SAUNDERS STRATEGIES FOR TEST SUCCESS: Passing Nursing School and the NCLEX Exam (Saunders Strategies for Success for the Nclex Examination) 5TH EDITION By LINDA SILVESTRI, ANGELA E. SILVESTRI ISBN: 978-0-323-47960-8 415 PAGES

SAUNDERS STRATEGIES FOR TEST SUCCESS: Passing Nursing School and the NCLEX Exam (Saunders Strategies for Success for the Nclex Examination) 5TH EDITION By LINDA SILVESTRI, ANGELA E. SILVESTRI ISBN: 978-0-323-47960-8 415 PAGES Table of Contents Instructions for online access Cover image Title page Copyright Dedication About the Authors Contributors Reviewers Preface Welcome to Saunders Pyramid to Success! Organization Special Features of the Book How to Use This Book RN Products PN Products Acknowledgments Chapter 1: Preparing for Nursing Examinations When and Why Are Nursing Exams Administered? The Beginning Nursing Student: What Should You Think About? What Can You Expect on Nursing Exams? Your Course Syllabus: Why Is It Important? How Can You Best Use Your Textbook to Get Ready for a Nursing Exam? Classroom Notes: How Can You Best Use Them? Study Guides Study Groups Standardized Testing: Why Is It So Important? 3 Chapter 2: Developing Study Skills What Are Good Study Skills? How Do You Identify and Plan Your Study Times? What Study Habits Do You Need to Develop? What Study Skills Are Important? When Should You Start to Study for an Exam? Will a Study Group Work for You? Chapter 3: Reducing Test Anxiety What Is Test Anxiety? How Can You Know If You Have Test Anxiety? What Causes Test Anxiety? What Will Help Prevent Test Anxiety? What Can You Do When You Are Experiencing Test Anxiety? What Is Positive Pampering, and Why Is It Important? What Should You Do the Night Before the Exam? How Can You Control Your Test Anxiety Before the Exam? How Can You Control Your Test Anxiety During the Exam? That Positive Attitude: How Can You Maintain It? Chapter 4: NCLEX® Preparation Where Does Preparation Begin? The NCLEX Test Plan: Why Is It So Important? What Are the Steps for Preparing? Chapter 5: Alternate Item Formats Introduction What Is an Alternate Item Format? What Test-Taking Strategies Are Helpful for Answering Fill-in-the-Blank Questions? What Test-Taking Strategies Are Helpful for Answering Multiple Response Questions? What Test-Taking Strategies Are Helpful for Answering Prioritizing (Ordered Response) Questions? What Test-Taking Strategies Are Helpful for Answering Figure/Illustration Questions? What Test-Taking Strategies Are Helpful for Answering Chart/Exhibit Questions? What Test-Taking Strategies Are Helpful for Answering Graphic Item Option Questions? What Test-Taking Strategies Are Helpful for Answering Audio or Video Questions? What Test-Taking Strategies Are Helpful for Answering Testlet (Case Study) Questions? Chapter 6: How to Avoid “Reading into the Question” Clinical Reasoning Ingredients of a Question Strategic Words or Strategic Phrases The Subject of the Question 4 Using Nursing Knowledge and the Process of Elimination Chapter 7: Positive and Negative Event Queries Positive Event Queries Negative Event Queries Chapter 8: Questions Requiring Prioritization Prioritizing Priority Classification System Strategic Words or Strategic Phrases The ABCs Maslow’s Hierarchy of Needs Theory Nursing Process (Clinical Problem-Solving Process) Chapter 9: Leading and Managing, Delegating, and Assignment-Making Questions Delegation and Assignment-Making Time Management Chapter 10: Communication Questions How Are Communication Concepts Tested in a Question? What Guidelines Can Be Used to Answer Communication Questions? Communication Techniques Why Are Cultural Considerations Important? Other Cultural Considerations Sample Communication Questions Chapter 11: Pharmacology, Medication, and Intravenous Calculation Questions Pharmacology: General Guidelines to Follow Pharmacology: Assessment/Data Collection Guidelines Pharmacology: Assessment/Data Collection Guidelines to Follow Medication Effects Medication Names Medication Classifications Commonalities in Medication Names What Strategies Will Help When Answering Medication and Intravenous Calculation Questions? Chapter 12: Additional Pyramid Strategies Eliminating Options That Contain Closed-Ended Words: How Will This Help? Eliminating Options That Contain Medical Rather Than Nursing Interventions: How Will This Help? Eliminating Comparable or Alike Options: How Will This Help? Ensuring That All Parts of an Option Are Correct: How Will This Help? Selecting the