Exam (elaborations) SAUNDERS COMPREHENSIVE REVIEW for the NCLEX-PN Examination 6TH EDITION

SAUNDERS COMPREHENSIVE REVIEW for the NCLEX-PN Examination 6TH EDITION AUNDERS COMPREHENSIVE REVIEW for the NCLEX-PN Examination 6TH EDITION By LINDA ANNE SILVESTRI, PhD, RN ISBN: 978-0-323-28931-3 1042 PAGES Activate the complete learning experience that comes with each NEW textbook purchase by registering with your scratch-off access code at If you purchased a used book and the scratch-off code above has already been revealed, the code may have been used and cannot be re-used for registration. To purchase a new code to access these valuable study resources, simply follow the link above. *Evolve Student Resources are provided free with each NEW book purchase only. REGISTER TODAY! FPO: Scratch Off Sticker You can now purchase Elsevier products on Evolve! Go to Even more questions on Evolve! Evolve Access Code: How to Use the Online Practice Questions Customize your study session for your time and your own unique needs. Study Mode Receive immediate feedback after each question. Select questions by Client Needs, Integrated Process, Alternate Item Format Type, Priority Concepts, or specific Content Area. The answer, rationale, test-taking strategy, question codes, and reference source(s) for further remediation appear immediately after you answer each question. Exam Mode Take a practice exam, and receive your results and feedback at the end. Select questions by Client Needs, Integrated Process, Alternate Item Format Type, Priority Concepts, or specific Content Area. Then select the number of questions you’d like to take in your exam—10, 25, 50, or 100. When you’ve finished the exam, the percentage of questions you answered correctly will be shown in a table, and you can go back to review the questions and answers—as well as rationales, test-taking strategies, question codes, and reference(s)—for each question. S A U N D E R S COMPREHENSIVE REVIEW NCLEX-PN examination for the ® LINDA ANNE SILVESTRI, PhD, RN Instructor of Nursing Salve Regina University Newport, Rhode Island President Nursing Reviews, Inc. Charlestown, Rhode Island Professional Nursing Seminars, Inc. Charlestown, Rhode Island Nursing Reviews, Inc. Las Vegas, Nevada Elsevier Consultant HESI NCLEX-RN® and NCLEX-PN® Live Review Courses 6 EDITION examination ® NCLEX-PN for the S A U N D E R S COMPREHENSIVE REVIEW 3251 Riverport Lane St. Louis, Missouri 63043 SAUNDERS COMPREHENSIVE REVIEW FOR THE NCLEX-PN® EXAMINATION, SIXTH EDITION ISBN: 978-0-323-28931-3 Copyright © 2016, 2013, 2010, 2008, 2005, 2002, 1999 by Saunders, an imprint of 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). NCLEX®, NCLEX-RN®, and NCLEX-PN® are registered trademarks of the National Council of State Boards of Nursing, Inc. Library of Congress Cataloging-in-Publication Data Silvestri, Linda Anne, author. Saunders comprehensive review for the NCLEX-PN examination/Linda Anne Silvestri. – 6 edition. p. ; cm. Comprehensive review for NCLEX-PN examination Includes bibliographical references and index. ISBN 978-0-323-28931-3 (pbk. : alk. paper) I. Title. II. Title: Comprehensive review for NCLEX-PN examination. [DNLM: 1. Nursing, Practical–Examination Questions. 2. Nursing Care–Examination Questions. WY 18.2] RT62 610.73076–dc23 0 Senior Content Strategist: Yvonne Alexopoulos Content Development Manager: Laurie Gower Content Development Specialist: Laura Goodrich Marketing Manager: Danielle LeCompte Publishing Services Manager: Jeff Patterson Project Manager: Bill Drone Designer: Margaret Reid Printed in Canada Last digit is the print number: 9 8 7 6 5 4 3 2 1 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 practitioners, relying on their own experience and 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. To my parents— To my mother, Frances Mary, and in loving memory of my father, Arnold Lawrence, who taught me to always love, care, and be the best I could be. To All Future Licensed Practical 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 licensed practical nurse. I 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 my 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 licensed practical nurse. I am 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 licensed practical nurse. I want to thank all of my former nursing students whom I have assisted in their studies for the NCLEX-PN exam 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 you need to ready yourself for the NCLEX-PN exam. These products include material that is required for the NCLEX-PN exam 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, Linda Anne Silvestri, PhD, RN vii About the Author Linda Anne Silvestri 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 my 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 (UNLV), and conducted research on self-efficacy and the predictors of NCLEX success. In 2012, I received the UNLV School of Nursing Alumna of the Year Award. I am also a member of the Honor Society of Nursing, Sigma Theta Tau International, Phi Kappa Phi, the Western Institute of Nursing, the Eastern Nursing Research Society, the Golden Key International Honour Society, the National League for Nursing, and the America Nurses Association. 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 psychiatric 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 exams aided me as I developed a comprehensive review course to prepare nursing graduates for the NCLEX examination. In 1994, I began teaching medical-surgical nursing at Salve Regina University in Newport, Rhode Island, and I am currently there as an adjunct faculty member. I also prepare nursing students for the NCLEX examination at Salve Regina University. I established Professional Nursing Seminars, Inc., in 1991 and Nursing Reviews, Inc., in 2000. These companies are located in Charlestown, Rhode Island. In 2012, I established an additional company, Nursing Reviews, Inc., in Las Vegas, Nevada. Both companies are dedicated to assisting students in their success with the NCLEX-RN and the NCLEX-PN examinations. 