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Saunders Comprehensive Review for the NCLEX-RN® Examination, 8th Edition (2019)

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    Saunders Comprehensive Review for the NCLEX-RN® Examination EIGHTH EDITION Linda Anne Silvestri, PhD, RN Instructor of Nursing, Salve Regina University, Newport, Rhode Island Part-Time Instructor, University of Nevada, Las Vegas, Las Vegas, Nevada President, Nursing Reviews, Inc. and Professional Nursing Seminars, Inc., Henderson, Nevada Elsevier Consultant, HESI NCLEX-RN® and NCLEX-PN® Live Review Courses Angela E. Silvestri, PhD, APRN, FNP-BC, CNE Assistant Professor & BSN Program Director, University of Nevada, Las Vegas, Las Vegas, Nevada Registered Nurse, Henderson Hospital Medical Center, Henderson, Nevada Consultant, Nursing Reviews, Inc., Henderson, Nevada Associate Editor Katherine M. Silvestri, BSN, RN Consultant, Nursing Reviews, Inc., Henderson, Nevada 2

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    Table of Contents Instructions for online access Cover image Title page Copyright Dedication Letter from the Authors About the Authors Contributors Reviewers Contributors to Previous Edition Preface Welcome to Saunders Pyramid to Success! Organization Special Features of the Book Special Features Found on Evolve Practice Questions Pharmacology and Medication Calculations Review 3

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    Next Generation NCLEX (NGN) Questions How to Use This Book Climbing the Pyramid to Success Acknowledgments A Few Words From Linda A Few Words From Angela A Few Words From Both Linda and Angela Unit I: NCLEX-RN® Exam Preparation Chapter 1: The NCLEX-RN® Examination The Pyramid to Success Examination Process Computer Adaptive Testing Development of the Test Plan Test Plan Types of Questions on the Examination Next Generation NCLEX (NGN) Item Types Registering to Take the Examination Authorization to Test Form and Scheduling an Appointment Changing Your Appointment Day of the Examination Testing Accommodations Testing Center Testing Time Length of the Examination Pass-or-Fail Decisions 4

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    Completing the Examination Processing Results Candidate Performance Report Interstate Endorsement and Nurse Licensure Compact The Foreign-Educated Nurse Chapter 2: Pathways to Success The Pyramid to Success Pathways to Success (Box 2-1) This Is Not a Test Chapter 3: The NCLEX-RN® Examination: From a Graduate’s Perspective Chapter 4: Test-Taking Strategies Unit II: Professional Standards in Nursing Introduction Pyramid to Success Client Needs: Learning Objectives Chapter 5: Care of Special Populations Practice Questions Answers Chapter 6: Ethical and Legal Issues Practice Questions Answers Chapter 7: Prioritizing Client Care: Leadership, Delegation, and Emergency 5

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    Response Planning Practice Questions Answers Unit III: Foundations of Care Introduction Pyramid to Success Client Needs: Learning Objectives Chapter 8: Fluids and Electrolytes Practice Questions Answers Chapter 9: Acid-Base Balance Practice Questions Answers Chapter 10: Vital Signs and Laboratory Reference Intervals Practice Questions Answers Chapter 11: Nutrition Practice Questions Answers Chapter 12: Health and Physical Assessment of the Adult Client Practice Questions Answers 6

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    Chapter 13: Provision of a Safe Environment Practice Questions Answers Chapter 14: Calculation of Medication and Intravenous Prescriptions Practice Questions Answers Chapter 15: Perioperative Nursing Care Practice Questions Answers Chapter 16: Positioning Clients Practice Questions Answers Unit IV: Growth and Development Across the Life Span Introduction Pyramid to Success Client Needs: Learning Objectives Chapter 17: Theories of Growth and Development Practice Questions Answers Chapter 18: Growth, Development, and Stages of Life Practice Questions Answers 7

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    Chapter 19: Care of the Older Client Practice Questions Answers Unit V: Maternity Nursing Introduction Pyramid to Success Client Needs: Learning Objectives Chapter 20: Reproductive System Practice Questions Answers Chapter 21: Prenatal Period Practice Questions Answers Chapter 22: Risk Conditions Related to Pregnancy Practice Questions Answers Chapter 23: Labor and Birth Practice Questions Answers Chapter 24: Problems with Labor and Birth Practice Questions Answers 8