Umbrella Option: How Will This Help? 5 What Strategies Will Help When Answering Questions Related to Laboratory Values? Visualizing the Information in the Case Event, Question Query, and Options: How Will This Help? Looking for Concepts in the Question That Are Comparable or Alike to a Concept in One of the Options: How Will This Help? What Strategies Will Help When Answering Questions Related to Client Positioning? What Strategies Will Help When Answering Questions Related to Therapeutic Diets? What Strategies Will Help When Answering Questions Related to Disasters? Chapter 13: Fundamentals of Care Questions Chapter 14: Adult Health Questions Chapter 15: Mental Health Questions Chapter 16: Maternity Questions Chapter 17: Pediatric Questions Chapter 18: Pharmacology Questions Chapter 19: Delegating/Prioritizing Questions Chapter 20: Leadership/Management Questions References Index 6 Copyright 3251 Riverport Lane St. Louis, Missouri 63043 Saunders 2018–2019 Strategies for Test Success, Fifth Edition ISBN: 978-0-323-47960-8 Copyright © 2018 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: This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on their own experience and the knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability 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 2016, 2014, 2010, and 2005. International Standard Book Number: 978-0-323-47960-8 Senior Content Strategist: Jamie Blum Senior Content Development Manager: Laurie Gower 7 Senior Content Development Specialist: Laura Goodrich Publishing Services Manager: Jeff Patterson Book Production Specialist: Bill Drone Designer: Bridget Hoette Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 8 Dedication To all nursing students, your commitment to becoming successful, and your dedication to the profession of nursing, will bring never-ending rewards! 9 About the Authors Linda Anne Silvestri, PhD, RN 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. While there, 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 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 and published research on self-efficacy and the predictors for 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. Additionally, I received the 2012 Alumna of the Year/Nurse of the Year Award from the University of Nevada, Las Vegas, School of Nursing. As a native of Springfield, Massachusetts, I began my teaching career as an instructor of medicalsurgical nursing and leadership-management nursing at Baystate Medical Center School of Nursing in 1981. In 1989, I relocated to Rhode Island and began teaching medical-surgical nursing and 10 psychiatric nursing to RN and LPN students at the Community College of Rhode Island. Later in 1994, I began teaching nursing at Salve Regina University in Newport, Rhode Island, and remain there as an adjunct faculty member. I established Nursing Reviews, Inc. in 2000. This company is located in Henderson, Nevada, and is 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 that prepare students for the NCLEX® examination. Also, I serve as an Elsevier Consultant for HESI live reviews, the review courses for the NCLEX examination 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 examination! Angela Silvestri, PhD, RN, CNE When asked what I wanted to do with my life and as a career, I always answered that I wanted to work in the medical field. At first my ambition was to become a physician; however, learning that nurses interact with their patients more often than physicians do swayed me to pursue nursing. While in nursing school, I worked as a tutor for my peers. I realized how much I enjoyed doing this and how much of a difference my help made in these students’ college careers and ultimately their lives. I received my baccalaureate degree in Nursing and Sociology at Salve Regina University in Newport, Rhode Island. After earning my degree, I worked in long-term care, rehabilitation, and acute care settings. I then went on to earn my master’s degree and PhD in Nursing and published the findings related to cultural competence in the curriculum. I am a member of Nevada Nurses Association, Sigma Theta Tau International Honour Society, and Golden Key International Honour Society. I received a scholarship from Sigma Theta Tau for academic excellence while attending Salve Regina University and an award from the University of Nevada, Las Vegas, for Outstanding MSN Student. I have also received the Xu Family Scholarship for research in cultural