainly assisted nursing students in achieving successwith the NCLEX-RN examination. I also want to extend avery special thank-you to my niece, Angela, for joining mein preparing and authoring these NCLEX resources. Angelais wonderful to work with. Her tremendous theoretical andclinical knowledge and expertise and her consistently out-standing ideas and work in creating clinical judgment test-taking strategies certainly added to the excellent quality ofthis product and all of the other products in thePyramid toSuccess.She is very dedicated to promoting and ensuringstudent success. Thank you, Angela!A special thank-you goes to Loren Wilson, formerSenior Vice President, for her years of expert guidanceand continuous support for all of the products in thePyramid to Success.I would also like to acknowledge Patricia Mieg andJeff Price, former educational sales representatives, whoencouraged me to submit my ideas and initial workfor the rst edition of this book to the W.B. SaundersCompany.And nally, a very sincere and special acknowledg-ment to my husband, Laurent (Larry) W. Valliere, forhis contribution to this publication, for teaching in myreview courses for the NCLEX-RN examination, and forhis commitment and dedication in assisting my nursingstudents 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 andevery moment as I worked to achieve my professionalgoals. Larry, you are my “rock of support!” Thank youso much!A Few Words From AngelaThere are many people who contributed to my successin my work on this product. I am very grateful for theircontinued 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, especiallywhen I’m stressed. All of this would not be possiblewithout him!I would also like to thank my parents, Mary andLarry, for their continued support throughout the years.Their words of encouragement and wisdom have beentremendously important to my success. I also don’tAcknowledgments
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 19 preview imageAcknowledgmentsxviknow what I would do without their support in caringfor my kids!I would like to thank my sister Katie, who is a won-derful nurse. Her ambitions as a nursing student were soinspiring 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 mywork. His wit and sarcasm are always a great way to liftyour mood at the end of the day.Finally, I want to extend a special thank you to Lindafor her collaboration, guidance, and expertise. Withouther, I would not be where I am today. Thank you, Linda!A Few Words From Both Linda and AngelaFirst and foremost, we want to thank our associate edi-tor, Jessica Grimm, for all of her dedicated and hardwork in editing and preparing manuscript for this edi-tion. Her expertise and close attention to details havecertainly added to the quality of this resource.We also want to acknowledge and thank Laurent W.Valliere for writing a chapter addressing those importantself-efcacy and nonacademic test-preparation issues.A very special thank-you goes to all of the review-ers, contributors, and item writers who updated andprovided many of the practice questions, and to all ofthe previous contributors to this book. You were allawesome!Additionally, we want to thank Paula Richards forher expertise and input in reviewing our chapter titledPopulation Health Nursing. Thank you, Paula!We thank Dianne E. Fiorentino for her continuoussupport and dedication to our work and in her researchand reference support and other administrative assistantresponsibilities for the ninth edition of this book. Wethank Karen Machnacz for her help with reference sup-port, Jimmy Guilbault for providing medication researchsupport, and Mary and Larry Silvestri for their assistancewith getting through all of the tasks and projects weneeded 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 forthis book. She has been passionate about creating teach-ing and learning strategies that promote thinking andclinical judgment in nursing students. Her case studiespresent real-world situations that nursing graduates arelikely to encounter in the clinical settings. Thank youDonna!Wesincerelyacknowledgeandthanksomeveryimportant and special people from Elsevier. We thankHeather Bays-Petrovic, Content Strategist, for her con-tinuous support, enthusiasm, and expert professionalguidance throughout the preparation of this edition.Heather, thank you so much—you are awesome! Wealso thank Laurie Gower, Director of Development, foralways 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 prioritizingfor us to keep us on track, for her ideas for the product,and for her professional and expert skills in organizingand maintaining an enormous amount of manuscriptfor production. And we thank Senior Content Develop-ment Specialist Rebecca Leenhouts for her expertise inassisting us to complete this book. Thank you, Becky!We could not have completed this project without Lauraor Becky!We want to acknowledge all of the staff at Elsevierfor their tremendous help throughout the preparationand production of this publication. A special thanksto all of them. We want to thank and acknowledgeTamara 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 BookDesigner. You have all played such signicant roles innalizing this publication. And we need to especiallyacknowledge Cindy Thoms, Senior Project Manager,who so expertly managed all of our copyedited manu-script and pages for review for this book. Cindy, youwere so organized, supportive, and so awesome to workwith. Your attention to the many details to ensure andmaintain the quality of this book was so greatly appreci-ated. We thank you so much!Lastly, a very special thank-you to all our nursingstudents: past, present, and future. All of you light upour lives! Your love and dedication to the profession ofnursing and your commitment to provide expert andquality health care will bring never-ending rewards!
