Saunders NCLEX-RN® Midterm Test Bank 2025/2026 | Real Exam-Level Qs Answers Rationales | Silvestri 9th Edition

Contents


Unit I Unit IV
NCLEX-RN® Exam Preparation, 1 Growth and Development Across
1 Clinical Judgment and the Next Generation the Life Span, 234
NCLEX (NGN)-RN® Examination, 2 18 Theories of Growth and Development, 236
2 Self-Efcacy and Pathways to Success, 17 19 Growth, Development, and Stages of Life, 244
3 The NCLEX-RN® Examination from a Graduate’s 20 Care of the Older Client, 266
Perspective, 22
4 Clinical Judgment and Test-Taking
Strategies, 24
Unit V
Maternity Nursing, 275
Unit II 21 Reproductive System, 277
22 Prenatal Period, 285
Professional Standards in Nursing, 38 23 Risk Conditions Related to Pregnancy, 300
5 Population Health Nursing, 40 24 Labor and Birth, 323
6 Ethical and Legal Issues, 53 25 Problems with Labor and Birth, 336
7 Prioritizing Client Care: Leadership, Delegation, 26 Postpartum Period, 343
and Emergency Response Planning, 68 27 Postpartum Complications, 350
28 Care of the Newborn, 358
29 Maternity and Newborn Medications, 380
Unit III
Foundations of Care, 85 Unit VI
8 Fluids and Electrolytes, 88
9 Acid-Base Balance, 106 Pediatric Nursing, 391
10 Vital Signs and Laboratory Reference 30 Integumentary Problems, 392
Intervals, 116 31 Hematological Problems, 399
11 Nutrition, 132 32 Oncological Problems, 406
12 Health and Physical Assessment of the Adult 33 Metabolic and Endocrine Problems, 416
Client, 143 34 Gastrointestinal Problems, 425
13 Safety and Infection Control, 166 35 Eye, Ear, and Throat Problems, 444
14 Medication Administration and Intravenous 36 Respiratory Problems, 451
Therapies, 178 37 Cardiovascular Problems, 467
15 Perioperative Nursing Care, 189 38 Renal and Genitourinary Problems, 479
16 Hygiene, Mobility, and Skin Integrity, 204 39 Neurological and Cognitive Problems, 487
17 Urinary and Bowel Elimination, 218 40 Musculoskeletal Problems, 498
41 Immune Problems and Infectious Diseases, 507
42 Pediatric Medication Administration and
Calculations, 520


iii

,iv Contents


Unit VII Unit XIV
Integumentary Problems of the Adult Eye and Ear Problems of the Adult
Client, 527 Client, 821
43 Integumentary Problems, 528 57 Eye and Ear Problems, 822
44 Integumentary Medications, 538 58 Eye and Ear Medications, 842


Unit VIII Unit XV
Oncological and Hematological Neurological Problems of the Adult
Problems of the Adult Client, 547 Client, 852
45 Oncological and Hematological Problems, 549 59 Neurological Problems, 853
46 Oncological and Hematological 60 Neurological Medications, 877
Medications, 587

Unit XVI
Unit IX
Musculoskeletal Problems of the Adult
Endocrine Problems of the Adult Client, 598
47 Endocrine Problems, 599
Client, 888
48 Endocrine Medications, 626 61 Musculoskeletal Problems, 889
62 Musculoskeletal Medications, 910

Unit X
Unit XVII
Gastrointestinal Problems of the Adult
Immune Problems of the Adult
Client, 641
49 Gastrointestinal Problems, 643
Client, 918
50 Gastrointestinal Medications, 671 63 Immune Problems, 919
64 Immune Medications, 933

Unit XI
Unit XVIII
Respiratory Problems of the Adult
Client, 679 Mental Health Problems of the Adult
51 Respiratory Problems, 680 Client, 940
52 Respiratory Medications, 701 65 Foundations of Psychiatric Mental Health
Nursing, 941
66 Mental Health Problems, 954
Unit XII 67 Addictions, 975
68 Crisis Theory and Intervention, 987
Cardiovascular Problems of the Adult 69 Psychotherapeutic Medications, 1001
Client, 719
53 Cardiovascular Problems, 720
54 Cardiovascular Medications, 760
Unit XIX
Complex Care, 1015
Unit XIII 70 Complex Care, 1017