competence, the Harry & Rebecca Lahr Scholarship, and the Sierra Health Nursing Fellowship at the University of Nevada, Las Vegas. I am an Assistant Professor at the University of Nevada, Las Vegas, and 11 teach Fundamental Skills and Medical-Surgical Nursing in the didactic, simulation, skills lab, and clinical settings. My short-term goals include conducting research focused on nursing education and finding the best student-centered teaching strategies to help students transition to successful nurses at practice. I am also working to earn the Family Nurse Practitioner post-master’s graduate certificate and plan to conduct research in the area of sepsis management. Working with students while having been a student for quite some time helped me understand and realize the individual needs of each student. This experience, in addition to my experience in item writing and other contributions to nursing textbooks, has helped me coauthor this text. I am very excited to be a part of this opportunity to further assist nursing students in their ultimate goal: passing nursing school and the NCLEX® exam! 12 Contributors Consultants Dianne E. Fiorentino Research Coordinator Nursing Reviews, Inc. Henderson, Nevada James Guilbault, Jr., BS, PharmD Clinical Pharmacist Greenfield, Massachusetts Pharmacology Consultant Nursing Reviews, Inc. Henderson, Nevada Nicholas L. Silvestri, BA Editorial and Communications Analyst Nursing Reviews, Inc. Henderson, Nevada Previous Item Writers Linda Ann Aubrey, MSN, RN, CMSRN, CNE Martha Barry, RN, CNM, MS Jacqueline Rosenjack Burchum, DNSc, FNP-BC, CNE Reitha Cabaniss, MSN Mary C. Carrico, MS, RN Mary L. Dowell, PhD, RN, BC Kimberly R. Foisy, RN, MSN, CMSRN Lena R. Greene, MSN, RN Rebecca Russo Hill, DNP, FNP-C Tiffany Jakubowski, RN Christina Keller, RN, MSN Lynn M. Korvick, PhD, RN, CNE Terri Peterson, RN, BSN, MSNEd Donna Russo, RN, MSN, CCRN, CNE Julie S. Snyder, MSN, RN-BC Bethany Hawes Sykes, EdD, RN, CEN, CCRN Linda Turchin, MSN, RN, CNE Koni J. Utley, MSN, RN Polly Gerber Zimmermann, RN, MS, MBA, CEN, FAEN 13 14 Reviewers Rita R. Armstrong, DNP, MSN Ed, RN Professor Dallas Nursing Institute Dallas, Texas Anna M. Bruch, RN, MSN Nursing Professor, Illinois Valley Community College, Oglesby, Illinois Lisa Hollett, RN, BSN, MA, MICN, TCRN, CFN, DABFN Trauma Performance Improvement Coordinator, MedPartners, Ennis, Texas Peter D. Smith, BA, MSN, RN Instructor & Clinical Lead/Critical Care Nurse, Otolaryngology/Plastics & Cardio-Thoracic Acute Care, Goldfarb School of Nursing at Barnes- Jewish College, Barnes-Jewish Hospital, St. Louis, Missouri Elaine Kay Strouss, MSN, RN, CNE Professor—Nursing, Community College of Beaver County, Monaca, Pennsylvania Elizabeth Wright, MSN, RN, CNE Assistant Professor of Nursing, Indiana Wesleyan University, Marian, Indiana 15 Preface Linda Anne Silvestri, PhD, RN; Angela Silvestri, PhD, RN, CNE 16 Welcome to Saunders Pyramid to Success! Saunders 2018–2019 Strategies for Test Success: Passing Nursing School and the NCLEX Exam is one in a series of products designed to assist you in achieving your goal of passing your nursing courses and becoming a licensed nurse. This product provides you with test-taking strategies that will help you pass your nursing examinations and the NCLEX examination. 17 Organization Saunders 2018–2019 Strategies for Test Success: Passing Nursing School and the NCLEX Exam contains three parts and 20 chapters. The chapters in Part I describe the test-taking strategies and include several sample questions that illustrate how to use each test-taking strategy. The sample questions represent all types of question formats, including multiple choice and alternate item formats. In addition to the sample questions in the chapters, a total of 1200 practice questions accompany this book. In Part II of the book, there are 200 practice questions, and the accompanying Evolve site contains the 200 practice questions from the book along with an additional 1000 practice questions. All of the practice questions reflect the framework and the content identified in the most current NCLEX test plans. The practice questions in this resource relate to each Client Needs category and each Integrated Process of the NCLEX exam. The Client Needs categories include Safe and Effective Care Environment, Health Promotion and Maintenance, Psychosocial Integrity, and Physiological Integrity. The Integrated Processes include Caring, Communication and Documentation, Culture and