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 20 preview imagePreparationUNITINCLEX-RN®Exam Preparation
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 21 preview imagePreparationThe Pyramid to SuccessSaunders Comprehensive Review for the NCLEX-RN®ExaminationAbout This Resource and the NCLEX-RN®ExaminationWelcome to thePyramid to SuccessandSaunders Com-prehensive Review for the NCLEX-RN® Examination.Thisresource is specially designed to help you begin yoursuccessful journey to the peak of the pyramid, becominga registered nurse. As you begin your journey, you willbe introduced to all of the important points regardingthe NCLEX-RN examination and the process of testing,and to unique and special tips regarding how to prepareyourself for this important examination, both academi-cally and nonacademically. You will read what a nursinggraduate who recently passed the NCLEX-RN exami-nation has to say about the test. Important test-takingstrategies are detailed. These details will guide you inselecting the correct option or assist you in making aneducated guess if you are not entirely sure about the cor-rect answer; they will also guide you in ways to answerthe NGN test items. Each unit in this book begins withthe Pyramid to Success. The Pyramid to Success addressesspecic points related to the NCLEX-RN examination.Client Needs and activities as identied in the test planframework for the examination are listed, as are learn-ing outcomes and competencies for the unit. CognitiveSkills identied in the National Council of State Boardsof Nursing (NCSBN) Clinical Judgment MeasurementModel (NCJMM) are a focus in chapters and practicequestions. Pyramid Terms are key words that are denedin the glossary on the accompanying Evolve site and setin a green color throughout each chapter to direct yourattention to signicant points for the examination.Thisresourceprovidesyouwithnursingcontentreview, including the content identied in the currentNCLEX test plan, and practice questions of all types,each chapter, you will nd Pyramid Point bulletsNCLEX-RN examination and Pyramid Alert bulletsin red text throughout the chapter that alert you toimportant information about nursing concepts. Eachchapter includesClinical Judgment: Cognitive Skill clientscenariosthat focus on one of the cognitive skills.The book contains 854 NCLEX-style questions. TheEvolve site accompanying this book contains all of thequestions 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(selectallthatapply); ordered-response; questions that contain a g-ure, chart/exhibit, or a graphic option item; and audioitem formats. Examples of some question types can belocated throughout this chapter. In addition, the NGNitem types are provided on the accompanying Evolvesite.As you read each chapter, identify your strengths andareas that are in need of further review.Test your strengths and abilities by answering allpractice questions provided in this book and on theaccompanying Evolve site. Be sure to read all rationalesand test-taking strategies. The rationale provides youwith signicant information regarding the correct andincorrect options. The test-taking strategy provides youwith the logical path to selecting the correct option. Areference source and page number are provided so thatyou can easily nd information you need to review inanother Elsevier text. Each practice question on theaccompanying Evolve site is coded on the basis of theClinical Judgment and the Next GenerationNCLEX (NGN)-RN®ExaminationLinda A. Silvestri, PhD, RN, FAANAngela E. Silvestri, PhD, APRN, FNP-BC, CNEC H A P T E R1
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 22 preview imagePreparationCHAPTER 1Clinical Judgment and the Next Generation NCLEX (NGN)-RN®Examination3Level 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 isa unique and helpful feature that allows you to lter andselect questions based on a disease process when youare practicing questions on Evolve. For example, if heartfailure is your area of interest, you can select “AdultHealth, Cardiovascular, Heart Failure” on the Evolvesite, and all questions on this content will be gener-ated for practice. In addition, two Priority Concepts thatrelate to the content of the question are identied. Thiscode is especially helpful for students whose curriculumis concept-based. Additionally, information about allof the special features of this resource and the questiontypes is located in the preface of this book.Other Resources in the Saunders Pyramid to SuccessThere 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-TakingStrategies: Passing Nursing School and the NCLEX® Exam,StrategiesforStudentSuccessontheNextGenerationNCLEX® (NGN) Test Items,Saunders Q&A Review Cardsfor the NCLEX-RN® Exam,andSaunders RNtertainmentfor the NCLEX-RN® Exam.The HESI®CompassTMCourseis also a resource for NCLEX preparation and providesyou with an individual coach to guide you in your prep-aration. Ask your nursing instructors about institutionalaccess to this course.The resources in the Saunders Pyramid to Successare described in the preface of this book and can beobtained online by visiting elsevierhealth.com or bycalling 800-545-2522.Let’s begin our journey through the Pyramid toSuccess.Clinical Judgment and Next GenerationNCLEX®ItemsClinical judgment is the observed outcome of criticalthinkinganddecision-making(Dickison,Haerling,& Lasater, 2019). In recent years, heightened atten-tion has been paid to clinical judgment as a means ofteaching, learning, and assessment and testing. TheNextGenerationNCLEX-RN®examinationrequirescandidates to demonstrate a higher level of ability inapplying 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). TheNational Council of State Boards of Nursing (NCSBN)has created a Clinical Judgment Measurement Model(NCJMM) that consists of applying six cognitive skillsor processes. These include: (1) recognizing cues; (2)analyzing cues; (3) prioritizing hypotheses; (4) gener-ating solutions; (5) taking action; and (6) evaluatingoutcomes (Dickison et al., 2019). Table 1.1 provides adescription of these six cognitive skills/processes identi-ed in the NCJMM. The NCJMM also serves as a guidefor the NCSBN to create NGN®questions. The NCJMMcontinues to evolve as may the NGN®item types thatwill be presented in the exam. All of the current NCLEXitem types known as stand-alone items, the new clinicaljudgment stand-alone items (bow-tie and trend), andunfolding case studies that include six NGN items willbe 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-tableNGN item can be located in Chapter 4, Box 4.5. TheNCSBN conducts ongoing research on the NGN testdesign and NGN items. The information in this chapterreects what is currently published by the NCSBN. TheNGN will be implemented in April 2023 and becausesome additional changes in item types may occur, weencourage you to frequently access the NCSBN websiteat www.ncsbn.org for updates about the NGN design,items, and test plan updates.Examination ProcessAn important step in the Pyramid to Success is tobecome as familiar as possible with the examinationprocess. Candidates facing the challenge of this exami-nation can experience signicant anxiety. Knowing whatthe examination is all about and knowing what you willTABLE 1.1Cognitive Skills/Processes and DescriptionsCognitive Skill/ProcessDescriptionRecognize cuesIdentifying signicant data; data can befrom many sources (assessment)Analyze cuesConnecting data to the client's clinicalpresentation—determining if the data isexpected? Unexpected? (analysis)Prioritize hypothesesRanking hypotheses; what are theconcerns or client needs/problems andtheir priority? (analysis)Generate solutionsUsing hypotheses or client needs todetermine interventions for an expectedoutcome (planning)Take actionImplementing the generated solutionsaddressing the highest priorities orhypotheses (implementation)Evaluate outcomesComparing observed outcomes withexpected ones (evaluation)From Dickison, P., Haerling, K.A., & Lasater, K. (2019). Integrating theNational Council of State Boards of Nursing Clinical Judgment Modelinto Nursing Educational Frameworks.Journal of Nursing Education,58(2), 72–78.
