Ebook NCLEX-RN EXCEL - Test success through unfolding case study review (2/E): Part 1

®

NCLEX-RN EXCEL


Ruth A. Wittmann-Price, PhD, RN, CNS, CNE, CHSE, ANEF, FAAN, is the dean of the School of Health
Sciences at Francis Marion University, Florence, South Carolina. Dr.Wittman-Price has been an obstetrical/women’s
health nurse for 38 years. She received her BSN degree from Felician College in Lodi, New Jersey (1981), and her MS
as a perinatal clinical nurse specialist (CNS) from Columbia University, New York, New York (1983). Dr.WittmannPrice completed her PhD in nursing at Widener University, Chester, Pennsylvania (2006), and was awarded the Dean’s
Award for Excellence. She developed a mid-range nursing theory, Emancipated Decision-Making in Women’s Health
Care, and has tested her theory in four research studies. International researchers are currently using her theory as the
foundation for further studies. Her theory is being used at the University of Limpopo, South Africa, in their campaign,
“Finding Solutions for Africa,” which helps women and children. Dr.Wittmann-Price was also the appointed research
coordinator for Hahnemann University Hospital, Philadelphia, Pennsylvania, and oversaw the evidence-based
practice projects for nursing (2007–2010). Hahnemann University Hospital was granted initial Magnet® designation
in December of 2009. Dr. Wittmann-Price has taught all levels of nursing students over the past 20 years and has
completed an international service-learning trip. She mentors doctor of nursing practice and doctor of philosophy
students and is on several committees for both Drexel and Widener Universities. Dr. Wittmann-Price has authored
14 books, two book chapters, and more than 20 articles. She has presented her research regionally, nationally, and
internationally. Dr.Wittmann-Price was inducted into the National League for Nursing (NLN) Academy of Nurse
Educator Fellows in 2013 and named a fellow of the American Academy of Nursing in October 2015.
Brenda Reap Thompson, MSN, RN, CNE, is an adjunct faculty member at Drexel University, College of
Nursing and Health Professions, Philadelphia, Pennsylvania. She received a BSN degree from Gwynedd Mercy
University, Gwynedd Valley, Pennsylvania (1982), and an MSN degree (Adult Health and Education) from Villanova
University, Villanova, Pennsylvania (1992). In 1990, she was the recipient of the Professional Nurse Traineeship
Award at Villanova. Her clinical experience in nursing is in the areas of critical care and emergency health care and
she has served as a director of cardiac rehabilitation. She has taught all levels of nursing throughout the past 15 years.
Her expertise is in test development and she has had the opportunity to contribute to the development and review
of test questions for the National Council Licensure Examination (NCLEX) under the direction of the National
Council of State Boards of Nursing. Ms.Thompson was also a clinical safety coordinator in risk management and is

an advocate for patient safety and quality improvement. She is a member of the American Society for Professionals
in Patient Safety (ASPPS). She is the coeditor and author of Nursing Concept Care Maps for Safe Patient Care (2013);
she has contributed five book chapters and two refereed abstracts, the latter on the use of standardized patients and
the human simulation experience for undergraduate students. She has presented nationally and internationally on
test development and construction and the human simulation experience. She is a member of the American Nurses
Association, National League for Nursing, and president of the Nu Eta Chapter of Sigma Theta Tau International.
Frances H. Cornelius, PhD, MSN, RN-BC, CNE, is a clinical professor and department chair for advanced
role master of science in nursing and complementary and integrative health programs at Drexel University in
Philadelphia. She is a board-certified nurse educator and has taught at the college and university level since
1990. She has an extensive clinical background in medical–surgical, psychiatric, oncology, and community
health nursing. In addition, Dr. Cornelius has substantial experience in the design, development, and delivery
of online, hybrid, and traditional course content as well as the integration of learning technologies into the
classroom. Her area of research involves student learning, development of clinical decision-making skills, and
clinical competency using handheld mobile devices.
In 2010, Dr. Cornelius was the recipient of the Outstanding Educator in Online Learning Award from Drexel
University Online. She is currently a master reviewer for Quality MattersTM, a faculty-centered peer-review process
that is designed to certify the quality of online and blended courses. She is a National League for Nursing (NLN)
Certified Nurse Informaticist and a National Library of Medicine Medical Informatics fellow. Dr. Cornelius is the
coeditor of PDA Connections: Mobile Technology for Health Care Professionals (2007), an innovative textbook designed
to teach health care professionals how to use mobile devices for “point-of-care” access of information. She is the
coeditor and author of Ethical Health Informatics: Challenges and Opportunities (2016). She is also a coauthor of an
innovative series of six National Council Licensure Examination (NCLEX) review books, published by Springer
Publishing Company, designed to support development of critical thinking among nursing students using unfolding
case studies infused with mobile decision support resources to replicate realistic clinical experiences.


