eBook: Saunders Q & A Review for the NCLEX-RN Examination 5th Silvestri 978-1437720228

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  • eBook: Saunders Q & A Review for the NCLEX-RN Examination 5th Silvestri 978-1437720228
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  • Published: 2011
  • ISBN-10: 1437720226
  • ISBN-13: 978-1437720228

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eBook: Saunders Q & A Review for the NCLEX-RN Examination 5th Silvestri 978-1437720228

Chapter 1

The NCLEX-RNW Examination

PYRAMID TO SUCCESS

Welcome to Saunders Q&A Review for the NCLEX-RNW Examination,

the second component of the Pyramid to Success! At this

time, you have completed your first path toward the peak of the

pyramid with Saunders Comprehensive Review for the NCLEXRN

W Examination. Now it is time to continue that journey to

become a registered nurse with Saunders Q&A Review for the

NCLEX-RNW Examination.

As you begin your journey through this book, you will be

introduced to all of the important points regarding the NCLEXRN

examination, the types of questions on the NCLEX, the process

of testing, and the unique and special tips regarding how to

prepare yourself academically and nonacademically for this

very important examination. You will read what a nursing

graduate who passed the NCLEX-RN examination has to say

about the examination. All of those important test-taking

strategies are detailed. These details will guide you in selecting

the correct option or in selecting an answer when you need

to guess.

About This Book

Saunders Q&A Review for the NCLEX-RNW Examination contains

more than 5800 NCLEX-RN–style practice questions. Question

types include multiple choice, multiple response, fill-in-theblank,

prioritizing (ordered-response); also known as drag

and drop), image (“hot spot”), chart/exhibit, graphic options,

and audio and video. The chapters have been developed to provide

a description of the components of the NCLEX-RN test

plan, including the Client Needs and the Integrated Processes.

In addition, chapters have been prepared to contain practice

questions specific to each category of Client Needs and the Integrated

Processes.

A rationale, priority nursing tip, test-taking strategy, and

reference source containing a page number are provided with

each question. Each question is coded on the basis of the Level

of Cognitive Ability, Client Needs category, Integrated Process,

and the Content Area being tested. The rationale contains significant

information regarding both the correct and incorrect

options. The priority nursing tip provides you with key information

about a nursing concept. The test-taking strategy maps

out a logical path for selecting the correct option and identifies

the content area to review, if necessary. The reference source

and page number provide easy access to the information that

you need to review.

Other Parts of the Pyramid to Success

Saunders Comprehensive Review for the

NCLEX-RNW Examination

Saunders Comprehensive Review for the NCLEX-RNW Examination

is a “must-have” book and is specially designed to help you begin

your successful journey to the peak of the pyramid, becoming

a registered nurse. Each of the content areas in this book

begins with the Pyramid to Success. The Pyramid to Success addresses

specific points related to the NCLEX-RN examination,

including the Pyramid Terms, and the Client Needs and Integrated

Processes as identified in the test plan framework for

the examination. Pyramid Terms are key words that are defined

and are set in boldface throughout each chapter to direct your

attention to those significant points for the examination. The

Client Needs and the Integrated Processes specific to the content

of the chapter are identified.

Throughout each chapter, you will find Pyramid Point

bullets that identify areas most likely to be tested on the

NCLEX-RN examination. You can test your strengths and abilities

by taking all the practice tests provided in this book and

on the accompanying Evolve Web site. Be sure to read all the

rationales and test-taking strategies. The rationale provides

you with significant information regarding the correct and incorrect

options. The test-taking strategy provides you with the

logical path to selecting the correct option. The test-taking

strategy also identifies the content area to review, if required.

The reference source and page number are provided so that

you can find the information easily that you need to review.

Each question is coded based on the Level of Cognitive Ability,

the Client Needs category, the Integrated Process, and the

nursing Content Area. This book also contains all question

types and Priority Nursing Action boxes that provide clinical

situations and the actions that the nurse should take in order

of priority and Pyramid Alerts that provide you with important

information about nursing concepts.

HESI/Saunders Online Review for the NCLEX-RNW

Examination

HESI/Saunders Online Review for the NCLEX-RNW Examination

addresses all areas of the test plan identified by the National

Council of State Boards of Nursing (NCSBN). The course contains

a pretest that provides feedback regarding your strengths

and weaknesses. After taking the pretest, an individualized

study schedule in a calendar format is generated to provide

guidance in preparing for the NCLEX. Content review is in

an outline format and includes self-check practice questions

2

and case studies, figures and illustrations, a glossary, and animations

and videos. Additional practice exams include 100-question

end of module exams, five “Crossing the Finish Line”

100-question exams, and a comprehensive exam. Types of practice

questions in this course include multiple choice, multiple

response, fill-in-the-blank, ordered-response (prioritizing); also

known as drag and drop), image (“hot spot”); chart/exhibit,

graphic options, heart and lung sound, and video.