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 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! (Photo by Laurent W. Valliere.) ix Contributors Special Contributor Mary Dowell, PhD, RN Graduate Nursing Faculty University of Phoenix Phoenix, Arizona Consultants Dianne E. Fiorentino Research Coordinator Nursing Reviews, Inc. Las Vegas, Nevada James Guilbault, Jr., BS, PharmD Clinical Pharmacist Wilbraham, Massachusetts Nicholas L. Silvestri, BA Editorial and Communications Analyst Nursing Reviews, Inc. Las Vegas, Nevada Angela Silvestri-Elmore, PhD, RN Assistant Professor of Nursing Touro University Henderson, Nevada Contributors Kristen Bagby, RN, MSN Staff Nurse St. Louis Children's Hospital St. Louis, Missouri Keara Cobbs, LPN Graduate St. Charles Community College St. Charles, Missouri Marie du Toit, BSN, MSN Assistant Professor West Liberty University West Liberty, West Virginia Margie Francisco, EdD(c), MSN, RN Nursing Professor Illinois Valley Community College Oglesby, Illinois Marilyn L. Johnessee Greer, MS, RN Associate Professor of Nursing Rockford College Rockford, Illinois Joyce Hammer, RN, MSN Adjunct Clinical Faculty Monroe Country Community College Monroe, Michigan Terri Hood-Brown, MSN, RN Assistant Professor, RN-to-BSN Coordinator Ohio University Athens, Ohio Tiffany Jakubowski, BSN, RN Adjunct Instructor Front Range Community College Longmont, Colorado Tara McMillan-Queen, RN, MSN, ANP, GNP Faculty II Mercy School of Nursing Charlotte, North Carolina Heidi Monroe, MSN, RN-BC, CPAN, CAPA Assistant Professor of Nursing Bellin College Green Bay, Wisconsin Robin Moyers, PhD, RN-BC Nursing Educator Carl Vinson VA Medical Center Dublin, Georgia Terri Peterson, RN, BSN, MSNEd Associate Professor Program Coordinator, Practical Nursing/Nursing Assistant Programs Bauder College Atlanta, Georgia Jennifer Ponto, RN, BSN Faculty, Vocational Nursing Program South Plains College Levelland, Texas Donna Russo, RN, MSN, CCRN Nursing Instructor Frankford Hospital School of Nursing Philadelphia, Pennsylvania x Contributors Horace Smith, III MHA, BBA, LPN Instructor University of Phoenix Phoenix, Arizona Tiffany M. Smith, MSN/ED, BSN, RN PhD Student University of Nevada, Las Vegas Las Vegas, Nevada Russlyn A. St. John, RN, MSN Professor, Practical Nursing St. Charles Community College Cottleville, Missouri Claudia Stoffel, MSN, RN, CNE Professor, Nursing West Kentucky Community and Technical College Paducah, Kentucky Bethany Hawes Sykes, EdD RN, CEN, CCRN Adjunct Faculty Department of Nursing Salve Regina University Newport, Rhode Island Laurent W. Valliere, BS, DD Vice President of Nursing Reviews, Inc. Professional Nursing Seminars, Inc. Charlestown, Rhode Island The author and publisher would also like to acknowledge the following individuals for contributions to the previous editions of this book: Alicia M. Adams, MN, RN, CEN Roosevelt, Utah Katrina D. Allen, RN, MSN, CCRN Chickasaw, Alabama Sonya S. Beacham, MSN, RN Wilmington, North Carolina Carol Boswell, EdD, RN Odessa, Texas Sharen Brady, MSN, RN Ogden, Utah Joyce Campbell, RN, MSN, CCRN, FNP-C Chattanooga, Tennessee Brenda E. Caranicas, MS, RN New Town, North Dakota Brigitte L. Casteel, RN, BSN Weber City, Virginia Faith Chumchal Darilek, RN, MSN Victoria, Texas Jean DeCoffe, MSN, RN Milton, Massachusetts Stephanie A. Dupler Lebanon, Pennsylvania Mary Ann Hogan, MSN, RN, CS Amherst, Massachusetts Mary Joanne Hovey, MSN, RN Wilmington, North Carolina Lisa Ivers, BSN, RN Hamilton, Ohio Lula Johnson, MSN, RN Detroit, Michigan Misty D. Johnson, LPN North Platte, Nebraska Mary T. Kowalski, MSN, BA, RN Ridgecrest, California Nancy K. Maebius, PhD, RN San Antonio, Texas Barbara Magenheim, EdD, MSN, BSN, RN, CNE Chandler, Arizona Lois S. Marshall, PhD, RN Miami, Florida Beverly McNeese, RN Baton Rouge, Louisiana Jan H. Mearkle, MSN, RN, CSNP Summit, Mississippi Jo Ann Barnes Mullaney, PhD, RN, CS Newport, Rhode Island Victoria Oxendine, RN, MSN, FNPC Wilmington, North Carolina Joann E. Potts Peuterbaugh, MSN, RN Alton, Illinois Elizabeth Pratt, BSN, RNC Magnolia, Arkansas Bonnie L. Shipferling, PhD(c), MSN, BSBA, RN Pasadena, Texas Jennifer C. Spencer, RN, BSN Wilmington, North Carolina Louis M. Stackler, RN, BSN, MS Tulsa, Oklahoma Jacquelyn Stovall, RN, BSN San Antonio, Texas Ruth Chandley Threlkeld, MSN, BSN Clark, Missouri Julie Traynor, MS, RN Devils Lake, North Dakota Ann Leiphart Unholz, MS, RN Highland Springs, Virginia Paula A. Viau, PhD, RN Kingston, Rhode Island Margaret Wafstet, MN, RN Missoula, Montana Kim Webb, RN, MN Tonkawa, Oklahoma Mary Louise White, MSN, RN University Center, Michigan Patricia H. White, BSN, RNC Wilmington, North Carolina xi Carol Annesser, RN, MSN, BC, CNE Assistant Professor, Nursing Mercy College of Ohio Toledo, Ohio Dawn Baker, MSN, RN, WHNP-BC Nursing Faculty Oakland Community College Bloomfield Hills, Michigan Amanda Benz, RN, MSN University of Saint Francis Fort Wayne, Indiana Sonya Blevins, DNP, RN, CMSRN, CNE Assistant Professor of Nursing University of South Carolina-Upstate Greenville, South Carolina Danese Boob, MSN/ED, RN-BC Pennsylvania State University, Hershey and World Campus Hershey, Pennsylvania Collin Bowman-Woodall, MS, RN Assistant Professor Samuel Merritt University San Mateo, California Anna Brunch, RN, MSN Nursing Professor