Spirituality, Nursing Process (Clinical Problem-Solving Process), and Teaching and Learning. Part I: Study and Test Preparation Chapter 1: Preparing for Nursing Examinations The information in this chapter focuses on the exams that you will take during your nursing program and provides you with information on how to prepare for these exams. Topics include the purpose of nursing exams, what you can expect on nursing exams, how nursing exams are different from other exams, and the types of questions on nursing exams. Additional topics include preparing for a nursing exam using your syllabus, textbook, classroom notes, flash cards, study guides, and study groups. Chapter 2: Developing Study Skills This chapter discusses several topics related to study skills and study habits. It provides you with information on how to develop or refine study skills and how to develop good study habits so that you will be well prepared for your nursing exams. Included are the top 10 Pyramid Points and study habits. Also, study skills such as listening, note-taking, reading, remembering content, and critical thinking skills are discussed. Chapter 3: Reducing Test Anxiety This chapter focuses on the important points related to test anxiety. In this chapter, you are provided with self-assessment points to determine if you experience test anxiety. Additionally, the causes of test anxiety, how to prevent test anxiety, and how to control test anxiety before an exam are discussed. Points about maintaining a positive attitude and what you can do when you experience test anxiety are presented in this chapter. Chapter 4: NCLEX® Preparation This chapter focuses on preparing for the NCLEX exam—the exam that you must take and pass after you graduate from nursing school in order to become a licensed nurse. This chapter emphasizes the important point that NCLEX preparation begins the moment you enter your nursing program. Specific to the NCLEX, it provides you with the steps for preparing for the NCLEX, self-assessment points to determine your readiness, and a plan for preparation. Part II: Strategies for Success Chapter 5: Alternate Item Formats Alternate item format questions are designed to test competency in nursing skills and abilities. This chapter describes the various types of alternate item format questions that you may encounter on the NCLEX examination and on nursing school examinations and provides you with test-taking strategies to answer them correctly. These alternate item format types include fill-in-the-blank, multiple response, prioritizing (ordered response), figure or illustration (hot spot), chart/exhibit, 18 graphic item options, testlets (case studies), and audio and video. Chapter 6: How to Avoid “Reading into the Question” One of the pitfalls that can cause a problem when answering a question is “reading into the question.” This means that you are considering issues beyond the information presented in the question. This chapter describes the strategies to use when answering a question to prevent this from happening and includes topics such as how to read a question, using strategic words, identifying the subject of the question, determining if an abnormality exists, focusing on the client of the question, considering available resources, and using nursing knowledge and the process of elimination. Chapter 7: Positive and Negative Event Queries This chapter describes the differences between a positive and a negative event query in a question. Reading the question carefully and noting the type of query used are important to assist in answering a question correctly. This chapter also identifies the strategic words or phrases that indicate whether the question contains a positive or negative event query. Chapter 8: Questions Requiring Prioritization Some of the test questions on your nursing exams and on the NCLEX will require you to use the skill of prioritizing nursing actions. These types of questions can be difficult because when a question requires prioritization, all of the options may be correct, and you will need to determine the correct order of action. This chapter describes the test-taking strategies that you can use to answer prioritizing questions correctly. Some of these strategies include the ABCs—airway, breathing, and circulation—Maslow’s Hierarchy of Needs theory, and the steps of the nursing process (clinical problem-solving process). Also included in this chapter are the strategies for determining the need to contact the health care