Saunders Strategies for Test Success: Passing

Nursing School and the NCLEXW Exam

Saunders Strategies for Test Success: Passing Nursing School and the

NCLEXW Exam focuses on the test-taking strategies that will help

you pass your nursing examinations while in nursing school and

will prepare you for the NCLEX-RN examination. The chapters

describe all the test-taking strategies and include several sample

questions that illustrate howto use the test-taking strategy. There

are a total of 500 NCLEX-style questions, including multiplechoice

and alternate itemformat questions.NCLEX tips and tips

for the beginning nursing student are included. Several appendixes

are included that provide a review of test-taking strategies,

cultural characteristics and practices, pharmacology strategies,

medication and intravenous calculations, laboratory values, positioning

guidelines, and therapeutic diets.

Saunders Mobile Review Questions for the

NCLEX-RNW Exam

This app allows you to study on the go and access questions by

client need or content area to get the practice that you need

most. The main app contains 1500 questions, with 1000 additional

questions available for purchase. These 2500NCLEX-style

questions include multiple choice and alternate item format

questions, as well as rationales, test-taking strategies, and references

for each question. The app can be purchased by searching

“Saunders Mobile Review Questions for the NCLEX-RN Exam”

in the iTunes store at http://store.apple.com/us. For a free 25-

question version of the app, search “Saunders Mobile Review

Questions for the NCLEX-RN Exam Lite.”

Saunders Q&A Review Cards for the

NCLEX-RNW Exam

The Saunders Q&A Review Cards for the NCLEX-RNW Exam is organized

specifically by the Test Plan framework of the current

NCLEX-RN test plan. This product provides you with 1000

practice test questions on portable and easy to use cards. The

question is on the front of the card and the answer, rationale,

test-taking strategy, and Integrated Process code is on the back

of the card. This product includes both multiple choice questions

and alternate item format questions including fill-inthe-

blank, multiple response, prioritizing (ordered response),

image (hot spot questions), and chart/exhibit questions. All

the products in Saunders Pyramid to Success can be obtained

online by visiting http://www.elsevierhealth.com or by calling

800-426-4545.

Let’s begin our journey through the Pyramid to Success.

THE EXAMINATION PROCESS

An important step in the Pyramid to Success is to become as

familiar as possible with the examination process. A significant

amount of anxiety can occur in candidates facing the

challenge of this examination. Knowing what the examination

is all about and knowing what you will encounter during

the process of testing will assist in alleviating fear and anxiety.

The information contained in this chapter addresses the procedures

related to the development of the NCLEX-RN examination

test plan, the components of the test plan, and the

answers to the questions most commonly asked by nursing

students and graduates preparing to take the NCLEX-RN examination.

The information contained in this chapter related

to the test plan was obtained from the NCSBN Web site

(http://www.ncsbn.org) and the National Council of State

Boards of Nursing Test Plan for the NCLEX-RN Examination

(effective date, April 2010). You can obtain additional information

regarding the test and its development by accessing

the NCSBN Web site at www.ncsbn.org or by writing to the

National Council of State Boards of Nursing, 111 East Wacker

Drive, Suite 2900, Chicago, IL 60601. You are encouraged to

access the NCSBNWeb site because the site provides youwith

valuable information about the NCLEX and other resources

available to an NCLEX candidate.

COMPUTER ADAPTIVE TESTING

The acronym CAT stands for computer adaptive test, which

means that the examination is created as the test-taker answers

each question. All the test questions are categorized

based on the test plan structure and the level of difficulty of

the question. As you answer a question, the computer determines

your competency based on the answer you selected. If

you selected a correct answer to a question, the computer scans

the question bank and selects a more difficult question. If you

selected an incorrect answer, the computer scans the question

bank and selects an easier question. This process continues until

the test plan requirements are met and a reliable pass or fail

decision is made. Additional information about computer

adaptive testing can be located at the NCSBN Web site.

When a test question is presented on the computer screen,

you must answer it or the test will not move on. This means

that you will not be able to skip questions, go back and review

questions, or go back and change answers. Remember, in a

CAT examination, once an answer is recorded, all subsequent

questions administered depend, to an extent, on the answer selected

for that question. Skipping and returning to earlier questions

are not compatible with the logical methodology of a

computer adaptive test. The inability to skip questions or go

back to change previous answers will not be a disadvantage

to you. Actually, you will not fall into that “trap” of changing

a correct answer to an incorrect one with the CAT system.

If you are faced with a question that contains unfamiliar

content, you may need to guess at the answer. There is no penalty

for guessing on this examination. Remember, with most of

the questions, the answer will be right there in front of you. If

you need to guess, use your nursing knowledge and clinical experiences

to their fullest extent, as well as all the test-taking

strategies that you have practiced in this review program.

You do not need any computer experience to take this examination.

A keyboard tutorial is provided and administered

to all test-takers at the start of the examination. The tutorial

will instruct you on the use of the on-screen optional calculator,

the use of the mouse, and how to record an answer.