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    Chapter 25: Postpartum Period Practice Questions Answers Chapter 26: Postpartum Complications Practice Questions Answers Chapter 27: Care of the Newborn Practice Questions Answers Chapter 28: Maternity and Newborn Medications Practice Questions Answers Unit VI: Pediatric Nursing Introduction Pyramid to Success Client Needs: Learning Objectives Chapter 29: Integumentary Problems Practice Questions Answers Chapter 30: Hematological Problems Practice Questions Answers 9

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    Chapter 31: Oncological Problems Practice Questions Answers Chapter 32: Metabolic and Endocrine Problems Practice Questions Answers Chapter 33: Gastrointestinal Problems Practice Questions Answers Chapter 34: Eye, Ear, and Throat Problems Practice Questions Answers Chapter 35: Respiratory Problems Practice Questions Answers Chapter 36: Cardiovascular Problems Practice Questions Answers Chapter 37: Renal and Genitourinary Problems Practice Questions Answers Chapter 38: Neurological and Cognitive Problems Practice Questions 10

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    Answers Chapter 39: Musculoskeletal Problems Practice Questions Answers Chapter 40: Immune Problems and Infectious Diseases Practice Questions Answers Chapter 41: Pediatric Medication Administration and Calculations Practice Questions Answers Unit VII: Integumentary Problems of the Adult Client Introduction Pyramid to Success Client Needs: Learning Objectives Chapter 42: Integumentary Problems Practice Questions Answers Chapter 43: Integumentary Medications Practice Questions Answers Unit VIII: Oncological and Hematological Problems of the Adult Client 11

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    Introduction Pyramid to Success Client Needs: Learning Objectives Chapter 44: Oncological and Hematological Problems Practice Questions Answers Chapter 45: Oncological and Hematological Medications Practice Questions Answers Unit IX: Endocrine Problems of the Adult Client Introduction Pyramid to Success Client Needs: Learning Objectives Chapter 46: Endocrine Problems Practice Questions Answers Chapter 47: Endocrine Medications Practice Questions Answers Unit X: Gastrointestinal Problems of the Adult Client 12

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    Introduction Pyramid to Success Client Needs: Learning Objectives Chapter 48: Gastrointestinal Problems Practice Questions Answers Chapter 49: Gastrointestinal Medications Practice Questions Answers Unit XI: Respiratory Problems of the Adult Client Introduction Pyramid to Success Client Needs: Learning Objectives Chapter 50: Respiratory Problems Practice Questions Answers Chapter 51: Respiratory Medications Practice Questions Answers Unit XII: Cardiovascular Problems of the Adult Client 13

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    Introduction Pyramid to Success Client Needs: Learning Objectives Chapter 52: Cardiovascular Problems Practice Questions Answers Chapter 53: Cardiovascular Medications Practice Questions Answers Unit XIII: Renal and Urinary Problems of the Adult Client Introduction Pyramid to Success Client Needs: Learning Objectives Chapter 54: Renal and Urinary Problems Practice Questions Answers Chapter 55: Renal and Urinary Medications Practice Questions Answers Unit XIV: Eye and Ear Problems of the Adult Client 14

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    Introduction Pyramid to Success Client Needs: Learning Objectives Chapter 56: Eye and Ear Problems Practice Questions Answers Chapter 57: Eye and Ear Medications Practice Questions Answers Unit XV: Neurological Problems of the Adult Client Introduction Pyramid to Success Client Needs: Learning Objectives Chapter 58: Neurological Problems Practice Questions Answers Chapter 59: Neurological Medications Practice Questions Answers Unit XVI: Musculoskeletal Problems of the Adult Client 15

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    Introduction Pyramid to Success Client Needs: Learning Objectives Chapter 60: Musculoskeletal Problems Practice Questions Answers Chapter 61: Musculoskeletal Medications Practice Questions Answers Unit XVII: Immune Problems of the Adult Client Introduction Pyramid to Success Client Needs: Learning Objectives Chapter 62: Immune Problems Practice Questions Answers Chapter 63: Immune Medications Practice Questions Answers Unit XVIII: Mental Health Problems of the Adult Client 16