®

NCLEX-RN EXCEL
Test Success

Through Unfolding
Case Study Review
Second Edition
Ruth A.Wittmann-Price, PhD, RN, CNS, CNE, CHSE, ANEF, FAAN
Brenda Reap Thompson, MSN, RN, CNE
Frances H. Cornelius, PhD, MSN, RN-BC, CNE


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Names: Wittmann-Price, Ruth A., editor. | Thompson, Brenda Reap., editor. | Cornelius, Frances H., editor. | Preceded by (work):
Wittmann-Price, Ruth A. NCLEX-RN excel.
Title: NCLEX-RN excel: test success through unfolding case study review/[edited by] Ruth A. Wittmann-Price, Brenda Reap
Thompson, Frances H. Cornelius.
Description: Second edition. | New York, NY: Springer Publishing Company, LLC, [2017] | Preceded by NCLEX-RN excel/
Ruth A. Wittmann-Price, Brenda Reap Thompson. 2010. | Includes bibliographical references and index.
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Contents
Contributors
vii
Reviewer
xi
Foreword Gloria Ferraro Donnelly, PhD, RN, FAAN
xiii
Preface

xv
Share NCLEX-RN ® Excel: Test Success Through Unfolding Case Study
Review, Second Edition
1. Strategies for Studying and Taking Standardized Tests
1
Ruth A.Wittmann-Price, Brenda Reap Thompson, and Frances H. Cornelius
2. Medical–Surgical Nursing
27
Part I: Nursing Care of the Patient With a Cardiovascular Disorder
27
Karen K. Gittings and Brenda Reap Thompson
Part II: Nursing Care of the Patient With a Pulmonary Disorder
40
Nina Russell and Brenda Reap Thompson
Part III: Nursing Care of the Patient With Renal Disease
47
Karen K. Gittings and Brenda Reap Thompson
Part IV: Nursing Care of the Patient With a Musculoskeletal Disorder
58
Nina Russell and Brenda Reap Thompson
Part V: Nursing Care of the Patient With a Neurological Disorder
67
Nina Russell and Brenda Reap Thompson
Part VI: Nursing Care of the Patient With an Endocrine Disorder
79
Karen K. Gittings and Brenda Reap Thompson
Part VII: Nursing Care of the Patient With a Gastrointestinal Disorder
91
Karen K. Gittings, Ruth A.Wittmann-Price, and Brenda Reap Thompson
Part VIII: Nursing Care of Patients With Infectious Diseases

113
Nina Russell and Brenda Reap Thompson
3. Mental Health Nursing
167
Roseann V. Regan and Roberta Waite
4. Women’s Health Nursing
249
Mary Foster Cox and Ruth A.Wittmann-Price


vi

Contents

5. Pediatric Nursing
Maryann Godshall
6. Pharmacology
Brian J. Fasolka

337
409

7. Community Health Nursing
Mary Gallagher Gordon

479

8. Leadership and Management in Nursing
Cheryl Portwood
9. Men’s Health

Tracy P. George

563

10. Geriatric Health
Deborah L. Hopla

589

11. Veterans’ Health
Karyn E. Holt

617

Index

633

531


Contributors
Frances H. Cornelius, PhD, MSN, RN-BC, CNE
Clinical Professor and Department Chair
Advanced Role MSN and Complementary and Integrative Health Programs
Drexel University
Philadelphia, Pennsylvania
Mary Foster Cox, PhD, CPNP-PC
Clinical Assistant Professor
Department of Nursing

University of South Carolina
Columbia, South Carolina
Brian J. Fasolka, PhD, RN, CEN
Assistant Clinical Professor
College of Nursing and Health Professions
Drexel University
Philadelphia, Pennsylvania
Tracy P. George, DNP, APRN-BC, CNE
Assistant Professor
Francis Marion University
Florence, South Carolina
Karen K. Gittings, DNP, RN, CNE
Associate Dean of Health Sciences Chair, Nursing Program
Director of MSN Nurse Educator Track
Associate Professor of Nursing
Francis Marion University
Florence, South Carolina


viii

Contributors

Maryann Godshall, PhD, CCRN, CPN, CNE
Assistant Clinical Professor
College of Nursing and Health Professions
Drexel University
Philadelphia, Pennsylvania
Mary Gallagher Gordon, PhD, MSN, RN, CNE
Clinical Associate Professor