CHAPTER 1 The NCLEX-RN s3 W Examination

In addition to the traditional four-option multiple-choice

question, the tutorial also provides instructions on how to respond

to alternate itemformat questions. This tutorial is provided

on the NCSBNWeb site and you are encouraged to view

the tutorial when you are preparing for the NCLEX. Additionally,

at the testing site, a proctor is present to assist in explaining

the use of the computer to ensure your full understanding

of how to proceed.

DEVELOPMENT OF THE TEST PLAN

The test plan for the NCLEX-RN examination is developed by

the NCSBN. The NCLEX examination is a national examination;

therefore, the NCSBN considers the legal scope of nursing

practice as governed by state laws and regulations, including

the nurse practice act, and uses these laws to define the areas

on the examination that will assess the competence of the test

taker for licensure.

The NCSBN also conducts a very important study every

3 years, known as a practice analysis study, to determine

the framework for the test plan for the examination. The participants

in this study include newly licensed registered

nurses from all types of basic nursing education programs.

The participants select from a list provided those nursing

activities that they perform, the frequency of performing

these specific activities, their impact on maintaining client

safety, and the setting where the activities were performed.

A panel of content experts at the NCSBN analyzes the results

of the study and makes decisions regarding the test plan

framework. The results of this study,most recently conducted

in 2008, provided the structure for the test plan implemented

in April 2010.

ITEM WRITERS

The NCSBN selects question (item) writers after an extensive

application process. The writers are registered nurses who hold

a master’s or higher degree. Many of the writers are nursing

educators; however, a nurse currently employed in clinical

nursing practice and working directly with nurses who have

entered practice within the last 12 months may be selected

to participate in this process. Question writers voluntarily submit

an application to become a writer and must meet specific

criteria established by the council to be accepted as participants

in the process.

THE TEST PLAN

The content of the NCLEX-RN examination reflects the

activities identified in the practice analysis study conducted by

the NCSBN. The questions are written to address the levels of

cognitive ability, Client Needs, and Integrated Processes as

identified in the test plan developed by the NCSBN (Box 1-1).

Levels of Cognitive Ability

The practice of nursing requires critical thinking in decision

making. Therefore, most questions on the NCLEX examination

are written at the applying level or higher levels of cognitive

ability, such as the analyzing, synthesizing, evaluating, and

creating levels. Box 1-2 presents an example of a question that

requires you to apply data.

Client Needs

In the test plan implemented in April 2010, the NCSBN has

identified a test plan framework based on Client Needs. The

NCSBN identifies four major categories of Client Needs including

Safe and Effective Care Environment, Health Promotion

and Maintenance, Psychosocial Integrity, and Physiological Integrity.

Some of these categories are further divided into subcategories.

Refer to Chapter 6 for a detailed description of the

categories of Client Needs and the NCLEX-RN examination,

and refer to Table 1-1 for the percentages of questions from

each Client Needs category.

Integrated Processes

The NCSBN identifies four processes that are fundamental to

the practice of nursing. These processes are a component

of the test plan and are incorporated throughout the major

categories of Client Needs. Box 1-3 identifies these processes.

Refer to Chapter 7 for a detailed description of the Integrated

Processes and the NCLEX-RN examination.

tBox 1-1 Examination Questions

Each examination question addresses:

• A Level of Cognitive Ability

• A Client Needs category

• An Integrated Process

tBox 1-2 Level of Cognitive Ability

Question

A woman at 32 weeks’ gestation is brought into the emergency department

after an automobile accident. The client is bleeding vaginally

and fetal assessment indicates moderate fetal distress.

Which of the following should the nurse do first in an attempt to reduce

the stress on the fetus?

1. Start intravenous (IV) fluids at a keep open rate.

2. Set up for an immediate cesarean section delivery.

3. Elevate the head of the bed to a semi-Fowler’s position.

4. Administer oxygen via a facemask at 7 to 10liters per minute.

Answer: 4

Rationale:

This question requires you to identify the first nursing action that

you will take. Administering oxygen will increase the amount of

oxygen for transport to the fetus, partially compensating for the loss

of circulating blood volume. This action is essential regardless of

the cause or amount of bleeding. IV fluids will also be initiated.

The client will be positioned per physician’s prescription. Although

a cesarean delivery may be needed, there are no data that indicate

it is necessary at this time.

Level of Cognitive Ability:

Applying

Reference

Perry, S., Hockenberry, M., Lowdermilk, D., & Wilson, D. (2010). Maternal

child nursing care (4th ed.). St. Louis: Elsevier.

s4 UNIT I NCLEX-RNW Preparation

TYPES OF QUESTIONS ON

THE EXAMINATION

The types of questions that may be administered on the examination

(Box 1-4) include multiple choice, fill in the blank,

multiple response, prioritizing (ordered response; also

known as drag and drop), questions that contain a picture

or graphic (hot spot), chart/exhibit, graphic options, and audio

or video item formats. Some questionsmay require you to

use the mouse and cursor on the computer. For example, you

may be presented with a visual that displays the heart of an

adult client. In this visual, you may be asked to “point and

click” (using the mouse) on the area where you would place

the stethoscope to count the apical heart rate. In all types of

questions, the answer is scored as either right or wrong. In

other words, credit is not given for a partially correct answer.