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    Introduction Pyramid to Success Client Needs: Learning Objectives Chapter 64: Foundations of Mental Health Nursing Practice Questions Answers Chapter 65: Mental Health Problems Practice Questions Answers Chapter 66: Addictions Practice Questions Answers Chapter 67: Crisis Theory and Intervention Practice Questions Answers Chapter 68: Psychiatric Medications Practice Questions Answers Unit XIX: Complex Care Introduction Pyramid to Success 17

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    Client Needs: Learning Objectives Chapter 69: Complex Care Practice Questions Answers Unit XX: Comprehensive Test Introduction Practice Questions Answers References Index Last Page United States (U.S.) Top 100 Prescription Medications (by Generic Name) 18

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    Copyright Elsevier 3251 Riverport Lane St. Louis, Missouri 63043 SAUNDERS COMPREHENSIVE REVIEW FOR THE NCLEX-RN® EXAMINATION EIGHTH EDITION ISBN: 978-0-323-35841-5 Copyright © 2020 by Elsevier, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notice Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. NCLEX®, NCLEX-RN®, and NCLEX-PN® are registered trademarks of the National Council of State Boards of Nursing, Inc. Previous editions copyrighted 2017, 2014, 2012, and 2009. Library of Congress Control Number: 2019946366 Senior Content Strategist: Jamie Blum Senior Content Development Specialist: Laura Goodrich 19

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    Publishing Services Manager: Julie Eddy Senior Project Manager: Cindy Thoms Senior Book Designer: Amy Buxton Printed in Canada Last digit is the print number: 9 8 7 6 5 4 3 2 1 20

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    Dedication In loving memory of my parents— To my mother, Frances Mary , and my father, Arnold Lawrence , who taught me to always love, care, and be the best that I could be. My memories of their love, support, and words of encouragement will remain in my heart forever! Linda Anne Silvestri To my parents, Mary Elizabeth and Lawrence Peter , who have instilled in me the values of working hard and being selfless, and who have been my support system as I pursue my professional goals and life aspirations. My success thus far would not have been possible without them. From the bottom of my heart, thank you, Mom & Dad! Angela E. Silvestri 21

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    Letter from the Authors To All Future Registered Nurses, Congratulations to you! You should be very proud and pleased with yourself on your most recent well- deserved accomplishment of completing your nursing program to become a registered nurse. We know that you have worked very hard to become successful and that you have proven to yourself that indeed you can achieve your goals. In our opinion, you are about to enter the most wonderful and rewarding profession that exists. Your willingness, desire, and ability to assist those who need nursing care will bring great satisfaction to your life. In the profession of nursing, your learning will be a lifelong process. This aspect of the profession makes it stimulating and dynamic. Your learning process will continue to expand and grow as the profession continues to evolve. Your next very important endeavor will be the learning process involved to achieve success in your examination to become a registered nurse. We are excited and pleased to be able to provide you with the Saunders Pyramid to Success products, which will help you prepare for your next important professional goal, becoming a registered nurse. We want to thank all of our former and current nursing students whom we have assisted in their studies for the NCLEX-RN® examination for their willingness to offer ideas regarding their needs in preparing for licensure. Student ideas have certainly added a special uniqueness to all of the products available in the Saunders Pyramid to Success . Saunders Pyramid to Success products provide you with everything that you need to ready yourself for the NCLEX-RN examination. These products include material that is required for the NCLEX-RN examination for all nursing students regardless of educational background, specific strengths, areas in need of improvement, or clinical experience during the nursing program. So let’s get started and begin our journey through the Saunders Pyramid to Success , and welcome to the wonderful profession of nursing! Sincerely, Dr. Linda Anne Silvestri and Dr. Angela E. Silvestri 22