Assistant Dean, Student and Technology Operations
College of Nursing and Health Professions
Drexel University
Philadelphia, Pennsylvania
Karyn E. Holt, PhD, CNM, NCC
Associate Clinical Professor
Division of Graduate Nursing Advanced Role MSN Department
College of Nursing and Health Professions
Drexel University
Philadelphia, Pennsylvania
Deborah L. Hopla, DNP, APRN-BC
Assistant Professor
Director, MSN/FNP Program
Francis Marion University
Florence, South Carolina
Cheryl Portwood, MSN, RN, NEA-BC, CNE
Assistant Clinical Professor
College of Nursing and Health Professions
Drexel University
Philadelphia, Pennsylvania
Roseann V. Regan, PhD, APRN, BC
Assistant Professor
Gwynedd Mercy University
Gwynedd Valley, Pennsylvania
Nina Russell, DNP, FNP-C, APRN
Nursing Instructor
Francis Marion University
Florence, South Carolina

Contributors

Brenda Reap Thompson, MSN, RN, CNE
Adjunct Faculty
RN-BSN Degree Completion Program College of Nursing and Health Professions
Drexel University
Philadelphia, Pennsylvania
Roberta Waite, EdD, PMHCNS-BC, FAAN, ANEF
Professor and Assistant Dean
Academic Integration and Evaluation of Community Programs, Doctoral Nursing
Department
College of Nursing and Health Professions
Drexel University
Philadelphia, Pennsylvania
Ruth A. Wittmann-Price, PhD, RN, CNS, CNE, CHSE, ANEF, FAAN
Dean
School of Health Sciences
Francis Marion University
Florence, South Carolina

ix



Reviewer
Amanda Myrhen, RN, MSN
Instructor
Francis Marion University
Florence, South Carolina

Foreword
The most important test that any nurse will ever take is the National Council Licensure
Examination-RN (NCLEX-RN®), validating safety to practice nursing and opening
the door to professional nursing practice opportunities. Therefore, preparation for the
NCLEX must begin early in the nursing program and provide a scaffold on which
to hang the nursing knowledge and the skill base on which safe practice is built. The
authors of this review book understand the scaffolding process and its relationship to
NCLEX success. They have watched nursing students struggle with NCLEX preparation and have learned what works and what does not.
Instead of an exhaustive list of questions attached to a snippet of case information, this
unique review book presents a group of unfolding case studies that tell stories about
real patients, clinical issues, and the role of the nurse in providing high-quality, safe
care. Integrated into each unfolding case study are activities to increase comprehension,
rapid response terms that highlight important information, and the pharmacological
interventions required for the conditions being discussed. This book allows the student
to make decisions about the cases as they unfold and encourages the student to “think
like a nurse.” Practicing the role of the nurse is a novel and beneficial review method of
studying for the NCLEX.
There are at least two schools of thought concerning NCLEX preparation. One asserts
that passing the NCLEX is the sole responsibility of the student, the program having
provided the curriculum and experiences. The second school of thought asserts that the
nursing program is a collaborative partner in the student’s quest for licensure. Measures
focusing on the attainment of licensure must be built into the curriculum from nursing
foundations to senior seminar. Every nursing faculty member who teaches undergraduate nursing students needs resource material to use in the course of teaching or to recommend to students as they prepare for the test that will launch their careers.
It is incumbent on every nursing faculty member involved in undergraduate, prelicense nursing education to know and use the resources that will enable the graduate’s
successful career entry. Given the human and fiscal investment that a student makes


xiv

Foreword

while pursuing a nursing career, we need more effective tools to enable success on the
licensure examination. Ruth A. Wittmann-Price, Brenda Reap Thompson, and Frances
H. Cornelius have developed a creative and engaging approach to NCLEX preparation
that has the potential of ensuring success for many more nursing school graduates.
Gloria Ferraro Donnelly, PhD, RN, FAAN
Dean and Professor
College of Nursing and Health Professions
Drexel University
Philadelphia, Pennsylvania