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 23 preview imagePreparationUNIT INCLEX-RN®Exam Preparation4encounter during the process of testing will assist inalleviating fear and anxiety. The information containedin this chapter was obtained from the NCSBN website(www.ncsbn.org) and from the current NCSBN testplan for the NCLEX-RN and includes some proceduresrelated to registering for the exam, testing procedures,and the answers to the questions most commonly askedby nursing students and graduates preparing to take theNCLEX. You can obtain additional information regard-ing the test and its development by accessing the NCSBNwebsite and clicking on the NCLEX Examination tab orby writing to the National Council of State Boards ofNursing, 111 East Wacker Drive, Suite 2900, Chicago, IL60601. 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 andother resources available to an NCLEX candidate. Youare also encouraged to access the most up-to-dateCan-didate Bulletin.This document provides you with every-thing you need to know about registration proceduresand scheduling a test date.Computer Adaptive TestingThe acronymCATstands forcomputer adaptive test.Theexam is delivered as a variable length CAT, which allowsfor 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 balancedon the basis of the percentages of each of the test plancategories and subcategories. Each item is selected totarget the candidate’s ability level. Once all test planrequirements are met, a stopping rule is triggered inwhich a reliable pass-or-fail decision is made.When taking a CAT, once an answer is recorded,all subsequent questions administered depend, to anextent, on the answer selected for that question. Skip-pingquestionsorreturningtoearlierquestionsisincompatible 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 willnot fall into that “trap” of changing a correct answer toan 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 makean educated guess. With most of the questions, theanswer will be right there in front of you. If you need toguess, use your nursing knowledge and clinical experi-ences and clinical judgment skills to their fullest extentand all of the test-taking strategies you have practiced inthis review program.You do not need any computer experience to takethis examination. A keyboard tutorial is provided onthe NCSBN website, and you are encouraged to view theonline tutorial when you are preparing for the NCLEXexamination. The tutorial will instruct you on the use ofthe on-screen optional calculator, the use of the mouse,and how to record an answer. The tutorial also providesinstructions on how to respond to the different ques-tion types on this examination. NCSBN also providesan online tutorial about the new item types that allowsyou to interact with these items as much as you need tobefore taking the exam. In addition, at the testing site,a test administrator is present to assist in explaining theuse of the computer to ensure your full understandingof how to proceed.The new NGN item types will not be scored as eitherall correct or all incorrect. Instead, new scoring modelswill be applied for new NGN items that allow partialcredit scoring for most items. For specic informationon the scoring models, refer to the NCSBN website atwww.ncsbn.org and the National Council of State Boardsof Nursing’sNext Generation NCLEX News(2021) athttps://www.ncsbn.org/NGN_Summer21_Eng.pdf.Development of the Test PlanThe test plan for the NCLEX-RN examination is devel-oped by the NCSBN. The examination is a nationalexamination; the NCSBN considers the legal scope ofnursing practice as governed by state laws and regula-tions, including the nurse practice act, and uses theselaws to dene the areas on the examination that willassess the competence of the test-taker for licensure.The NCSBN also conducts an important study every3 years, known as apractice analysis study,to link theexamination to nursing practice. The results of thisstudy determine the framework for the test plan forthe examination. The participants in this study includenewly licensed registered nurses from all types of gen-eralist nursing education programs. Participants of thisstudy 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 theseactivities in relation to client safety. A panel of contentexperts at the NCSBN analyzes the results of the studyand makes decisions regarding the test plan framework.The NCSBN also conducted extensive research andexperimentation and sought out subject matter expertfeedback 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 formeasuring clinical judgment in the test plan design. Thisled to the development of new NGN test items and con-tinuous research to test item reliability and validity.