Renal and Urinary Problems of the Adult References, 1088
Index, 1090
Client, 778
55 Renal and Urinary Problems, 779
56 Renal and Urinary Medications, 811

, CHAPTER 8 Fluids and Electrolytes 101


2. Tumor lysis syndrome 4. Potassium chloride intravenously is prescribed for a
3. Increased intake of phosphorus, including di- client with heart failure experiencing hypokalemia.
etary intake or overuse of phosphate-containing Which actions would the nurse take to plan for
laxatives or enemas preparation and administration of the potassium?
4. Hypoparathyroidism Select all that apply.
C. Assessment: (see Table 8.5) 1. Obtain an intravenous (IV) infusion pump.
D. Interventions 2. Monitor urine output during administration.
1. Interventions entail the management of hypoc- 3. Prepare the medication for bolus administration.
alcemia. 4. Monitor the IV site for signs of inltration or
2. Administer phosphate-binding medications that phlebitis.
increase fecal excretion of phosphorus by bind- 5. Ensure that the medication is diluted in the
ing phosphorus from food in the gastrointesti- appropriate volume of uid.
nal tract. 6. Ensure that the bag is labeled with the volume
3. Instruct the client to avoid phosphate-containing of potassium in the solution.
medications, including laxatives and enemas.
4. Instruct the client to decrease the intake of food 5. The nurse is assessing a client with a lactose intoler-
that is high in phosphorus (see Box 11.2). ance disorder for a suspected diagnosis of hypoc-
5. Instruct the client in medication administration: alcemia. Which clinical manifestation would the
Take phosphate-binding medications, empha- nurse expect to note in the client?
sizing that they should be taken with meals or 1. Twitching
immediately after meals. 2. Hypoactive bowel sounds
3. Negative Trousseau’s sign
4. Hypoactive deep tendon reexes

PRACTICE QUESTIONS 6. The nurse is caring for a client with Crohn’s disease
who has a calcium level of 8 mg/dL (2 mmol/L).
1. The nurse is caring for a client with heart failure. On Which patterns would the nurse watch for on the
assessment, the nurse notes that the client is dysp- electrocardiogram? Select all that apply.
neic, and crackles are audible on auscultation. What 1. Peaked T wave
additional manifestations would the nurse expect to 2. Widened T wave
note in this client if excess uid volume is present? 3. Prominent U wave
1. Weight loss and dry skin 4. Prolonged QT interval
2. Flat neck and hand veins and decreased urinary 5. Prolonged ST segment
output
3. An increase in blood pressure and increased res- 7. The nurse reviews the electrolyte results of a client
pirations with chronic kidney disease and notes that the po-
4. Weakness and decreased central venous pressure tassium level is 5.7 mEq/L (5.7 mmol/L). Which
(CVP) patterns would the nurse watch for on the cardiac
monitor as a result of the laboratory value? Select
2. The nurse reviews a client’s record and determines all that apply.
that the client is at risk for developing a potassium 1. ST depression
decit if which situation is documented? 2. Prominent U wave
1. Sustained tissue damage 3. Tall peaked T waves
2. Requires nasogastric suction 4. Prolonged ST segment
3. Has a history of Addison’s disease 5. Widened QRS complexes
4. Uric acid level of 9.4 mg/dL (557 mcmol/L)
8. Which client is at risk for the development of a so-
3. The nurse reviews a client’s electrolyte laboratory re- dium level at 130 mEq/L (130 mmol/L)?
port and notes that the potassium level is 2.5 mEq/L 1. The client who is taking diuretics
(2.5 mmol/L). Which patterns would the nurse 2. The client with hyperaldosteronism
watch for on the electrocardiogram (ECG) as a re- 3. The client with Cushing’s syndrome
sult of the laboratory value? Select all that apply. 4. The client who is taking corticosteroids
1. U waves
2. Absent P waves 9. The nurse is caring for a client with heart failure who
3. Inverted T waves is receiving high doses of a diuretic. On assessment,
4. Depressed ST segment the nurse notes that the client has at neck veins,
5. Widened QRS complex generalized muscle weakness, and diminished deep