Illinois Valley Community College Oglesby, Illinois Jean Burt, MS, RN Instructor, Nursing Program Wilbur Wright College Chicago, Illinois Johnathan Carlos Associate Professor Southern California University of Health Sciences Judy Carlyle, MNSC, RN ARNEC Nashville, Arkansas Mary Carrico, MS Ed, RN Professor of Nursing West Kentucky Community and Technical College Paducah, Kentucky Judith Carrion, EdD, MSN/Ed, MSHS, BSN, RN-BC, CRRN, CNOR Assistant Professor Roseman University Henderson, Nevada Lori Catalano, JD, MSN, CCNS, PCCN University of Cincinnati Cincinnati, Ohio Janie Corbitt, RN, MS Retired, Instructor of Nursing Michelle Cox, RN, MSN Assistant Professor Sinclair Nursing Department Julie Darby, MSN, RN, CNE Baptist College of Health Sciences Memphis, Tennessee Patricia Delmoe, RN, BSN, MN, MA Boswell School of Nursing Sun City, Arizona Kathy Dillard, RN, BSN Northwestern State University Natchitoches, Louisiana Sherry Donovan, MSN, RN-BC Yakima, Washington Christine Emch, MSN, RN Mercy College of Ohio Toledo, Ohio Amber Essman, MSN, APRN, FNP-BC, CNE Minute Clinic/Chamberlain College of Nursing Grove City, Ohio/Columbus, Ohio Mary Fabick, MSN, MEd, RN-BC, CEN Associate Professor of Nursing Milligan College Milligan College, Tennessee Donna Fabry, DNP Clinical Assistant Professor University at Buffalo, School of Nursing Buffalo, New York Abimbola Farinde, PharmD, MS Clear Lake Regional Medical Center Webster, Texas Pamela B. Fouche, PhD Senior Coordinator of Natural Science Online Course Delivery Walters State Community College Morristown, Tennessee Margie Francisco, EdD, MSN, RN Illinois Valley Community College Oglesby, Illinois Gwendolyn Gaston, MSN, RN Dallas Nursing Institute Dallas, Texas Shari Gould, MSN, RN Victoria College Victoria, Texas Mary Griffin, PhD, RN, CNE Faculty, School of Nursing Carolinas College of Health Sciences Charlotte, North Carolina Sheila Grossman, PhD, FNP-BC, APRN, FAAN Fairfield University School of Nursing Fairfield, Connecticut Joyce Hammer, RN, MSN Adjunct Clinical Faculty Monroe Country Community College Monroe, Michigan Lilah Harper Anderson Continuing Education Jerry Harvey, MS, RN, BC Assistant Professor of Nursing Liberty University Lynchburg, Virginia Dorothy M. Hendrix, PhD, RHIT East Los Angeles College Monterey Park, California Traci Hermann, RN, MSN, CNE University of Cincinnati, Blue Ash College Cincinnati, Ohio Reviewers xii Reviewers Judith Hochberger, PhD, MS, RN Assistant Professor Roseman University of Health Sciences Henderson, Nevada Laura Hope, MSN, RN Florence Darlington Technical College Florence, South Carolina Celeste Hughes, MSN, RN Georgia Northwestern Technical College Rome, Georgia Renee Hyde, MSN, RN-BC Faculty Rowan Cabarrus Community College Kannapolis, North Carolina Katherine Kelly, RN, DNP, FNP-C Assistant Professor, School of Nursing California State University Sacramento, California Marci Langenkamp, MS, RN Edison Community College Piqua, Ohio Cheryl Lehman, PhD, CNS-BC, RN-BC, CRRN San Antonio, Texas Sue McCann, MSN, RN, DNC Advanced Practice Nurse, Clinical Research Coordinator University of Pittsburgh Medical Center Presbyterian-Shadyside Pittsburgh, Pennsylvania Molly McClelland, PhD, RN, CMSRN, ACNS-BC Associate Professor of Nursing University of Detroit Detroit, Michigan Janie V. McCloskey, RN, MSN Faculty Carolinas College of Health Sciences Charlotte, North Carolina Nancy McManus, BSN, MEd, RN-BC, CGRS Summa Health System Hospitals Akron, Ohio Tara McMillian Queen, RN, MSN, ANP, GNP Faculty II Mercy School of Nursing Charlotte, North Carolina Kathleen E. Meyer, DNP, CNE, APRN, ACHPN Stafford Services, Inc. Cleveland, Ohio Helena Moissant, RN, MSN Asante Rogue Regional Medical Center Medford, Oregon Ann Motycka, RN, MSN, CNE Professor Ivy Tech Community College Evansville, Indiana Robin Moyers, PhD, MSN, RN-BC Nursing Educator Carl Vinson VA Medical Center Dublin, Georgia Linda Nance, EdD, RN-BC, MSN, BSN, FNP Professor of Nursing, Curriculum Development Facilitator Scottsdale Community College Scottsdale, Arizona Lazette Nowicki, RN, MSN Professor of Nursing American River College Sacramento, California Becky Oglesby, DNP, RN Terri Peterson, RN, BSN, MSNEd Bauder College Atlanta, Georgia Heather Pollet, BSN, RN Interim Nursing Director Coffeyville Community College Nursing Program Coffeyville, Kansas Catherine Powers, MSN, FNP-BC East Tennessee State University Johnson City, Tennessee Marty Richardson, RN, MS Nursing Professor Grayson College Denison, Texas Heather Roberts, RN, MSN Faculty Presbyterian School of Nursing Queens University of Charlotte Karen Robertson, MSN, MBA, PhD/ABD Rock Valley College Rockford, Illinois Russlyn St. John, RN, BSN, MSNEd Associate Professor, Program Coordinator Practical Nursing/Nursing Assistant Programs Bauder College Atlanta, Georgia Charlotte D. Strahm, DNSc, RN, CNS Associate Professor Colorado Mountain College Glenwood Springs, Colorado Serena Strain, RN, BSN, MSN Nurse Faculty Forsyth Technical Community College Deema L. Tackett, MSN, RN, CNL Assistant Professor of Nursing Southern State Community College Hillsboro, Ohio Lisa Tardo-Green, MSN, RN Faculty Cabarrus College of Health Sciences Concord, North Carolina Lindsay Tucholski, MSN, RN Assistant Professor Cedarville University Cedarville, Ohio Tonya Turnage, MSN, RN Nursing Faculty Armstrong Atlantic State University Savannah, Georgia Amy Voris, DNP, AOCN, CNS Assistant Professor of Nursing, Adjunct Clinical Faculty, and Clinical Site Coordinator Cedarville University Cedarville, Ohio Donna Walker Hubbard, RN, MSN Assistant Professor Retired University of Mary Hardin Baylor Belton, Texas Donna Wilsker, MSN, RN Dishman Department of Nursing Lamar