Additionally, all question types may include pictures,

graphics, tables, charts, sound, or video. The NCSBN provides

specific directions for you to follow with all question types

to guide you in your process of testing. Be sure to read these

directions as they appear on the computer screen. Examples of

some of these types of questions are noted in this chapter.

Most question types are placed in this book, and all types

are on the accompanying Evolve Web site.

Multiple-Choice Questions

Most of the questions that you will be asked to answer will be

in the multiple-choice format. These questions provide you

with data about a client situation and four answers or options.

There will be only one correct answer.

Fill-in-the-Blank Questions

Fill-in-the-blank questions may ask you to perform a medication

calculation, determine an intravenous flow rate, or

calculate an intake or output record on a client. You will need

to type only a number (your answer) in the answer box.

The unit of measure for your answer will already be noted

for you outside of the answer box. If the question requires

rounding the answer, this needs to be performed at the

end of the calculation. The rules for rounding an answer

are provided in the tutorial provided by the NCSBN and

are also provided in the specific question. Additionally,

you must type in a decimal point if necessary; however, it

is not necessary to type a “0” before the decimal point. See

Box 1-5 for an example.

tBox 1-4 Types of Questions on NCLEX

Multiple choice

Multiple response (select all that apply)

Fill-in-the blank

Prioritizing (ordered response or drag and drop)

Picture or graphic (hot spot)

Chart/exhibit

Graphic options

Audio (heart, lung, bowel sounds)

Video

tBox 1-5 Fill-in-the-Blank

Question

The physician prescribes 12 mEq of liquid potassium chloride. The

medication label reads 20 mEq/15 mL. The nurse administers

how many mL to the client?

Answer: 9 mL

Rationale:

For this fill-in-the-blank question, use the formula for calculating

medication doses. Once the dose is determined, you will need to

type your numeric answer in the answer box. Always follow the specific

directions noted on the computer screen when answering a

question. Also, remember that there will be an on-screen calculator

on the computer for your use if needed.

Formula:

Desired

Available

mL . mL per dose

12 mEq

20 mEq

15 mL . 9 mL

Reference

Potter, P., & Perry, A. (2009). Fundamentals of nursing (7th ed.).

St. Louis: Mosby.

Table 1-1 Client Needs Categories and Percentage of

Questions on the NCLEX-RNW Examination

Client Needs Category

Percentage of

Questions

Safe and Effective Care Environment

Management of Care 16%-22%

Safety and Infection Control 8%-14%

Health Promotion and Maintenance 6%-12%

Psychosocial Integrity 6%-12%

Physiological Integrity

Basic Care and Comfort 6%-12%

Pharmacological and Parenteral

Therapies

13%-19%

Reduction of Risk Potential 10%-16%

Physiological Adaptation 11%-17%

From National Council of State Boards of Nursing. (2010). 2010 NCLEX-RNW

detailed test plan. Chicago: Author.

tBox 1-3 Integrated Processes

Caring

Communication and Documentation

Teaching and Learning

Nursing Process/Assessment

Nursing Process/Analysis

Nursing Process/Planning

Nursing Process/Implementation

Nursing Process/Evaluation

CHAPTER 1 The NCLEX-RN s5 W Examination

Multiple Response Questions (Select

All That Apply)

For a multiple response question, you will be asked to select or

check all the options, such as nursing interventions, that relate

to the information in the question. No partial credit is given for

correct selections. You need to do exactly as the question asks,

which will be to select all the options that apply. See Box 1-6 for

an example.

Prioritizing (Ordered Response or Drag

and Drop) Questions

In this type of question, you will be asked to use the computer

mouse to drag and drop your nursing actions in order of priority.

Information will be presented in a question and, based on

the data, you need to determine what you will do first, second,

third, and so forth. The unordered options will be located in

boxes on the left side of the screen and you need tomove all options

in order of priority to ordered response boxes on the right

side of the screen. Specific directions formoving the options are

provided with the question. See Box 1-7 for an example.

Picture or Graphic (Hot Spot) Questions

A question with a picture or graphic will ask you to answer the

question based on the picture or graphic. The question could

contain a chart, table, or a figure or illustration. You also

may be asked to use the computer mouse to point and click

on a specific area in the visual. A figure or illustration may appear

in any type of question, including a multiple-choice question.

See Box 1-8 for an example.

tBox 1-6 Multiple Response (Select All That Apply)

Question

A nurse is caring for a client with a terminal condition who is dying.

Which respiratory assessment findings would indicate to the nurse

that death is imminent? Select all that apply.