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 24 preview imagePreparationCHAPTER 1Clinical Judgment and the Next Generation NCLEX (NGN)-RN®Examination5Test PlanThe questions are written to address Level of CognitiveAbility, Client Needs, and Integrated Processes, includ-ing Clinical Judgment and Cognitive Skills, as identiedin the test plan developed by the NCSBN.The content of the NCLEX-RN examination reectsthe activities identied in the practice analysis studyconducted by the NCSBN. Exam items are written basedon the test plan framework and these activitiesratherthanon content areas such as adult health, maternity,pediatrics, or mental health.Level of Cognitive AbilityLevels 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 andin making clinical judgments. Therefore, you will notencounter anyrememberingorunderstandingquestionson the NCLEX. Questions on this examination are writ-ten at theapplyinglevel or higher in terms of cognitiveability. Table 1.2 provides descriptions and examples ofeach level of cognitive ability. Box 1.1 presents an exam-ple of a question that requires you to apply data.Client NeedsThe NCSBN identies a test plan framework based onClient Needs, which includes four major categories.Some of these categories are divided further into sub-categories. The Client Needs categories are Safe andEffectiveCareEnvironment,HealthPromotionandMaintenance, Psychosocial Integrity, and PhysiologicalIntegrity (Table 1.3).Safe and Effective Care EnvironmentThe Safe and Effective Care Environment categoryincludestwosubcategories:ManagementofCare,and Safety and Infection Control. According to theNCSBN, Management of Care addresses prioritizingcare and providing and directing nursing care thatwill ensure a safe care delivery setting to protect cli-ents and health care personnel. The NCSBN indicatesthat Safety and Infection Control addresses contentthat will protect clients and health care personnelfrom health and environmental hazards within healthcare facilities and in community settings. Box 1.2presents examples of questions that address these twosubcategories.Health Promotion and MaintenanceTheHealthPromotionandMaintenancecategoryaddresses the principles related to growth and devel-opment. According to the NCSBN, this Client Needscategory also addresses content required to assist theindividual to prevent health problems; to recognizealterations in health; and to develop health practicesthat promote and support optimal wellness. See Box1.3 for an example of a question in this Client Needscategory.Psychosocial IntegrityThe Psychosocial Integrity category addresses contentrequired to promote and support the ability of the cli-ent to cope, adapt, and problem-solve during stressfulevents. The NCSBN also indicates that this Client Needscategory addresses the emotional, mental, and socialwell-being of the client experiencing stressful events andcare for the client with an acute or chronic mental ill-ness. See Box 1.4 for an example of a question in thisClient Needs category.TABLE 1.2Levels of Cognitive Ability: Level andDescriptions and ExamplesLevelDescription and ExampleRememberingRecalling, retrieving information from memoriza-tion, previous learning, or long-term memory.Example: A normal blood glucose level is 70-99mg/dL (3.9-5.5 mmol/L).UnderstandingDetermining the meaning of information.Example: A blood glucose level of 60 mg/dL (3.34mmol/L) is lower than the normal reference range.ApplyingCarrying out an appropriate action based oninformation.Example: Administering 10–15 g of carbohydratesuch as a ½ glass of fruit juice to treat mild hypo-glycemia.AnalyzingExamining concepts or data and interpreting howthe concepts or data connect or relate to oneanother.Example: The concept is mild hypoglycemia andthe connecting data are the signs and symptomsof mild hypoglycemia, such as hunger, irritability,weakness, headache, blood glucose level lowerthan 60 mg/dL (3.34 mmol/L).EvaluatingMaking judgments, conclusions, or validationsbased on evidence.Example: Determining that treatment for mildhypoglycemia was eective if the blood glucose levelreturned to a normal level between 70-99 mg/dL(3.9-5.5 mmol/L) and signs and symptoms resolved.CreatingGenerating or producing a new outcome or plan ofcare by putting parts of information together.Example: Designing a safe and individualized planof care with the interprofessional health care teamfor a client with diabetes mellitus that meets theclient’s physiological, psychosocial, and healthmaintenance needs.Adapted fromUnderstanding 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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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 25 preview imagePreparationUNIT INCLEX-RN®Exam Preparation6Physiological IntegrityThe Physiological Integrity category includes four sub-categories: Basic Care and Comfort, Pharmacologicaland Parenteral Therapies, Reduction of Risk Potential,and Physiological Adaptation. The NCSBN describesthese subcategories as follows: Basic Care and Comfortaddresses content for providing comfort and assistanceto the client in the performance of activities of daily liv-ing. Pharmacological and Parenteral Therapies addressescontent for administering medications and parenteraltherapies, such as intravenous therapies and parenteralnutrition, and administering blood and blood prod-ucts. Reduction of Risk Potential addresses content forThe nurse notes blanching, coolness, and edema at theperipheral 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 inltration.Answer: 1This question requires that you focus on thedata in the ques-tionand analyze that data to determine that the client is expe-riencing an inltration. Note thestrategic word,rst.Next, youneed to consider the harmful effects of inltration and deter-mine the action to implementrst.Because inltration canbe damaging to the surrounding tissue, the appropriaterstaction is to remove the IV to prevent further damage. Oncethe IV is removed, further action would be taken, depend-ing on the medication infusing at the time of inltration andbased 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 specied time intervals,or elevation of the extremity.BOX 1.1Level of Cognitive Ability: ApplyingTABLE 1.3The Client Needs Categories andSubcategories and Percentage of Questions on theNCLEX-RN ExaminationClient Needs Category and SubcategoryPercentage