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    About the Authors Linda Anne Silvestri, PhD, RN (Photo by Laurent W. Valliere.) As a child, I always dreamed of becoming either a nurse or a teacher. Initially I chose to become a nurse because I really wanted to help others, especially those who were ill. Then I realized that both of my dreams could come true; I could be both a nurse and a teacher. So I pursued my dreams. I received my diploma in nursing at Cooley Dickinson Hospital School of Nursing in Northampton, Massachusetts. Afterward, I worked at Baystate Medical Center in Springfield, Massachusetts, where I cared for clients in acute medical-surgical units, the intensive care unit, the emergency department, pediatric units, and other acute care units. Later I received an associate degree from Holyoke Community College in Holyoke, Massachusetts; my BSN from American International College in 23

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    Springfield, Massachusetts; and my MSN from Anna Maria College in Paxton, Massachusetts, with a dual major in Nursing Management and Patient Education. I received my PhD in Nursing from the University of Nevada, Las Vegas, and conducted research on self-efficacy and the predictors of NCLEX® success. I am also a member of the Honor Society of Nursing, Sigma Theta Tau International, Phi Kappa Phi, the American Nurses Association, the National League for Nursing, the Western Institute of Nursing, the Eastern Nursing Research Society, and the Golden Key International Honour Society. In addition, I received the 2012 Alumna of the Year/Nurse of the Year Award from the University of Nevada, Las Vegas, School of Nursing. I was selected for Fellowship in the American Academy of Nursing and will be inducted in October, 2019. As a native of Springfield, Massachusetts, I began my teaching career as an instructor of medical-surgical nursing and leadership-management nursing in 1981 at Baystate Medical Center School of Nursing. In 1989, I relocated to Rhode Island and began teaching advanced medical-surgical nursing and mental health nursing to RN and LPN students at the Community College of Rhode Island. While teaching there, a group of students approached me for assistance in preparing for the NCLEX examination. I have always had a very special interest in test success for nursing students because of my own personal experiences with testing. Taking tests was never easy for me, and as a student I needed to find methods and strategies that would bring success. My own difficult experiences, desire, and dedication to assist nursing students to overcome the obstacles associated with testing inspired me to develop and write the many products that would foster success with testing. My experiences as a student, nursing educator, and item writer for the NCLEX examinations aided me as I developed a comprehensive review course to prepare nursing graduates for the NCLEX examination. Later, in 1994, I began teaching medical-surgical nursing at Salve Regina University in Newport, Rhode Island, and I remain there as an adjunct faculty member preparing senior nursing students for the NCLEX-RN examination. Also, I am currently a part-time instructor at the University of Nevada, Las Vegas. I established Professional Nursing Seminars, Inc. in 1991 and Nursing Reviews, Inc. in 2000. These companies are located in Henderson, Nevada. Both companies are dedicated to helping nursing graduates achieve their goals of becoming registered nurses, licensed practical/vocational nurses, or both. Today, I am the successful author of numerous review products. Also, I serve as an Elsevier consultant for HESI Live Reviews, the review courses for the NCLEX examinations conducted throughout the country. I am so pleased that you have decided to join me on your journey to success in testing for nursing examinations and for the NCLEX-RN examination! 24

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    Angela E. Silvestri, PhD, APRN, FNP-BC, CNE (Photo by Brent A. Elmore) Being a nurse is one of the most enriching aspects of my life. It is a career that is multifaceted and complex, and allows me to be challenged scientifically, technically, and spiritually. As a nurse educator, I feel honored to impart my knowledge and experience to others who are hoping to serve in this selfless, caring profession. As a nurse scientist, I aim to make an impact on health care delivery methods, quality of care provided, and overall health care outcomes. I earned my baccalaureate of science in nursing at Salve Regina University in Newport, Rhode Island. Upon graduation, I worked in long-term care, subacute care, rehabilitation, and acute care settings. I continue to work as a bedside nurse to maintain my technical skills set and to remain apprised of the changes reflected in health care today. I had the opportunity to serve as a preceptor for new graduate RNs while working in these areas. With the desire to become an educator, I pursued my Master of Science in nursing with a focus in education from the University of Nevada, Las Vegas, and began my teaching career. I continued my studies in the Doctor of Philosophy program at the University of Nevada, Las Vegas, focusing on beginning my research program as a nurse scientist. I completed my postgraduate certificate in advanced practice recently and am looking forward to serving in the role of the advanced practice nurse. Throughout the years, I have worked extensively in the development of NCLEX 25