1. Dyspnea

2. Cyanosis

3. Kussmaul’s respiration

4. Tachypnea without apnea

5. Irregular respiratory pattern

6. Adventitious bubbling lung sounds

Answer: 1, 2, 5, 6

Rationale:

In a multiple response question, you will be asked to select or check

all the options, such as interventions, that relate to the information in

the question. To answer this question think about the respiratory assessment

findings that indicate death is imminent. These include altered

patterns of respiration, such as slow, labored, irregular, or

Cheyne-Stokes pattern (alternating periods of apnea and deep, rapid

breathing); increased respiratory secretions and adventitious bubbling

lung sounds (death rattle); irritation of the tracheobronchial airway

as evidenced by hiccups, chest pain, fatigue, or exhaustion; and

poor gas exchange as evidenced by hypoxia, dyspnea, or cyanosis.

Kussmaul’s respirations are abnormally deep, very rapid sighing respirations

characteristic of diabetic ketoacidosis. For multiple response

questions, follow the specific directions given on the

computer screen.

Reference

Black, J., & Hawks, J. (2009). Medical-surgical nursing: Clinical management for

positive outcomes (8th ed.). St. Louis: Saunders.

tBox 1-7 Prioritizing (Ordered Response or Drag and Drop)

Question

A nurse is preparing to insert a nasogastric tube in a client. Arrange in

order of priority the actions that the nurse takes to perform this procedure.

All options must be used.

Rationale:

Unordered Options Correctly Ordered Response

• Verify tube placement.

• Anchor the tube to the nose.

• Position the client in high-

Fowler’s position.

• Document the tube length in

the client’s record.

• Measure the distance to insert

the tube and mark the length of

the tube; lubricate the end of

the tube with water-soluble

lubricating jelly.

• Insert the tube through the

naris and instruct the client to

take a sip of water and

swallow, continuing to

advance the tube until the tape

mark is reached.

• Position the client in high-

Fowler’s position.

• Measure the distance to

insert the tube and mark the

length of the tube; lubricate

the end of the tube with watersoluble

lubricating jelly.

• Insert the tube through the

naris and instruct the client to

take a sip of water and

swallow, continuing to

advance the tube until the

tape mark is reached.

• Verify tube placement.

• Anchor the tube to the nose.

• Document the tube length in

the client’s record.

This question requires you to arrange in order of priority the nursing

actions that should be taken to insert a nasogastric tube. To insert

a nasogastric tube, the nurse first performs hand hygiene and explains

the procedure to the client. The nurse applies gloves and positions

the client in high-Fowler’s position, then places a bath towel over

the client’s chest. The nurse next measures the distance to insert the

tube (the distance from the tip of the nose to the earlobe to the xiphoid

process), marks the length of the tube, and lubricates the end of the

tube with water-soluble lubricating jelly. The nurse inserts the tube

through the naris and, with the tube just above the oropharynx, instructs

the client to flex the head forward and take a sip of water

and swallow. The nurse continues to advance the tube until the tape

mark is reached. The nurse then verifies tube placement and anchors

the tube to the nose. Once the procedure is complete, the nurse documents

the tube length and other appropriate data in the client’s record.

Also, remember that on the NCLEX examination, you will use the

computer mouse to place the unordered options in an ordered

response.

Reference

Potter, P., & Perry, A. (2009). Fundamentals of nursing (7th ed.).

St. Louis: Mosby.

s6 UNIT I NCLEX-RNW Preparation

Chart/Exhibit Questions

In this type of question, you will be presentedwith a question and

a chart or exhibit. You will be provided with tabs or buttons that

you need to click to obtain the information needed to answer the

question. A prompt message will appear that will indicate the

need to click on a tab or button. See Box 1-9 for an example.

Graphic Options Questions

In this type of question, the option selections will be pictures

rather than text. Each option will be preceded by a circle and

you will need to use the computer mouse to click in the circle

that represents your answer choice. See Box 1-10 for an example.

Audio Questions

Audio questions will require listening to a sound in order to

answer the question. These questions will prompt you to use

the headset provided and to click on the sound icon. You will

be able to click on the volume button to adjust the volume to

your comfort level and you will be able to listen to the sound as

many times as necessary. Content examples include but are not

limited to various lung sounds, heart sounds, or bowel sounds.

These question types are located on the accompanying Evolve

Web site. See Figure 1-1 for an example.

Video Questions

Video questions will require viewing an animation or video clip

in order to answer the question. These questions will prompt

you to click on the video icon. There may be sound associated

tBox 1-8 Picture or Graphic (Hot Spot) Questions

From Potter, P., & Perry, A. (2009). Fundamentals of nursing (7th ed.).

St. Louis: Mosby.

Question

The nurse performs client rounds and notes that a client with a respiratory

disorder is wearing this oxygen device (see preceding figure).

The nurse documents that the client is receiving oxygen by which type

of low-flow oxygen delivery system?

1. Venturi mask

2. Nasal cannula

3. Simple face mask

4. Partial rebreather mask

Answer: 3

Rationale:

For some of these question types you will need to use the computer

mouse and point and click at a designated area to answer the question.

For this question, use of the computer mouse is not necessary.