ofQuestionsSafe and Eective Care EnvironmentManagement of Care17-23Safety and Infection Control9-15Health Promotion and Maintenance6-12Psychosocial Integrity6-12Physiological IntegrityBasic Care and Comfort6-12Pharmacological and Parenteral Therapies12-18Reduction of Risk Potential9-15Physiological Adaptation11-17From National Council of State Boards of Nursing:2019 NCLEX-RN®examination: Test plan for the National Council Licensure Examination forRegistered Nurses. Chicago, 2018, National Council of State Boards ofNursing.Management of CareThe nurse has received the client assignment for the day.Which client would the nurse assessfirst?1.The client who has a nasogastric tube attached to inter-mittent suction2.The client who needs to receive subcutaneous insulinbefore breakfast3.The client who is 2 days postoperative and is complain-ing of incisional pain4.The client who has a blood glucose level of 50 mg/dL(2.8 mmol/L) and complains of blurred visionAnswer: 4This question addresses the subcategory Management ofCare in the Client Needs category Safe and Effective CareEnvironment. Note thestrategic word,rst,so you need toestablish priorities by comparing the needs of each client anddeciding which need is urgent. The client described in thecorrect option has a low blood glucose level and symptomsreective of hypoglycemia. This client should be assessed rstso that treatment can be implemented. Although the clients inoptions 1, 2, and 3 have needs that require assessment, theirassessments can wait until the client in the correct option isstabilized.Safety and Infection ControlThe nurse prepares to care for a client on contact precau-tions who has a hospital-acquired infection caused bymethicillin-resistantStaphylococcusaureus(MRSA).Theclient has an abdominal wound that requires irrigationand has a tracheostomy attached to a mechanical ventila-tor, which requires frequent suctioning. The nurse wouldassemble which necessary protective items before enteringthe client’s room?1.Gloves and gown2.Gloves and face shield3.Gloves, gown, and face shield4.Gloves, gown, and shoe protectorsAnswer: 3This question addresses the subcategory Safety and Infec-tion Control in the Client Needs category Safe and EffectiveCare Environment. It addresses content related to protectingoneself from contracting an infection and requires that youconsider the methods of possible transmission of infection,based on the client’s condition. Note thedata in the ques-tion.Because of the potential for splashes of infective mate-rial occurring during the wound irrigation or suctioning of thetracheostomy, option 3 is correct.BOX 1.2Safe and Effective Care Environment
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 26 preview imagePreparationCHAPTER 1Clinical Judgment and the Next Generation NCLEX (NGN)-RN®Examination7preventing complications or health problems related tothe client’s condition or any prescribed treatments orprocedures. Physiological Adaptation addresses contentfor managing and providing care to clients with acute,chronic, or life-threatening conditions. See Box 1.5 forexamples of questions in this Client Needs category.Integrated ProcessesThe NCSBN identies ve processes in the test plan thatare fundamental to the practice of nursing. These pro-cesses are incorporated throughout the major categoriesof Client Needs. The Integrated Process subcategories areCaring, Communication and Documentation, NursingProcess (Assessment, Analysis, Planning, Implementa-tion, and Evaluation), Culture and Spirituality, and Teach-ing and Learning. See Box 1.6 for an example of a questionthat incorporates the Integrated Process of Caring.Types of Questions on the Examinationand ScoringThe types of questions on the current NCLEX includemultiple-choice;ll-in-the-blank;multiple-response;ordered-response (prioritizing); image (hot spot) ques-tions; gure, chart/exhibit, or graphic option items; andaudio formats. These question types will continue tobe a part of the NCLEX examination, and each of thesequestion types will be scored as either correct or incor-rect, known asdichotomous scoring.Currently, no partialcredit 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 approachas stand-alone items and unfolding case studies. Thestand-alone items will be accompanied by a question thattests more than one cognitive skill. Each unfolding casestudy 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 85questions on the exam (minimum length exam). Afterthe 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 theexam. Examples of both stand-alone items and unfold-ing case studies and NGN items can be located on theEvolve site accompanying this book. These are speciallydesigned to simulate the NCLEX experience of testing forthese NGN item types. Both NGN stand-alone items (cur-rently known as bow-tie and trend) and unfolding caseswith accompanying NGN items are included. Refer to theEvolve site for practice with these question types. Addi-tionally, the unique test-taking strategies used to answerNGN items are illustrated with each bow-tie and trenditem and with items accompanying the unfolding casestudies. Chapter 4, Box 4.5 provides an example of onetype of NGN question and its unique test-taking strategy.In addition to the stand-alone items (bow-tie andtrend), according to the NCSBN, other NGN item typeswill be used. Table 1.4 provides a list of the NGN ques-tion types. The NCSBN also identies three scoringmethods for NGN items. These scoring methods aredescribed in Table 1.5The NCSBN provides specic directions for you tofollow with all question types on the NCLEX to guideyou through the testing process. Be sure to read thesedirectionsastheyappearonthecomputerscreen.The nurse is choosing age-appropriate toys for a toddler.Which toy is thebestchoice for this age?1.Puzzle2.Toy soldiers3.Large stacking blocks4.A card game with large picturesAnswer: 3This question addresses the Client Needs category HealthPromotion and Maintenance and specically relates to theprinciples of growth and development of a toddler. Note thestrategic word,best.Toddlers like to master activities inde-pendently, such as stacking blocks. Because toddlers do nothave the developmental ability to determine what could beharmful, toys that are safe need to be provided. A puzzle andtoy soldiers provide objects that can be placed in the mouthand may be harmful for a toddler. A card game with large pic-tures may require cooperative play, which is more appropriatefor a school-age child.BOX 1.3Health Promotion and MaintenanceA client with end-stage chronic obstructive pulmonary diseasehas selected guided imagery to help cope with psychologicalstress. Which client statement indicates thebestunderstand-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: 4This question addresses the Client Needs category Psychoso-cial Integrity, and the content addresses coping mechanisms.Note thestrategic word,best.Focus on thesubject,a charac-teristic of guided imagery. Guided imagery involves the clientcreating 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 useother relaxation techniques or play music with it.BOX 1.4Psychosocial Integrity