University Beaumont, Texas Karen Winsor, MSN, RN, ACNS-BC Advanced Practice Nurse for Orthopedic Trauma University Medical Center at Brackenridge Austin, Texas Tricia Winters, RRT, BBA North Central State College Mansfield, Ohio Nancee Wozney, PhD, RN Dean of Nursing and Allied Health Southeast Technical Minnesota State College Susan Yeager, MS, RN, CCRN, ACNP Wexner Medical Center at The Ohio State University Columbus, Ohio xiii Preface To laugh often and much, to appreciate beauty, to find the best in others, to leave the world a bit better, to know that even one life has breathed easier because you have lived, this is to have succeeded. Ralph Waldo Emerson Welcome to Saunders Pyramid to Success! An Essential Resource for Test Success Saunders Comprehensive Review for the NCLEX-PN® Examination is one in a series of products designed to assist you in achieving your goal of becoming a licensed practical nurse. This text provides you with a comprehensive review of all of the nursing content areas specifically related to the new 2014 test plan for the NCLEX-PN examination, which is implemented by the National Council of State Boards of Nursing. This resource will help you achieve success on your nursing examinations during nursing school and on the NCLEX-PN examination. Organization This book contains 20 units and 67 chapters. The chapters are designed to identify specific components of nursing content, and they contain practice questions, including a critical thinking question and both multiplechoice and alternate item formats that reflect the chapter content and the 2014 test plan for the NCLEX-PN exam. The final unit contains an 85-question Comprehensive Test. The new test plan identifies a framework based on Client Needs. These Client Needs categories include Safe and Effective Care Environment, Health Promotion and Maintenance, Psychosocial Integrity, and Physiological Integrity. Integrated Processes are also identified as a component of the test plan. These include Caring, Communication and Documentation, Nursing Process, and Teaching and Learning. All the chapters address the components of the test plan framework. Special Features of the Book Pyramid Terms Each unit begins with Pyramid Terms and their definitions. These Pyramid Terms are important to the discussion of the content in the chapters of the unit. Therefore, they are in bold blue type throughout the content section of each chapter. Pyramid to Success The Pyramid to Success, a feature part of the unit introduction, provides you with an overview, guidance, and direction regarding the focus of review in the particular content area, as well as the content areas of relative importance to the 2014 test plan for the NCLEX-PN exam. The Pyramid to Success reviews the Client Needs as they pertain to the content in that unit or chapter. These points identify the specific components to keep in mind as you review the chapter. Pyramid Points Pyramid Points are the little icons that are placed next to specific content throughout the chapters. The Pyramid Points highlight content that is important for preparing for the NCLEX-PN examination and identify content that typically appears on the NCLEX-PN examination. Pyramid Alerts Pyramid Alerts are the red text found throughout the chapters that alert you to important nursing information. These alerts identify content that typically appears on the NCLEX-PN examination. Priority Nursing Actions Numerous Priority Nursing Actions boxes have been placed throughout the chapters. These boxes present a clinical nursing situation and the priority actions to take in the event of its occurrence. A rationale is provided that explains the correct order of action, along with a reference for additional research. Critical Thinking: What Should You Do? Questions Each chapter contains a Critical Thinking: What Should You Do? question. These questions provide a brief clinical scenario related to the content of the chapter and ask you what you should do about the client xiv Preface situation presented. A narrative answer is provided along with a reference source for researching further information. Special Features Found on Evolve Pretest and Study Calendar The accompanying Evolve site contains a 75-question pretest that provides you with feedback on your strengths and weaknesses. The results of your pretest will generate an individualized study calendar to guide you in your preparation for the NCLEX-PN examination. Heart, Lung, and Bowel Sound Questions The accompanying Evolve site contains Audio Questions representative of content addressed in the 2014 test plan for the NCLEX-PN exam. These questions are in NCLEXstyle format, and each question presents an audio sound as a component of the question. Video Questions The accompanying Evolve site also contains new Video Questions representative of content addressed in the 2014 test plan for the NCLEX-PN exam. These questions are in NCLEX-style format, and each question presents a video clip as a component of the question. Testlet Questions The accompanying Evolve site contains testlet (case study) questions. These question types include a client scenario and several accompanying practice questions that relate to the content of the scenario. Audio Review Summaries The companion Evolve site includes three Audio Review Summaries that cover challenging subject areas under the 2014 NCLEX-PN test plan, including Pharmacology, Acid- Base Balance, and Fluids and Electrolytes. Practice Questions While preparing for the NCLEX-PN examination, it is crucial for students to practice taking test questions. This book contains 825 NCLEX-style multiple-choice and alternate item format questions. The accompanying