To answer correctly, you need to recognize the type of face mask that

the client is wearing. A simple face mask is used to deliver oxygen concentrations

of 40% to 60% for short-term oxygen therapy. It may also

be used in an emergency. A minimum flow rate of 5 L/min is needed

to prevent the rebreathing of exhaled air. The simple face mask fits

over the nose and mouth, has exhalation ports, and has a tube that

connects to the oxygen source. A Venturi mask is a high-flow oxygen

delivery system that delivers an accurate oxygen concentration. An

adaptor is located between the bottom of the mask and the oxygen

source. The adaptor contains holes of different sizes that allow specific

amounts of air to mix with the oxygen. The nasal cannula contains

nasal prongs that are used to deliver oxygen flow rates at 1 to

6 L/min. A partial rebreather mask is a mask with a reservoir bag without

flaps. It provides oxygen concentrations of 60% to 75% with flow

rates of 6 to 11 L/min.

Reference

Potter, P., & Perry, A. (2009). Fundamentals of nursing (7th ed.).

St. Louis: Mosby.

tBox 1-9 Chart/Exhibit

Question

Oral prednisone is prescribed for a hospitalized client. The nurse

reviews the client’s medical record and is most concerned about

this prescription because of which documented item?

CHART/EXIBIT

History: Diabetes mellitus

Hypertension

Medications: Furosemide (Lasix) 40 mg oral daily

Diagnostic Tests: Electrocardiogram: normal

CLIENT’S CHART

Answer: 1

Rationale:

This chart/exhibit question provides you with data from a client’s

medical chart, identifies a prescribed medication, and asks about

a concern related to this medication. Read all the data in the question

and the client’s chart. Use nursing knowledge about the interactions

and effects of prednisone and recall that this medication

may increase the blood glucose level. This will assist in directing

you to item 1, diabetes mellitus. For these question types, be certain

to read all of the data in the client’s chart before selecting the

answer.

Reference

Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis:

Saunders.

CHAPTER 1 The NCLEX-RN s7 W Examination

tBox 1-10 Graphic Options

Question

The physician prescribes a tuberculin skin test to be done on a client.

Which syringe should the nurse select to perform the test?

Answer: 2

1/2

11/2

1

2

21/2

3

.20

1. 2. 3. 4.

.40

.60

.80

1.00

ml

10

20

30

40

50

60

70

80

90

100

5

10

15

20

25

30

35

40

45

50

ml

Luer-Lok

UNITS

UNITS

From Potter, P., & Perry, A. (2009). Fundamentals of nursing (7th ed.).

St. Louis: Mosby.

Rationale:

This question requires you to select the picture that represents your

answer choice. To perform a tuberculin skin test, the nurse would use

a tuberculin syringe that is marked in 0.01 (hundredths) because the

dose for administration is less than 1 mL. A Luer-Lok syringe (option 1)

is marked in 0.1 (tenths) and is used for most subcutaneous or intramuscular

injections. Insulin syringes are available in 50 and 100 units

and are used to administer insulin.

Reference

Potter, P., & Perry, A. (2009). Fundamentals of nursing (7th ed.).

St. Louis: Mosby

s FIGURE 1-1 Screenshot of an audio question.

s8 UNIT I NCLEX-RNW Preparation

with the animation and video, for which you will be prompted

to use the headset. Content examples include but are not limited

to assessment techniques, nursing procedures, or communication

skills. These question types are located on the accompanying

Evolve Web site. See Figure 1-2 for an example.

REGISTERING TO TAKE THE EXAMINATION

It is important to obtain an NCLEX examination candidate bulletin

fromtheNCSBNWebsite at http://www.ncsbn.org,because

thisbulletinprovides all the informationthat youneed toregister

forandscheduleyour examination. It alsoprovidesyouwithWeb

siteandtelephoneinformationforNCLEXexaminationcontacts.

The initial step in the registration process is to submit an application

to the state board of nursing in the state in which you intend

to obtain licensure. You need to obtain information from the

board of nursing regarding the specific registration process because

the processmay vary fromstate to state.Once you receive

confirmation fromthe board of nursing that you have met all

of the state requirements, you can register to take the NCLEX

examination with Pearson Vue. You may register for the examination

through the Internet, by United States (U.S.) mail, or

by telephone. The NCLEX candidate Web site is http://www.

pearsonvue.com/nclex. Following the registration instructions

and completing the registration forms precisely and

accurately are important. Registration forms not properly

completed or not accompanied by the proper fees in

the required method of payment will be returned to you

and will delay testing. You must pay a fee for taking

the examination, and you also may have to pay additional

fees to the board of nursing in the state in which you are applying.

You will then be made eligible by the licensure board

and will receive an Authorization to Test (ATT). If you

do not receive an ATT within 2 weeks of registration, you

should contact the candidate services at 1-866-496-2539

(U.S. candidates).