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    review products, as well as with students in live review courses for the NCLEX. I am very excited at the prospect of helping graduates take the final step in becoming a licensed nurse. Thank you for your dedication to the profession of nursing, and I hope you find this resource useful as you move forward in your journey in becoming a licensed nurse. If you don’t already know, nursing is an amazing profession! 26

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    Contributors Consultants Dianne E. Fiorentino Research Coordinator, Nursing Reviews, Inc., Henderson, Nevada James J. Guilbault, PharmD, BS Pharmacy Manager, Walgreens Pharmacy, Palmer, Massachusetts Clinical Staff Pharmacist, Mercy Medical Center, Springfield, Massachusetts Nicholas L. Silvestri, BA Editorial and Communications Analyst, Nursing Reviews, Inc., Henderson, Nevada Contributors Carmen George, DNP, MSN, BSN, APRN, WHNP-C Women’s Health Associates of Southern Nevada, Las Vegas, Nevada Eileen H. Gray, DNP, RN, CPNP Adjunct Professor, Nursing, Salve Regina University, Newport, Rhode, Island Debra Hagler, PhD, RN, ACNS-BC, CNE, CHSE, ANEF, FAAN Clinical Professor, College of Nursing and Health Innovation, Arizona State University, Phoenix, Phoenix, Arizona Lisa Nicholas, MSN, RN Clinical Instructor/Lecturer, School of Nursing, University of Nevada, Las Vegas Registered Nurse, Sunrise Hospital Medical Center, Las Vegas, Nevada Paula Richards, BA Counsellor, Behaviorial Health, Baystate Medical Center, Springfield, Massachusetts Katherine M. Silvestri, BSN, RN Associate Editor, Consultant, Nursing Reviews, Inc., Henderson, Nevada Jane Tyerman, RN, MScN, PhD Professor, Nursing, Trent/Fleming School of Nursing, Peterborough, Ontario, Canada Laurent W. Valliere, BS, DD Vice President, Professional Nursing Seminars, Inc. Marketing, Nursing Reviews, Inc., Henderson, Nevada 27

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    Reviewers Amber Ballard, MSN, RN Registered Nurse, Emergency Department, Sparrow Health System, Lansing, Michigan Brenda A. Battle, RN, BSN, MBA Vice President, Urban Health Initiative and Chief Diversity, Inclusion and Equity Officer Administration, The Office of Community Affairs and Diversity, Inclusion and Equity, The University of Chicago Medicine, Chicago, Illinois Dawn Carpenter, DNP, ACNP-BC, CCRN Assistant Professor, Coordinator, Adult Gerontology Acute Care Nurse Practitioner track, University of Massachusetts Medical School, Worcester, Massachusetts Mary Carrico, MSN, RN Associate Professor of Nursing, West Kentucky Community and Technical College, Paducah, Kentucky Debra A. Cherubini, PhD, RN Assistant Professor, Chair, Department of Nursing, Salve Regina University, Newport, Rhode, Island Kim Clevenger, EdD, MSN, RN, BC Associate Professor of Nursing, Morehead State University, Morehead, Kentucky Christine R. Durbin, PhD, JD, RN Associate Professor and Chair, Primary Care & Health Systems, Southern Illinois University Edwardsville School of Nursing, Edwardsville, Illinois Janine Eagon, RNC, MS, CNS Certified Inpatient Obstetrics Professor, Nursing Faculty, Bryant & Stratton College, Wauwatosa, Wisconsin Alena Grewal, MSN, APRN, FNP-BC Clinical Instructor, University of Nevada, Las Vegas School of Nursing, Las Vegas, Nevada Jessica Leanne Grimm, DNP, APRN, ACNP-BC, CNE Assistant Professor, College of Nursing, Touro University Nevada, Henderson, Nevada Brad Harrell, DNP, APRN, ACNP-BC Assistant Professor, Director of MSN and TNeCampus Programs, Loewenberg College of Nursing, University of Memphis, Memphis, Tennessee Kimberly Head, BA, BS, DC Director, Healthcare Programs, Collin College, Plano, Texas Tiffany Jakubowski, BSN, RN, CMSRN, ONC Clinical Nurse III, Ortho/Neuro, 28