provider. Chapter 9: Leading and Managing, Delegating, and Assignment-Making Questions Some test questions that you will need to answer will relate to the nurse’s responsibilities regarding delegating care and assignment-making and the supervisory role of these responsibilities. This chapter reviews the guidelines and principles related to delegating and assignment-making, two very important roles of the nurse as a leader and manager. It also provides you with information about the tasks and activities that can be delegated and assigned to unlicensed assistive personnel (UAP), licensed practical/vocational nurses, and registered nurses. Guidelines for time management are also reviewed, because managing time efficiently is a key factor for completing activities and tasks within a given time period. Chapter 10: Communication Questions Communication is a process through which information is exchanged, either verbally or nonverbally, between two or more individuals and is an extremely important role of the nurse. This chapter reviews the guidelines to follow when answering communication questions and identifies various cultural aspects to consider when communicating and caring for clients. Additionally, therapeutic and nontherapeutic communication techniques are presented. Chapter 11: Pharmacology, Medication, and Intravenous Calculation Questions Pharmacology is one of the most difficult nursing content areas to master and feel comfortable with. One reason that it is so difficult is because of the enormous number of medications available. Another reason is that there is a vast amount of information to know about each medication. It is important for you to spend ample time studying and reviewing pharmacology in preparation for your nursing exams and for the NCLEX and to use this knowledge to answer pharmacology questions. However, you may be presented with pharmacology questions on your exams that present medications you are unfamiliar with, in which case you will need to make an educated guess to answer the question. This chapter provides you with the strategies and general guidelines to use for making an educated guess to answer pharmacology questions correctly. This chapter also includes medication and intravenous calculations strategies and examples. 19 Chapter 12: Additional Pyramid Strategies This chapter reviews additional helpful strategies that will assist in answering a test question correctly. Also included in this chapter are strategies that are useful for answering questions related to laboratory values, client positioning, and therapeutic diets. Strategies that will be helpful when answering questions related to disasters are also presented in this chapter. Part III: Practice Tests Part III is composed of eight practice tests that provide you the opportunity to practice answering exam questions using various test-taking strategies. These tests include Chapter 13, Fundamentals of Care Questions; Chapter 14, Adult Health Questions; Chapter 15, Mental Health Questions; Chapter 16, Maternity Questions; Chapter 17, Child Health Questions; Chapter 18, Pharmacology Questions; Chapter 19, Delegating/Prioritizing Questions; and Chapter 20, Leadership/Management Questions. The correct answer, rationales for correct and incorrect options, a test-taking strategy, a tip for the nursing student, question codes, and a reference text with a page number are provided for each question. 20 Special Features of the Book Pyramid Points Pyramid Points are the bullets that are placed at specific areas throughout the chapters. The Pyramid Points identify content that is important in preparation for the NCLEX examination. Tip for the Nursing Student A tip for the nursing student is provided for each sample question in the book. Additionally, a tip for the nursing student accompanies each question in the practice tests located in Part III and on the accompanying Evolve site. This tip provides the nursing student with a description of the content or disorder addressed in the question. NCLEX® Tip NCLEX tips are located throughout Parts I and II of the text. These tips relate to NCLEX information and detail important points associated with the content addressed and with the NCLEX exam. Lifestyle Planning Tip Lifestyle planning tips are located throughout Parts I and II of the text. These tips provide information about healthy lifestyle choices that will help you live a well-balanced life, leading to success in nursing school. Scope of Practice Tip