AUTHORIZATION TO TEST AND SCHEDULING

AN APPOINTMENT

You cannot make an appointment until the board of nursing

declares eligibility and you receive an Authorization to Test

(ATT) form. Youwillnot receive anATT formuntil youhave been

deemedeligibleandhavecompletedallnecessary formsandhave

paid all required fees.Note the validity datesontheATT formand

schedule a date and time when you receive the ATT. The examination

will take place at a Pearson Professional Center, and

U.S. candidates can make an appointment through the Internet

(http://www.pearsonvue.com/nclex) or by telephone (1-866-

496-2539). You can schedule an appointment at any Pearson

Professional Center. You do not have to take the examination

in the same state in which you are seeking licensure. A confirmation

of your appointment with the appointment date and time

and the directions to the testing center will be sent to you.

s FIGURE 1-2 Screenshot of a video question.

CHAPTER 1 The NCLEX-RN s9 W Examination

The ATT form contains important information, including

your test authorization number, candidate identification number,

and validity date. You need to take your ATT form to the

test center on the day of your examination. You will not be admitted

to the examination if you do not have it.

CANCELING OR RESCHEDULING THE

APPOINTMENT

If for any reason you need to cancel or reschedule your appointment

to test, you can make the change on the candidate Web site

(http://www.pearsonvue.com/nclex) or by calling candidate services.

The change needs to be made 1 full business day (24

hours) before your scheduled appointment. If you fail to arrive

for the examination or fail to cancel your appointment to test

without providing appropriate notice, you will forfeit your examination

fee and yourAuthorization to Test will be invalidated.

This information will be reported to the board of nursing in the

state in which you have applied for licensure, and you will be required

to register and pay the testing fees again.

THE DAY OF THE EXAMINATION

It is important that you arrive at the testing center at least

30 minutes before the test is scheduled. If you arrive late for

the scheduled testing appointment, you may be required to forfeit

your examination appointment. If it is necessary to forfeit

your appointment, you will need to reregister for the examination

and pay an additional fee. The board of nursing will be notified

that you did not take the test. A few days before your

scheduled date of testing, take the time to drive to the testing

center to determine its exact location, the length of time

required to arrive to that destination, and any potential obstacles

thatmight delay you, such as road construction, traffic, or parking

sites. You must have the ATT and proper identification (ID)

to be admitted to take the examination. The ATT form will

clearly list the types of acceptable identification. Acceptable

identification includes U.S. driver’s license, passport, U.S. state

ID, or U.S. military ID. All acceptable identification must be

valid and not expired and contain a photograph and signature

(in English). Additionally, the first and last names on the ID

must match the ATT. According to the NCSBN guidelines, any

name discrepancies require legal documentation, such as a marriage

license, divorce decree, or court action legal name change.

SPECIAL TESTING CIRCUMSTANCES

If you require special testing accommodations, you should

contact the board of nursing before submitting a registration

form. The board of nursing will provide the procedures for

the request. The board of nursing must authorize special testing

accommodations. Following board of nursing approval, the

NCSBN reviews the requested accommodations and also must

approve the request. If the request is approved, the candidate

will be notified and provided the procedure for registering

for and scheduling the examination.

THE TESTING CENTER

The testing center is designed to ensure complete security of the

testing process. Strict candidate identification requirements

have been established. You must bring the ATT and required

forms of identification. You will be asked to read the rules related

to testing. A digital fingerprint and palm vein print will be

taken and this procedure is usually done twice. A digital signature

and photograph will also be taken at the test center. These

identity confirmations will accompany the NCLEX exam results.

Additionally, if you leave the testing room for any reason,

you may be required to perform these identity confirmation

procedures again to be readmitted to the room.

Personal belongings are not allowed in the testing room.

Secure storage, such as a locker and locker key, will be provided

for you; however, storage space is limited, so you must plan accordingly.

In addition, the testing center will not assume responsibility

for your personal belongings. The testing waiting

areas are generally small; therefore, friends or family members

who accompany you are not permitted to wait in the testing

center while you are taking the examination.

Once you have completed the admission process, the proctor

will escort you to the assigned computer. You will be seated

at an individual work space area that includes computer equipment,

appropriate lighting, and erasable note board or white

board and a marker. No items, including unauthorized scratch

paper, are allowed into the testing room. Electronic devices

such as watches, beepers, or cell phones, are not allowed in

the testing room. Eating, drinking, or the use of tobacco is

not allowed in the testing room. You will be observed at all

times by the test proctor while taking the examination. Additionally,

video and audio recordings of all test sessions are

made. Pearson Professional Centers has no control over the

sounds made by typing on the computer by others. If these

sounds are distracting, raise your hand to summon the proctor.

Earplugs are available on request.

You must follow the directions given by the testing center

staff and must remain seated during the test, except when authorized

to leave. If you think that you have a problem with the

computer, need an additional erasable or white board, need to

take a break, or need the test proctor for any reason, you must

raise your hand. You are also encouraged to access the candidate

Web site (http://www.pearsonvue.com/nclex) to obtain

additional information about the physical environment of

the testing center.