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 27 preview imagePreparationUNIT INCLEX-RN®Exam Preparation8Examples of some of these types of questions are notedin this chapter and in this book, and all types, includingthe NGN items, are on the accompanying Evolve site.Multiple-Choice QuestionsSome of the questions that you will be asked toanswer will be in the multiple-choice format. Thesequestions provide you with data about a client situ-ation and four answers, or options. Only one answeris correct.Fill-in-the-Blank QuestionsFill-in-the-blank questions will ask you to perform amedication calculation, determine an intravenous owrate, or calculate an intake or output record on a client.You will need to type only a number (your answer) inthe answer box. If the question requires rounding theanswer, this needs to be performed at the end of the cal-culation. The rules for rounding an answer are describedin the tutorial provided by the NCSBN and are also pro-vided in the specic question on the computer screen.Basic Care and ComfortA client with Parkinson’s disease develops akinesia while ambu-lating, increasing the risk for falls. Which suggestion would thenurse 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 awalker.4.Consciously think about walking over imaginary lines onthe oor.Answer: 4This question addresses the subcategory Basic Care and Com-fort in the Client Needs category Physiological Integrity andaddresses client mobility and promoting assistance in an activ-ity of daily living to maintain safety. Focus on thesubject,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 cankeep them moving forward while remaining safe.Pharmacological and Parenteral TherapiesThe nurse monitors a client receiving digoxin for whichearlymanifestation of digoxin toxicity?1.Anorexia2.Facial pain3.Photophobia4.Yellow color perceptionAnswer: 1This question addresses the subcategory Pharmacological andParenteral Therapies in the Client Needs category Physiologi-cal Integrity. Note thestrategic word,early.Digoxin is a cardiacglycoside that is used to manage and treat heart failure in someclients and to control ventricular rates in some clients with atrialbrillation. The most common early manifestations of toxicityinclude gastrointestinal disturbances such as anorexia, nau-sea, and vomiting. Neurological abnormalities can also occurearly 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 colorperception) are also signs of toxicity, but are not early signs.Reduction of Risk PotentialA magnetic resonance imaging (MRI) study is prescribed fora 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: 2This question addresses the subcategory Reduction of RiskPotential in the Client Needs category Physiological Integrity,and the nurse’s responsibilities in preparing the client for thediagnostic test to prevent risks associated with the test. Focuson thesubject,preparing a client for an MRI. In an MRI study,radiofrequency pulses in a magnetic eld are converted intopictures. All metal objects, such as rings, bracelets, hairpins,and watches, should be removed. In addition, a history shouldbe taken to ascertain whether the client has any internal metal-licdevices,suchasorthopedichardware,pacemakers,orshrapnel. An intravenous (IV) catheter may be inserted if a con-trast agent is prescribed. A femoral catheter is not used for thisdiagnostic test. Additionally, shaving is not a common practicebecause of the risk for microabrasions and infection. If needed,hair may be clipped away from an insertion site. NPO statusis not necessary for an MRI study of the head. Inhalation of aradioisotope may be prescribed with other types of scans, but itis not a part of the procedures for an MRI.Physiological AdaptationA client with renal insufciency has a magnesium level of 3.5mEq/L (1.44 mmol/L). On the basis of this laboratory result,the nurse interprets which sign as signicant?1.Hyperpnea2.Drowsiness3.Hypertension4.Physical hyperactivityAnswer: 2This question addresses the subcategory Physiological Adap-tation in the Client Needs category Physiological Integrity. Itaddresses an alteration in body systems. Focus on thedata inthe 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 (1.44mmol/L) indicates hypermagnesemia. Neurological manifesta-tions begin to occur when magnesium levels are elevated andare noted as symptoms of neurological depression, such asdrowsiness, sedation, lethargy, respiratory depression, muscleweakness, and areexia. Bradycardia and hypotension alsooccur.BOX 1.5Physiological Integrity
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 28 preview imagePreparationCHAPTER 1Clinical Judgment and the Next Generation NCLEX (NGN)-RN®Examination9A client is scheduled for angioplasty. The client says to thenurse, “I’m so afraid that it will hurt and will make me worseoff 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 thisprocedure.”3.“Those are very normal fears, but please be assuredthat everything will be okay.”4.