Preface
This book was designed with several purposes in mind. It is foremost a review and remediation workbook for students who are about to take the National Council Licensure
Examination-RN (NCLEX-RN®; National Council of State Boards of Nursing, 2016).
This book is also a unique case study workbook for instructors to assign to students
throughout their course of undergraduate study for the purposes of (a) assisting faculty
in delivering content in an innovative format, (b) assisting students in understanding
the nature of clinical thinking, and (c) use in simulation environments. The philosophy
of this book is to engage students in active learning using unfolding case studies. Carr
(2015) states:
The use of the unfolding case study moves health care provider education from
fact-based lecturing to situation-based discussion and decision making as a person’s
condition or situation changes. Use of the unfolding case facilitates collaborative
learning, covers necessary content, and assists students to think beyond the facts and
use their clinical imagination. Unfolding case studies require students to begin to
grasp the nature of a clinical situation and adjust interventions as the clinical situation unfolds. (p. 283)
In this way, unfolding case studies closely mimic real-life situations in nursing practice and are important situational mental models that are useful in assisting students to

problem solve and to actively engage in and use critical-thinking techniques (Kaylor &
Strickland, 2015). Unlike other NCLEX-RN preparation books that expect students
to answer question after unrelated question, this book builds content into the case scenarios, thereby engaging students in the process of having to consider an evolving, and
perhaps increasingly complex, clinical situation before answering each question.
As you, the student, work and twist your mind through the unfolding case studies,
you will begin to envision being a practicing registered nurse who is actively problem
solving and “thinking like a nurse.” Adopting this method of thinking will assist you in
developing clinical-thinking skills that are important for NCLEX-RN success in assessment, planning, intervention, and evaluation of patient care. The patient care content
areas that are essential to master for NCLEX-RN success—safe and effective care, health
promotion, and physiological and psychological integrity—are interwoven throughout


xvi

Preface

the unfolding case studies. You will find this unique format enjoyable; it will help you
escape the drudgery of answering multiple-choice question after multiple-choice question, studying flashcards, medical terminology definitions, or simply wasting valuable
time applying test-taking tricks.
Let’s face it: The NCLEX-RN is a content-driven test. The unfolding case studies
presented in this study guide deliver the content intermingled with active learning
strategies. Many different evaluative forms are used in this book to help you assess your
own learning. The question styles used include all those used on the NCLEX-RN
licensing examination, including multiple-choice questions, select all that apply, hot
spots, matching, true or false, prioritizing, and calculations. This book also has Rapid
Response Tips that help students make easy cognitive connections about content,
includes pharmacology principles of each nursing specialty, and has a chapter devoted
completely to the review of medication administration principles. The authors have
heard and listened to the recommendations of nursing students that continuously ask
for a pharmacology review that is applied to clinical situations.

The correct responses to each question related to the case studies are easily accessible
at the end of each chapter. The authors suggest that you work through each chapter,
then go back and evaluate yourself, paying close attention to the content areas that
might require remedial work before taking the NCLEX-RN examination.
The authors are committed to making this the best review book ever to break the
endless review cycle of question after question and to support students’ ability to walk
into the NCLEX-RN examination with confidence. This book was written and compiled by practicing clinicians: nurses who work at the bedside and know how to multitask, prioritize, and lead novice nurses to success. Please provide us with feedback on
your experience using this book at We look forward to hearing
from you and to you soon becoming one of our colleagues in nursing.
Ruth A.Wittmann-Price
Brenda Reap Thompson
Frances H. Cornelius

Resources
Carr, K. C. (2015). Using the unfolding case study in midwifery education. Journal of Midwifery & Women’s Health, 60(3), 283–290. doi:10.1111/jmwh.12293
Kaylor, S. K., & Strickland, H. P. (2015). Unfolding case studies as a formative teaching methodology
for novice nursing students. Journal of Nursing Education, 54(2), 106–110. doi:10.3928/01484834–
20150120-06
National Council of State Boards of Nursing. (2016). Home page. Retrieved from ncsbn.org


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NCLEX-RN® Excel: Test Success Through Unfolding Case Study Review,
Second Edition


CHAPTER

1

Strategies for
Studying and Taking
Standardized Tests
Ruth A. Wittmann-Price, Brenda Reap Thompson, and Frances H. Cornelius

Always bear in mind that your own resolution to succeed is more important
than any one thing.—Abraham Lincoln

Many factors contribute to success in studying and test taking. Once you learn about
these, your life becomes much easier because you are “in the know.” This chapter
briefly, but effectively, reviews key points that are important for all students who are
about to embark on a “high-stakes” test.