TESTING TIME

The maximum testing time is 6 hours; this period includes

the tutorial, the sample items, all breaks, and the examination.

All breaks are optional. The first optional break will

be offered after 2 hours of testing. The second optional break

is offered after 3ó hours of testing. Remember that all breaks

count against testing time. If you take a break, you must leave

the testing room and, when you return, you may be required

to perform identity confirmation procedures to be

readmitted.

LENGTH OF THE EXAMINATION

The minimum number of questions that you will need to answer

is 75. Of these 75 questions, 60 will be operational

(scored) questions and 15 will be pretest (unscored) questions.

The maximum number of questions in the test is 265. Fifteen of

the total number of questions that you need to answer will be

pretest (unscored) questions.

s10 UNIT I NCLEX-RNW Preparation

The pretest questions are questions that may be presented

as scored questions on future examinations. These pretest

questions are not identified as such. In other words, you

do not know which questions are the pretest (unscored)

questions.

PASS-OR-FAIL DECISIONS

All the examination questions are categorized by test plan area

and level of difficulty. This is an important point to keep in

mind when you consider how the computer makes a passor-

fail decision because a pass-or-fail decision is not based

on a percentage of correctly answered questions.

After the minimum number of questions have been answered

(75 questions; 60 operational and 15 pretest questions),

the computer compares the test-taker’s ability level to

the standard required for passing. The standard required for

passing is set based on the expert judgment of several individuals

appointed by the NCSBN. If the test-taker is clearly above

the passing standard, then the examination ends and the testtaker

passes the examination. If the test-taker is clearly below

the passing standard, the examination ends and the test-taker

fails the examination. If the computer is not able to determine

clearly whether the test-taker has passed or failed because the

test-taker’s ability is close to the passing standard, then the

computer continues asking questions until the outcome is

determined.

If the examination ends because you have run out of time,

the computer may not have enough information to make a

clear pass-or-fail decision. If this is the case, the computer will

review the test-taker’s performance during testing. If the testtaker’s

ability was consistently above the passing standard on

the last 60 questions, the test-taker passes. If the test-taker’s

ability falls to or below the passing standard, even once, the

test-taker fails.

COMPLETING THE EXAMINATION

Once the examination has ended, you will complete a brief

computer-delivered questionnaire about your testing experience.

After you complete this questionnaire, you need to raise

your hand to summon the test proctor. The test proctor will

collect and inventory all erasable or white boards and then permit

you to leave.

PROCESSING RESULTS

Every computerized examination is scored twice, once by

the computer at the testing center and then again after the

examination is transmitted to Pearson Professional Centers.

No results are released at the test center. The board of

nursing receives your result within 12 to 24 hours, and they

will be mailed to you from 2 days to 2 weeks after you take

the examination. In some states, an unofficial result can

be obtained via the Quick Results Service 2 business days

after taking the examination. This can be done through

the Internet or telephone and there is a fee for this service.

Information about obtaining NCLEX results by this method

can be obtained on the NCSBN Web site under candidate

services.

CANDIDATE PERFORMANCE REPORT

A candidate performance report is provided to a test-taker who

failed the examination. This report provides the test-taker with

information about her or his strengths and weaknesses in

relation to the test plan framework and provides a guide for

studying and retaking the examination. If a retake is necessary,

most states require 45 days between examination administration.

Test-takers should refer to the state board of nursing in

the state in which licensure is sought for procedures regarding

when the examination can be taken again.

INTERSTATE ENDORSEMENT

Because the NCLEX-RN examination is a national examination,

you can apply to take the examination in any state. Once

licensure is received, you can apply for interstate endorsement,

which is obtaining another license in another state to practice

nursing in that state. The procedures and requirements for interstate

endorsement may vary from state to state, and these

procedures can be obtained from the state board of nursing

in the state in which endorsement is sought. You may also

be allowed to practice nursing in another state if the state

has enacted a Nurse Licensure Compact. The state boards of

nursing can be accessed via the NCSBN Web site at http://

www.ncsbn.org. Additionally those states that participate in

the Nurse Licensure Compact can be located on this Web site.

NURSE LICENSURE COMPACT

It may be possible to hold one license from the state of residency

and practice nursing in another state under the mutual

recognition model of nursing licensure if the state has enacted

a Nurse Licensure Compact. To obtain information about the

Nurse Licensure Compact and the states that are part of this interstate

compact, access the National Council of State Boards of

Nursing Web site at http://www.ncsbn.org.

ADDITIONAL INFORMATION ABOUT

THE EXAMINATION

Additional information regarding the NCLEX-RN examination

can be obtained through the NCLEX examination candidate

bulletin located on the NCSBN Web site and from the National

Council of State Boards of Nursing, 111 East Wacker Drive,

Suite 2900, Chicago, IL 60601. The telephone number for

the NCLEX examinations department

eBook: Saunders Q & A Review for the NCLEX-RN Examination 5th Silvestri 978-1437720228