software includes all the questions from the book, plus additional Evolve questions for a total of over 4500 questions. Multiple-Choice and Alternate Item Format Questions Starting with Unit II, each chapter is followed by a practice test. Each practice test contains several multiplechoice questions and an alternate item format question. The alternate item format questions at the end of the chapters and on the accompanying Evolve site may be presented as one of the following: ■ Fill-in-the-blank question ■ Multiple response question ■ Prioritizing (ordered response) question, also known as a drag-and-drop question ■ Figure/illustration question, also known as a hot spot question ■ Graphic options question, in which each option contains a figure or illustration ■ Chart/exhibit question ■ Audio question that includes a heart, lung, or bowel sound ■ Video question ■ Testlet question These questions provide you with practice in prioritizing, decision-making, and critical thinking skills. Answer Section The answer sections include the correct answer, rationale, test-taking strategy, question categories, and a reference. The structure for the answer section is unique and provides the following information: ■ Rationale: The rationale provides you with the significant information regarding both correct and incorrect options. ■ Test-Taking Strategy: The test-taking strategy provides a logical path for selecting the correct option and helps you to select an answer to a question on which you might have to guess. In each practice question, the specific strategy that will assist in answering the question correctly is highlighted in bold blue type. Specific suggestions for review are identified in the test-taking strategy and are highlighted in bold magenta type to provide you direction for locating the specific content in this book. The highlighting of the specific test-taking strategies and specific content areas in the practice questions will provide you with guidance on what topics to review for further remediation in Saunders Strategies for Test Success: Passing Nursing School and the NCLEX® Exam and in this book, the Saunders Comprehensive Review for the NCLEX-PN® Exam. ■ Question Categories: Each question is tagged with categories based on the 2014 NCLEX-PN test plan. Additional content categories are provided with each question to assist you in identifying areas in need of review. The categories identified with each practice question include Level of Cognitive Ability, Client Needs, Integrated Process, and the specific nursing Content Area. New to this edition is a Priority Concepts code, which provides you with the specific concepts related to nursing practice. All categories are identified by their full names so you do not need to memorize codes or abbreviations. Additionally, every question on the accompanying Evolve site is Preface xv organized by these question codes, so you can customize your study session to be as specific or as generic as you need. ■ Reference: A reference, including a page number, is provided so you can easily find the information that you need to review in your undergraduate nursing textbooks. Pharmacology and Medication Calculations Review Students consistently state that pharmacology is an area with which they need assistance. The 2014 NCLEX-PN test plan continues to incorporate pharmacology in the examination as it has in the past. Therefore, pharmacology chapters have been included for your review and practice. This book includes 13 pharmacology chapters, a medication and intravenous calculation chapter, and a pediatric medication calculation chapter. Each of these chapters is followed by a practice test that uses the same question format described earlier. This book contains numerous pharmacology questions. Additionally, more than 900 pharmacology questions can be found on the accompanying Evolve site. How to Use This Book Saunders Comprehensive Review for the NCLEX-PN® Examination is especially designed to help you with your successful journey to the peak of the Saunders Pyramid to Success: becoming a licensed practical nurse. As you begin your journey through this book, you will be introduced to all the important points regarding the 2014 NCLEX-PN examination, the process of testing, and unique and special tips regarding how to prepare yourself for this very important examination. You should begin your process through the Saunders Pyramid to Success by reading all of Unit I in this book and becoming familiar with the central points regarding the NCLEX-PN examination. Read Chapter 4, which was written by a nursing graduate who recently passed the examination, and note what she has to say about the testing experience. Chapter 5, “Test-Taking Strategies,” will provide you with the critical testing strategies that will guide you in selecting the correct option or assist you in selecting an answer to a question if you must guess. Keep these strategies in mind as you proceed through this book. Continue by studying the specific content areas addressed in Units II through XIX. Review the Pyramid Terms and Pyramid to Success notes, and identify the Client Needs specific to the test plan in each area. Read through the chapters, and focus on the Pyramid Points and Pyramid Alerts that identify the areas most likely to be tested on the NCLEX-PN examination. Pay particular attention to the Priority Nursing Actions boxes because they provide information about the steps that you will take in clinical situations requiring prioritization. As you read each chapter, identify your areas of strength and those in need of further review. Highlight these areas, and test your abilities by answering the Critical Thinking: What Should You Do? question and taking all the practice tests provided at the end of the chapters. Be sure to review all the rationales and the test-taking strategies. The rationale provides you with information regarding both the correct and incorrect options. The test-taking strategy highlights the specific strategy in bold blue type and offers a logical path to selecting the correct option. The test-taking strategy also provides the content to review, highlighted in bold magenta type. Use the references to easily find any information you need to review. After reviewing all the chapters in the book, turn to Unit XX, the Comprehensive Test. Take this examination, and then review each question, answer, and rationale. Identify any areas requiring further review; then take the time to review those areas again in both the book and the companion Evolve site. Climbing the Pyramid to Success The purpose of this book is to provide a comprehensive review of the nursing content you will be tested on during the NCLEX-PN examination. However, Saunders Comprehensive Review for the NCLEX-PN® Examination is intended to do more than simply prepare you for the rigors of the NCLEX-PN. This book is also meant to serve as a valuable study tool that you can refer to throughout your nursing program, with customizable Evolve site selections to help identify and reinforce key content areas. At the base of the Pyramid to Success are my test-taking strategies, which provide a foundation for understanding and unpacking the complexities of NCLEX-PN exam questions, including alternate item formats. Saunders Strategies for Test Success: Passing Nursing School and the NCLEX® Exam takes a detailed look at all the test-taking strategies you will need to know to pass any nursing examination, including the NCLEX-PN. Special tips are xvi Preface integrated for beginning nursing students, and there are over 1000 practice questions included so you can apply the testing strategies. For on-the-go Q&A review, you can pick up Saunders Q&A Review Cards for the NCLEX-PN® Examination, which features 1200 practice NCLEX-type questions spanning all content areas. Your final step on the Pyramid to Success is to master the online review. Saunders Online Review for the NCLEX-PN® Examination provides an interactive and individualized platform to get you ready for your final licensure exam. This online course provides 10 high-level content modules, supplemented with instructional videos, animations, audio, illustrations, testlets, and several subject matter exams. End-of-module practice tests are provided, along with several Crossing the Finish Line practice tests. In addition, you can assess your progress with a pretest and posttest comprehensive exam in a computerized environment that prepares you for the actual NCLEX-PN exam. Using the Companion Evolve Site The main website for Evolve is . There is a code located in the front cover of your book that you’ll need to use to access the companion Evolve site for this book. The site contains more than 4500 questions and has three main functions: ■ Pretest and study calendar: To assess your strengths and weaknesses, take the 75-question pretest. Your results will generate a customized study calendar. ■ Study: Select questions by Client Needs, Integrated Process, Alternate Item Format Type, Priority Concepts, or specific Content Area. The answer, rationale, test-taking strategy, codes, and reference appear immediately after you answer each question. ■ Exam: Select questions by Client Needs, Integrated Process, Alternate Item Format Type, Priority Concepts, or specific Content Area. Then select the number of questions you’d like to take in your exam: 10, 25, 50, or 100. When you have finished the exam, the percentage of questions you answered correctly will be shown in a table, and you can go back to review the questions and answers—as well as rationales, test-taking strategies, question codes, and reference(s)—for each question. Good luck with your journey through the Saunders Pyramid to Success. I wish you continued success throughout your new career as a licensed practical nurse! Linda Anne Silvestri, PhD, RN xvii Acknowledgments Sincere appreciation and warmest thanks are extended to the many individuals who in their own ways have contributed to the publication of this book. First, I want to thank all my nursing students at the Community College of Rhode Island in Warwick who approached me in 1991 and persuaded me to help them prepare to take the NCLEX examination. Their enthusiasm and inspiration led to the commencement of my professional endeavors in conducting review courses for the NCLEX exam for nursing students. I also thank the numerous nursing students who have attended my review courses for their willingness to share their needs and ideas. Their input has certainly added a special uniqueness to this publication. I wish to acknowledge all the nursing faculty who taught in my NCLEX review courses. Their commitment, dedication, and expertise have certainly helped nursing students achieve success with the NCLEX exam. Additionally, I want to acknowledge and sincerely thank my husband Laurent W. Valliere, or Larry, for his contribution to this publication, for teaching in my NCLEX review courses, and for his commitment and dedication in helping my nursing students prepare for the NCLEX from a nonacademic point of view. Larry has supported my many professional endeavors and was so loyal and loving to me each and every moment as I worked to achieve my professional goals. Larry, thank you so much! A special thank you also goes to Keara Cobbs, PN, for writing a chapter for this book about her experiences preparing for and