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    Longmont United Hospital, Longmont, Colorado Ronald Jolley, MSN, RN Registered Nurse, Adult Health Medical-Surgical, Henderson Hospital, Henderson, Nevada Clinical Instructor, Chamberlain College of Nursing, Las Vegas, Nevada Donna E. McCabe, DNP, APRN-BC, GNP Clinical Assistant Professor, New York University Rory Meyers College of Nursing, New York, New York Janis Longfield McMillan, MSN, RN, CNE Associate Clinical Professor, School of Nursing, Northern Arizona University, Flagstaff, Arizona Lisa Nicholas, MSN, RN Clinical Instructor/Lecturer, School of Nursing, University of Nevada, Las Vegas Registered Nurse, Sunrise Hospital Medical Center, Las Vegas, Nevada David Petersen, MSN-Ed, RN Adjunct Faculty, Paradise Valley Community College, Phoenix, Arizona Karen Petersen, MSN-L, RN Adjunct Faculty, Maricopa Community College District, Phoenix, Arizona Misty Britt Stone, MSN RN Clinical Assistant Professor, Nursing, The University of North Carolina at Pembroke, Pembroke, North Carolina Jane Tyerman, RN, MScN, PhD Professor, Nursing, Trent/Fleming School of Nursing, Peterborough, Ontario, Canada Joanna Van Sant, MSN, RN RN Team Coordinator, Pain Management, Sentara Princess Anne Hospital, Virginia Beach, Virginia Veronica Vital, PhD, RN Clinical Assistant Professor, University of Arizona— College of Nursing, Tucson, Arizona Student and Graduate Reviewers Lea Adams, Graduate Nurse Salve Regina University, Newport, Rhode, Island Margaret Adams, Student Nurse Salve Regina University, Newport, Rhode, Island Emily Besaw, Student Nurse Salve Regina University, Newport, Rhode, Island Megan Bosetti, Student Nurse Salve Regina University, Newport, Rhode, Island Jenna Lynn Boyle, Student Nurse Salve Regina University, Newport, Rhode, Island Isabella Buda, Graduate Nurse Salve Regina University, Newport, Rhode, Island 29

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    Monica Burritt, MAEd, BSN, RN Graduate, Northern Arizona University, Flagstaff, Arizona Morgan Cahill, Graduate Nurse Salve Regina University, Newport, Rhode, Island Hayley Cambrola, Graduate Nurse Salve Regina University, Newport, Rhode, Island Jennifer Carlson, RN, BSN Graduate, Chamberlain College of Nursing, Phoenix, Arizona Mary Cugini, Student Nurse Salve Regina University, Newport, Rhode, Island Kirsten Cunneen, Graduate Nurse Salve Regina University, Newport, Rhode, Island Stefanie Dias, Graduate Nurse Salve Regina University, Newport, Rhode, Island Caitlin Ecsedy, Graduate Nurse Salve Regina University, Newport, Rhode, Island Kelly Feola, Student Nurse Salve Regina University, Newport, Rhode, Island Megan Gilmore, Student Nurse Salve Regina University, Newport, Rhode, Island Megan Guest, Student Nurse Salve Regina University, Newport, Rhode, Island Ashley Haskell, Student Nurse Salve Regina University, Newport, Rhode, Island Kristen Hickey, Graduate Nurse Salve Regina University, Newport, Rhode, Island Valerie Huard, Student Nurse Salve Regina University, Newport, Rhode, Island Ariana Incorvati, Student Nurse Salve Regina University, Newport, Rhode, Island Hathaithip Keophakdy, Student Nurse Salve Regina University, Newport, Rhode, Island Michaela Lacerra, Student Nurse Salve Regina University, Newport, Rhode, Island Brianna Machnacz, Student Nurse Salve Regina University, Newport, Rhode, Island Elizabeth Maher, Student Nurse Salve Regina University, Newport, Rhode, Island Kara Merryfield, Graduate Nurse Salve Regina University, Newport, Rhode, Island 30

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