Motivation
The most important aspect of test taking is studying, and the most important aspect of
studying is motivation. Do not worry if you are not always motivated to sit and study.
Motivation comes from both internal and external sources and is not always consistent
or stable for any one person. External factors that motivate are those that arise from the
environment around you. Many different things, people, and issues can be the source
of an external motivator, such as grades, parents, and career goals. Internal factors that
motivate you to study are those aspects that are part of you and drive you; they are part
of your personality makeup. Positive thinking can increase your motivation, as can the
task of creating a study schedule and following it seriously so that it becomes part of
your routine. The good news is that overall motivation can be improved through the


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NCLEX-RN® Excel

introduction of such strategies. Successful time management, study, and test-taking skills
will help you to improve your motivation.

Time Management
Time management is a key strategy that we hear much about these days, probably
because everyone’s day is so full.You cannot manage time; it just moves forward. But you
can manage what you do with your time. Here are some hints that help successful test
takers. Use a weekly calendar to schedule study sessions by outlining time frames for all
of your other activities: home, school, and appointments. Then find the “unscheduled
time” in your calendar. Make these times your study periods, and make them very visible
by using color to highlight them either on your paper calendar or in your electronic
timekeeper. Make these “study times” priorities. Another strategy is to investigate your
learning style to optimize the time you devote to study by applying methods that mesh
with your personal learning style (Thompson, 2009).You can use the 3-month calendar
template in Table 1.1.

TABLE 1.1 Three-Month Study Calendar
Month _______________________ (Add dates)
Week

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Wednesday

Thursday

Friday

Saturday

Wednesday

Thursday

Friday

Saturday

1
2
3
4

Month _______________________ (Add dates)
Week

Sunday

Monday

Tuesday

1
2
3
4

Month _______________________ (Add dates)
Week

Sunday

Monday

Tuesday

1
2
3
4
Clearly mark your study times and your NCLEX-RN® test date if you know it.


CHAPTER 1

|

Strategies for Studying and Taking Standardized Tests

3

Learning Styles
Different students learn differently. To maximize your learning potential, it is helpful to
determine what type of learner you are. Quite simply, a learning style is an approach
to learning; you want to use the style that works best for you. Most learners may have
a predominant learning style, but it is possible to have more than one style. The four
most common learning styles are defined by the acronym VARK, described by Fleming
(2001); VARK stands for:
■
■
■
■

Visual (V)
Auditory (A)
Read/write (R)
Kinesthetic (K)

The visual (spatial) learner learns best by what he or she sees, such as pictures, diagrams, flowcharts, timelines, maps, and demonstrations. A good way to learn a topic for
a visual learner may be by concept mapping or the use of computer graphics.
If you are an aural/auditory learner, you prefer information that is heard or spoken.You may learn best from lectures, tapes, tutorials, group discussion, speaking, web
chats, e-mails, mobile phones, and reading aloud the content you are studying. By
reading aloud, you may be able to sort things out and gain understanding (Brancato,
2007; Fleming, 2001).
A read/write learner prefers information offered in the form of written words. This
type of learner likes text-based input and output in all of its forms. Students who prefer
this method like PowerPoint presentations, the Internet, lists, dictionaries, thesauri, quotations, and anything with written words (Fleming, 2001).
The fourth type of learner is characterized as kinesthetic and uses the body and sense

of touch to enhance learning. This type of learner likes to think out issues while working out or exercising. Kinesthetic learners prefer learning content through gaming or
acting. This type of learner (Fleming, 2001) appreciates simulation or a real-life experience. Felder and Solomon (1998) refer to these learners as active learners.
It is not hard to find out what type of learning style will work best for you.You can
easily use the Internet to search “learning styles,” and a variety of self-administered tests
are available for self-assessment. Having this insight about yourself is just one more way
of becoming a more successful test taker!