taking the NCLEX-PN examination. I sincerely acknowledge and thank two very important individuals from Elsevier who are so dedicated to my work in creating NCLEX products for nursing students. I thank Yvonne Alexopoulos, senior content strategist, for her continuous assistance, enthusiasm, support, and expert professional guidance as I prepared this publication. And I thank Laura Goodrich, content developmental specialist, for her tremendous amount of support and assistance, her weekly priority lists to keep me on track, her ideas for the product, and her professional and expert skills in organizing and maintaining an enormous amount of manuscript for production. I could not have completed this project without Laura! So a very special and sincere thank you extends to both Yvonne and Laura. I also thank Angela E. Silvestri, PhD, RN, for reviewing content and practice questions and for her assistance with creating new practice questions; Mary Dowell for her expert assistance and contributions in the book and Evolve site; Elodia Dianne Fiorentino for researching content and preparing references for each practice question; Nicholas Silvestri for editing, formatting, and organizing manuscript files for me; and James Guilbault for researching and updating medications. A special thank you to all of you for providing continuous support and dedication to my work in preparing this publication and maintaining its excellent quality. I want to acknowledge all of the staff at Elsevier for their tremendous assistance throughout the preparation and production of this publication and all of the Elsevier staff involved in the publication of previous editions of this outstanding NCLEX review product. A special thank you to all of them. I thank all the important people in the production department, including Bill Drone, senior project manager; Jeff Patterson, publishing services manager; Emily Ogle, multimedia producer; David Rushing, multimedia manager; and Maggie Reid, designer, who all played such significant roles in finalizing this publication. I sincerely thank those in the marketing department who helped with the promotion of this book, including Danielle LeCompte, marketing manager, and Julie Mark, marketing coordinator. And a special thank you to Laurie Gower, Content Development Manager, Kristin Geen, director, and Loren Wilson, SVP & GM, Content, for their years of expert guidance and continuous support for all the products in the Pyramid to Success. I would also like to acknowledge Patricia Mieg, former educational sales representative, who encouraged me to submit my ideas and initial work for the first edition of this book to the W.B. Saunders Company. I want to acknowledge my parents, who opened my door of opportunity in education. I thank my mother, Frances Mary, for all of her love, support, and assistance as I continuously worked to achieve my professional goals. I thank my father, Arnold Lawrence, who always provided insightful words of encouragement. My memories of his love and support will always remain in my heart. I am certain that he would be very proud of my professional accomplishments. I also thank all my family for being continuously supportive, giving, and helpful during my research and preparation of this publication. xviii Acknowledgments I want to especially acknowledge each and every individual who contributed to this publication: the contributors, item writers, and updaters for your expert input and ideas. I also thank the many faculty and student reviewers of the manuscript for their thoughts and ideas. A very special thank you to all of you! I also need to thank Salve Regina University for the opportunity to educate nursing students in the baccalaureate nursing program and for its support during my research and writing of this publication. I would like to especially acknowledge my colleagues Dr. Eileen Gray, Dr. Ellen McCarty, and Dr. Bethany Sykes for all their encouragement and support. I wish to acknowledge the Community College of Rhode Island, which provided me the opportunity to educate nursing students in the Associate Degree of Nursing Program, and a special thank you to Patricia Miller, MSN, RN, and Michelina McClellan, MS, RN, from Baystate Medical Center, School of Nursing, in Springfield, Massachusetts, who were my first mentors in nursing education. Finally, I extend a very special thank you to all my nursing students, past, present, and future. All of you light up my life! Your love and dedication to the profession of nursing and your commitment to provide health care will bring never-ending rewards! Linda Anne Silvestri, PhD, RN xix Contents UNIT I NCLEX-PN® Exam Preparation, 1 1 The NCLEX-PN® Examination, 2 2 NCLEX-PN® Preparation for Foreign- Educated Nurses, 14 3 Pathways to Success, 18 4 The NCLEX-PN® Examination: From a Graduate’s Perspective, 22 5 Test-Taking Strategies, 24 UNIT II Issues in Nursing, 33 6 Cultural Awareness and Health Practices, 35 7 Ethical and Legal Issues, 46 8 Prioritizing Client Care: Leadership, Delegation, and Disaster Planning, 60 UNIT III Nursing Sciences, 74 9 Fluids and Electrolytes,77 10 Acid–Base Balance, 91 11 Laboratory Values, 100 12 Nutritional Components of Care, 114 13 Intravenous Therapy and Blood Administration, 126 UNIT IV Fundamental Skills, 140 14 Hygiene and Safety, 143 15 Medication and Intravenous Administration, 153 16 Basic Life Support, 163 17 Perioperative Nursing Care, 171 18 Positioning Clients, 184 19 Care of a Client with a Tube, 193 UNIT V Growth and Development Across the Life Span, 209 20 Theories of Growth and Development, 211 21 Developmental Stages, 219 22 Care of the Older Client, 233 23 Health and Physical Assessment of the