“Try not to worry. This is a well-known and easy proce-dure for the cardiologist.”Answer: 1This question addresses the subcategory Caring in the cat-egory of Integrated Processes. It also addresses the conceptof communication. The correct option utilizes atherapeuticcommunication techniquethat explores the client’s feelings,determines the level of client understanding about the proce-dure, and displays caring. Option 2 demeans the client anddoes not encourage further sharing by the client. Option 3does 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 theclient and toward the cardiologist’s importance.BOX 1.6Integrated ProcessesTABLE 1.4NGN Item TypesType ofItem/CaseScenarioDescriptionItem TypesStand-aloneItemA stand-alone itemwill include a shortscenario about a clientand will be accompa-nied by one questionthat tests more thanone cognitive skill.Bow-tieTrendUnfoldingCaseAn unfolding casestudy will includephases as the storyabout the client un-folds and changes.This will be accom-panied by six NGNitem type questions,and each of the sixcognitive skills will betested.Highlight in TextHighlight in TableMatrix Multiple ChoiceMatrix Multiple ResponseMultiple Response SelectNMultiple Response SelectAll That ApplyMultiple Response Group-ingDrag and Drop ClozeDrag and Drop RationaleDrop Down ClozeDrop Down RationaleDrop Down in TableFrom Betts, J., Muntean, W., Kim, D, Kao, S. (Winter 2022).Next Genera-tion NCLEX®: Test design. Chicago, NCSBN; National Council of StateBoards of Nursing. (2022).Next Generation NCLEX News. Retrievedfrom NGN_Winter22_English_Final.pdf (ncsbn.org).TABLE 1.5NGN Scoring MethodsMethodDescriptionPlus-Minus(+/-) ScoringOne 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 zerois assigned.Used when the test-taker can select any numberof options, such as a highlight in text, highlightin table, multiple response (select all that apply),multiple response grouping, or a matrix multipleresponseZero-One-(0/1) ScoringOne 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, dropdown cloze, drop down-in-table, matrix multiplechoice, multiple response select N or bow-tieRationaleScoringOne point is given for each correctgroupingof re-sponse elements; both parts of the paired informa-tion must be correct to earn a point. Used whenelements of a response are linked, such as dropdown rationale or drag and drop rationale itemsFrom National Council of State Boards of Nursing. (2021).Next Genera-tion NCLEX News. Retrieved from https://www.ncsbn.org/NGN_Summer21_Eng.pdf; National Council of State Boards of Nursing. (2021).Braving new pathways: Leading the way for regulatory transformation, 2021NCSBN annual meeting.A prescription reads: acetaminophen liquid, 650 mg orallyevery 4 hours PRN for pain. The medication label reads: 500mg/15 mL. The nurse prepares how many milliliters to admin-ister one dose?Fill in the blank. Record your answer using onedecimal place.Answer: 19.5 mLFormula:DesiredAvailable×Volume=mL65050015= 19.5mgmgmLmL×In this question, you need to focus on thesubject,mLper dose, and use the formula for calculating a medicationdose. When the dose is determined, you will need to type yournumeric answer in the answer box. Always follow the specicdirections noted on the computer screen. Also, rememberthat there will be an on-screen calculator on the computer foryour use.BOX 1.7Fill-in-the-Blank QuestionIn addition, you must type in a decimal point if neces-sary. See Box 1.7 for an example.Multiple-Response QuestionFor a multiple-response question, also known as a“select all that apply (SATA)” question, you will be asked
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 29 preview imagePreparationUNIT INCLEX-RN®Exam Preparationto select or check all of the options, such as nursinginterventions, that relate to the information in the ques-tion. In these question types, there may be one correctanswer, there may be more than one correct answer, orall answers could be correct. See Box 1.8 for an example.Ordered-Response QuestionIn 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 needto determine what you will do rst, second, third, andso forth. Specic directions for answering are providedwith the question. See Figure 1.1 for an example.Figure or Hot Spot QuestionA question with a picture or graphic will ask you toanswer the question based on the picture or graphic.The question could contain a chart, a table, or a gure orillustration. You also may be asked to use the computermouse to point and click on a specic area (hot spot)in the visual. A chart, table, gure, or illustration mayappear in any type of question, including a multiple-choice question. See Box 1.10 for an example.Chart/Exhibit QuestionIn this type of question, you will be presented with aclient situation and a chart, medical record, or exhibit.You will be provided with tabs or buttons that you needto click to obtain the information needed to answer thequestion. A prompt or message will appear that will indi-cate the need to click on a tab or button. See Box 1.9 foran example.Graphic Item Option QuestionIn this type of question, the option selections will bepictures rather than text. You will select the optionthat represents your answer choice. See Box 1.11 for anexample.Audio QuestionsAudio questions will require listening to a sound toanswer the question. These questions will prompt you touse the headset provided and to click on the sound icon.You will be able to click on the volume button to adjustthe volume to your comfort level, and you will be ableto listen to the sound as many times as necessary. Con-tent examples include, but are not limited to, variouslung sounds, heart sounds, or bowel sounds. Examplesof this question type are located on the accompanyingEvolve site See Figure 1.2 for an example..The NCSBN provides a practice test for candidatesthat is composed of previously used NCLEX questionsthat 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 canbe purchased through the NCSBN at www.ncsbn.orgRegistering to Take the ExaminationItisimportanttoobtainanNCLEXExaminationCandidateBulletinfromtheNCSBNwebsiteatwww.ncsbn.org, because this bulletin provides all of theinformation you need to register for and schedule yourexamination. It also provides you with website and tele-phone information for NCLEX examination contacts.The initial step in the registration process is to submitan application to the state board of nursing in the statein which you intend to obtain licensure. You need toobtain information from the board of nursing regardingThe emergency department nurse is caring for a child suspected of acute epiglottitis. Which interventions apply in the care of thechild?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 theinformation in the question. Focus on thesubject,interventions for the child with suspected acute epiglottitis. To answer this question,recall that acute epiglottitis is a serious obstructive inammatory process that requires immediate intervention and that airway patencyis a priority. Auscultating lung sounds allows the nurse to obtain information about airway patency without causing further airwaycompromise, which can happen by examining the throat. Examination of the throat with a tongue depressor or attempting to obtain athroat culture is contraindicated because the examination can precipitate further obstruction. A lateral neck and chest x-ray is obtainedto determine the degree of obstruction, if present. To reduce respiratory distress, the child should sit upright. The child is placed onan oxygen saturation monitor to monitor oxygenation status. Tracheostomy and intubation may be necessary if respiratory distress issevere. Remember to follow the specic directions given on the computer screen.BOX 1.8Multiple-Response Question