, 102 UNIT III Foundations of Care


tendon reexes. The nurse suspects hyponatremia. 13. The nurse caring for a client with heart failure who
What additional sign would the nurse expect to has been receiving intravenous (IV) diuretics sus-
Foundations of Care



note in a client with hyponatremia? pects that the client is experiencing a uid volume
1. Muscle twitches decit. Which assessment nding would the nurse
2. Decreased urinary output note in a client with this condition?
3. Hyperactive bowel sounds 1. Weight loss and poor skin turgor
4. Increased specic gravity of the urine 2. Lung congestion and increased heart rate
3. Decreased hematocrit and increased urine out-
10. The nurse reviews a client’s laboratory report and put
notes that the client’s serum phosphorus (phos- 4. Increased respirations and increased blood pres-
phate) level is 1.8 mg/dL (0.58 mmol/L). Which sure
condition most likely caused this serum phospho-
rus level? 14. On review of the clients’ medical records, the nurse
1. Malnutrition determines that which client is at risk for uid vol-
2. Renal insufciency ume excess?
3. Hypoparathyroidism 1. The client taking diuretics who has tenting of the
4. Tumor lysis syndrome skin
2. The client with an ileostomy from a recent ab-
11. The nurse is reading a physician’s progress notes dominal surgery
in the client’s record and reads that the physician 3. The client who requires intermittent gastrointes-
has documented “insensible uid loss of approxi- tinal suctioning
mately 800 mL daily.” The nurse plans to monitor 4. The client with kidney disease that developed as
the client, knowing that insensible uid loss occurs a complication of diabetes mellitus
through which type of excretion?
1. Urinary output 15. Which client is at risk for the development of a po-
2. Wound drainage tassium level of 5.5 mEq/L (5.5 mmol/L)?
3. Integumentary output 1. The client with colitis
4. The gastrointestinal tract 2. The client with Cushing’s syndrome
3. The client who has been overusing laxatives
12. The nurse is assigned to care for a group of clients. 4. The client who has sustained a traumatic burn
On review of the clients’ medical records, the nurse
determines that which client is most likely at risk
for a uid volume decit?
1. A client with an ileostomy
2. A client with heart failure
3. A client on long-term corticosteroid therapy
4. A client receiving frequent wound irrigations




ANSWERS all parts need to be correct in order for the option to be correct.
Think about the pathophysiology associated with a fluid vol-
1. Answer: 3 ume excess to assist in directing you to the correct option. Also,
Rationale: A fluid volume excess is also known as overhydra- note that the incorrect options are comparable or alike in that
tion or fluid overload and occurs when fluid intake or fluid each includes manifestations that reflect a decrease.
retention exceeds the fluid needs of the body. Assessment Reference: Lewis, S., Harding, M., Kwong, J., Roberts, D.,
findings associated with fluid volume excess include cough, Hagler, D., & Reinisch, C. (2020). Medical-surgical nursing:
dyspnea, crackles, tachypnea, tachycardia, elevated blood Assessment and management of clinical problems. (11th ed.). St.
pressure, bounding pulse, elevated CVP, weight gain, edema, Louis: Elsevier. pp. 740-741.
neck and hand vein distention, altered level of consciousness,
and decreased hematocrit. Dry skin, flat neck and hand veins, 2. Answer: 2
decreased urinary output, and decreased CVP are noted in Rationale: The normal serum potassium level is 3.5 to 5.0
fluid volume deficit. Weakness can be present in either fluid mEq/L (3.5 to 5.0 mmol/L). A potassium deficit is known
volume excess or deficit. as hypokalemia. Potassium-rich gastrointestinal fluids are lost
Test-Taking Strategy: Focus on the subject, fluid volume excess. through gastrointestinal suction, placing the client at risk
Remember that when there is more than one part to an option, for hypokalemia. The client with tissue damage or Addison’s