Adult Client, 240 UNIT VI Maternity Nursing, 260 24 Reproductive System, 262 25 Obstetrical Assessment, 270 26 Prenatal Period and Risk Conditions, 276 27 Labor and Delivery and Associated Complications, 302 28 The Postpartum Period and Associated Complications, 320 29 Care of the Newborn, 332 30 Maternity and Newborn Medications, 352 UNIT VII Pediatric Nursing, 362 31 Integumentary Disorders, 364 32 Hematological and Oncological Disorders, 370 33 Metabolic, Endocrine, and Gastrointestinal Disorders, 383 34 Eye, Ear, Throat, and Respiratory Disorders, 406 35 Cardiovascular Disorders, 425 36 Renal and Urinary Disorders, 436 37 Neurological, Cognitive, and Psychosocial Disorders, 444 38 Musculoskeletal Disorders, 455 39 Communicable Diseases and Acquired Immunodeficiency Syndrome, 464 40 Pediatric Medication Administration and Calculations, 476 UNIT VIII The Adult Client with an Integumentary Disorder, 482 41 Integumentary System, 484 42 Integumentary Medications, 505 UNIT IX Hematological and Oncological Disorders of the Adult Client, 514 43 Hematological and Oncological Disorders, 516 44 Antineoplastic Medications, 544 UNIT X The Adult Client with an Endocrine Disorder, 553 45 Endocrine System, 555 46 Endocrine Medications, 577 xx Contents UNIT XI The Adult Client with a Gastrointestinal Disorder, 591 47 Gastrointestinal System, 593 48 Gastrointestinal Medications, 617 UNIT XII The Adult Client with a Respiratory Disorder, 626 49 Respiratory System, 628 50 Respiratory Medications, 651 UNIT XIII The Adult Client with a Cardiovascular Disorder, 667 51 Cardiovascular Disorders, 669 52 Cardiovascular Medications, 705 UNIT XIV The Adult Client with a Renal Disorder, 720 53 Renal System, 722 54 Renal Medications, 754 UNIT XV The Adult Client with an Eye or Ear Disorder, 763 55 The Eye and the Ear, 765 56 Ophthalmic and Otic Medications, 785 UNIT XVI The Adult Client with a Neurological Disorder, 796 57 Neurological System, 798 58 Neurological Medications, 826 UNIT XVII The Adult Client with a Musculoskeletal Disorder, 838 59 Musculoskeletal System, 840 60 Musculoskeletal Medications, 860 UNIT XVIII The Adult Client with an Immune Disorder, 868 61 Immune Disorders, 870 62 Immunological Medications, 883 UNIT XIX The Adult Client with a Mental Health Disorder, 892 63 Foundations of Psychiatric Mental Health Nursing, 894 64 Mental Health Disorders, 906 65 Addictions, 926 66 Crisis Theory and Intervention, 938 67 Psychiatric Medications, 951 UNIT XX Comprehensive Test, 963 Comprehensive Test, 964 References, 988 Index, 989 Preparation UNIT I NCLEX-PN® Exam Preparation Preparation 2 The Pyramid to Success Welcome to the Pyramid to Success Saunders Comprehensive Review for the NCLEX-PN® Examination is specially designed to help you begin your successful journey to the peak of the pyramid, becoming a licensed practical/vocational nurse. As you begin your journey, you will be introduced to all the important points regarding the NCLEX-PN examination and the process of testing, and to the unique and special tips regarding how to prepare yourself for this important examination. You will read what a nursing graduate who recently passed the NCLEX-PN examination has to say about the test. Important test-taking strategies are detailed. These details will guide you in selecting the correct option or assist you in selecting an answer to a question at which you must guess. 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-PN examination, including the Pyramid Terms, and the Client Needs as identified in the test plan framework for the examination. Pyramid Terms are key words that are defined and are set in bold purple throughout each chapter to direct your attention to significant points for the examination. The Client Needs 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-PN examination. Read each chapter, and identify your strengths and areas that are in need of further review. Test your strengths and abilities by taking all the practice tests provided in this book and on the accompanying Evolve 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 easily find the information that you need to review. Each question is coded with the Level of Cognitive Ability, the Client Needs category, the Integrated Process, and the nursing Content Area. Following the completion of your comprehensive review in this book, continue on your journey through the Pyramid to Success with the companion book Saunders Q&A Review for the NCLEX-PN® Examination, which provides you with more than 4500 practice questions based on the NCLEX-PN examination test plan framework, with a specific focus on Client Needs and Integrated Processes. Then, you will be ready for HESI/ Saunders Online Review for the NCLEX-PN® Examination. Additional products in Saunders Pyramid to Success include Saunders Strategies for Test Success: Passing Nursing School and the NCLEX® Exam and Saunders Q&A Review Cards for the NCLEX-PN® Exam. These products are described next. HESI/Saunders Online Review for the NCLEX-PN® Examination This product 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 and generates an individualized study schedule in a calendar format. Content review is in an outline format and includes self-check practice questions and case studies, figures and illustrations, a glossary, and animations and videos. Numerous online exams are included. There are 2500 practice questions; the types of questions in this course include multiple-choice and alternate item formats. Saunders Strategies for Test Success: Passing Nursing School and the NCLEX® Exam This product 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 examination. The chapters describe various test-taking strategies