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 30 preview imagePreparationCHAPTER 1Clinical Judgment and the Next Generation NCLEX (NGN)-RN®Examination11FIG. 1.1Example of an ordered-response question.the specic registration process, because the process mayvary from state to state. Then, use the NCLEX Examina-tion Candidate Bulletin as your guide to complete theregistration process.Following the registration instructions and com-pleting the registration forms precisely and accuratelyare important. Registration forms not properly com-pleted or not accompanied by the proper fees in therequired method of payment will be returned to youand will delay testing. You must pay a fee for takingthe examination; you also may have to pay additionalfees to the board of nursing in the state in which youare applying.Authorization to Test Form andScheduling an AppointmentOnce 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 validitydates on the ATT form, and schedule a testing date andtime before the expiration date on the ATT form. TheNCLEX Examination Candidate Bulletin provides youwith the directions for scheduling an appointment; youdo not have to take the examination in the same state inwhich you are seeking licensure.TheATTformcontainsimportantinformation,including your test authorization number, candidateidentication number, and validity date. You need totake your ATT form to the testing center on the dayof your examination. You will not be admitted to theexamination if you do not have it.Changing Your AppointmentIf for any reason you need to change your appointmentto test, you can make the change on the candidate web-site or by calling candidate services. Refer to the NCLEXExamination Candidate Bulletin for this contact infor-mation and other important procedures for cancelingand changing an appointment. If you fail to arrive forthe examination or fail to cancel your appointmentto test without providing appropriate notice, you willforfeit your examination fee and your ATT form will beinvalidated. This information will be reported to theboard of nursing in the state in which you have appliedfor licensure, and you will be required to register andpay the testing fees again.
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Saunders Comprehensive Review for the NCLEX-RN® Examination (2022) - Page 31 preview imagePreparationUNIT INCLEX-RN®Exam Preparation12BOX 1.9Chart/Exhibit QuestionA 30-year-old client visits the clinic and requests a prescriptionfor oral contraceptives. The nurse performs an assessment onthe client and reviews the history and physical examinationdocumented in the medical record from the client’s previousvisit. The nurse determines that oral contraceptives are contra-indicated because of which documented items?Refer to chart.Select all that apply.Client’s ChartHistory andPhysicalMedicationsDiagnostic ResultsPast medical his-tory:Deep vein throm-bosis with asso-ciated thrombo-phlebitisHypertensionCoronary arterydiseasePrediabetesMultivitamin1 orally dailyLisinopril 40mg orallydailyAtorvastatin10 mg orally dailyMetformin500 mgorally twicedailyRenal ultrasoundshows no hydrone-phrosis, no renalartery stenosisComplete blood cellcount shows whiteblood cells (WBC)5,000 mm3(5 ×9/L), hemoglobin(Hgb) 16 g/dL(60 g/L), hematocrit(Hct) 47% (0.47),platelets 590,000mm3(590 × 109/L)1. Hypertension2. Prediabetes3. Coronary artery disease4. Renal ultrasound results5. Takes multivitamin orally daily6. Takes lisinopril 40 mg orally daily7. Takes atorvastatin 10 mg orally daily8. Complete blood cell count results9. Takes metformin 500 mg orally twice daily10. Past medical history of deep vein thrombosis withassociated thrombophlebitisAnswer: 1, 3, 8, 10This chart/exhibit question provides you with data from theclient’s medical record. Focus on thesubject,the item(s) thatare a contraindication to the use of oral contraceptives. Oralcontraceptives are contraindicated in women with a history ofany of the following: thrombophlebitis and thromboembolicdisorders, 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. Thisclient has prediabetes, which is not a contraindication. Items 1and 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 oralcontraceptives. The renal ultrasound result is not signicant.The medications the client is taking are not specic contraindi-cations to oral contraceptives. The normal WBC is 5000-10,000 mm3(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 mm3(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 andtherefore 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 tothe use of oral contraceptives.BOX 1.10Figure QuestionA client who experienced a myocardial infarction is being monitored via cardiac telemetry. The nurse notes the sudden onset of thiscardiac rhythm on the monitor(refer to figure)andimmediatelytakes which action?1.Takes the client’s blood pressure2.Initiates cardiopulmonary resuscitation (CPR)3.Places a nitroglycerin tablet under the client’s tongue4.Continues to monitor the client and then contacts thecardiologistAnswer: 2This question requires you to identify the cardiac rhythm andthen determine the priority nursing action. Note thestrategicword,immediately.This cardiac rhythm identies a coarse ven-tricular brillation (VF). The goals of treatment are to termi-nate VF promptly and to convert it to an organized rhythm. Thephysician, cardiologist, or an Advanced Cardiac Life Support(ACLS)–qualied nurse must immediately debrillate the client.If a debrillator is not readily available, CPR is initiated until thedebrillator arrives. Options 1, 3, and 4 are incorrect actionsand delay lifesaving treatment.
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