Successful Studying
Other studying tips are also helpful for many students. First, eliminate external sources
of distraction (TV, radio, phone) while studying. Even though many people feel that
they study better with music, there is no evidence to support this notion. Eliminate
your internal sources of distraction, such as hunger, thirst, or thoughts about problems


4

NCLEX-RN® Excel

that cannot be worked out at that moment. If there is an interpersonal relationship issue
bothering you—with a family member, friend, or partner—try to talk it out and clear it
up before your scheduled “study time.” In addition, do not forget to treat yourself well
and take breaks.Take a 10-minute break after each hour of study. During your break, get
up and stretch, have a glass of water, or get yourself a snack (Thompson, 2009).
Create a conducive study environment. Get comfortable but not so comfortable that
you fall asleep! Use a clean, clear, attractive workspace. Have all the materials that you
need assembled so that you won’t have to interrupt yourself to look for things like a pen
or a stapler.
What to study can pose another dilemma. Many nurse educators suggest that the
best way to go is to concentrate on questions of the National Council Licensure Examination-RN (NCLEX-RN®) type. Others propose that you should use material that
reviews content.We are suggesting that a combination of the two is best. By completing

questions as your only strategy, you may miss important information. Therefore, if you
are reviewing information that truly escapes your memory, go back to a reliable source,
such as a textbook, and reread that content. Let’s face it: Some of the topics learned in
the beginning of your professional education may be slightly harder to recall than content learned in the final courses.

Organizing Information
The use of studying frameworks can be helpful in organizing information. One of the
best ways to organize information is to think of the answer in terms of the nursing process framework.The nursing process was created as a logical method to solve problems of
patient care. Assessment is always the first step of the process, because you need to comprehend all aspects of the patient’s physical and emotional situation before making a nursing
diagnosis. Once you have a nursing diagnosis, you can create a nursing plan.Then you can
confidently carry out that plan by implementing the nursing interventions. The only way
to know whether those interventions work is to evaluate the outcome; then you reassess
the situation and the process then starts over again. An example of a question that can be
answered by applying the nursing process framework is shown in Exercise 1.1.
EXERCISE 1.1 Multiple-choice:
The physician orders the insertion of a catheter into the patient’s abdomen for peritoneal dialysis. In
preparing a preoperative teaching plan for this patient, the nurse would initially:
A. Invite the patient’s family to join the preoperative teaching session
B. Ask the physician what information was already discussed with the patient
C. Assess the patient’s knowledge and understanding about the procedure
D. Have the operative permit signed and then institute the teaching plan
The answer can be found on page 19


CHAPTER 1

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Strategies for Studying and Taking Standardized Tests

5

Other frameworks may include using mnemonics, and these work well for many students. A familiar one is ABC (airway, breathing, and circulation). Exercise 1.2 is a question that lends itself to the mnemonic principle.
EXERCISE 1.2 Multiple-choice:
The nurse is caring for a client who has returned from surgery after a below-the-knee amputation of the
right lower extremity. What would the nurse assess first?
A. Temperature
B. Tissue perfusion
C. Pain
D. Orientation
The answer can be found on page 19

Other mnemonics are not so familiar but often helpful, such as VEAL CHOP (see
Table 1.2). This mnemonic is further explained in Chapter 4.
Many other methods help learners to understand and remember what they need to
know; these include visualization strategies, games, fact sheets, and tables for comparison. For example,Table 1.3 shows a comparison for a patient experiencing midtrimester
vaginal bleeding to help a learner remember the primary symptoms.

Establishing Study Groups
Another strategy is to form study groups; these work well for many learners. If you choose
to try working with a study group, start with a small one whose members get along well.
You can choose a leader who can keep a list of members’ contact information and can
schedule a time and place that is convenient and comfortable for everyone. Each person

TABLE 1.2 Fetal-Monitoring Basics
V

Variable

C

Cord

E

Early deceleration

H

Head compression

A

Acceleration

O

OK

L

Late deceleration

P

Placental insufficiency

TABLE 1.3 Comparison of Third-Trimester Bleeding
Sign

Placenta Previa

Placental Abruption

Pain

No

Yes

Bleeding

Yes

Not always

Abdomen

Soft

Ridged


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NCLEX-RN® Excel

should be assigned a role and do some presession preparation. Everyone in the group
should take the responsibility of keeping the others on task and using the time together
in the most productive manner. This does not mean that the study group cannot take

breaks, but breaks should be planned (Thompson, 2009).

Understanding the NCLEX-RN Exam
The NCLEX-RN exam was developed from a specific test plan. Most nursing students
know that there are at least 75 questions and possibly as many as 265 (National Council
of State Boards of Nursing [NCSBN], 2016). Each NCLEX-RN test also contains 15
test or practice items mixed in with the scored questions. The questions are developed
by using Bloom’s revised taxonomy (Bloom, Englehart, Furst, Hill, & Drathwohl, 1956)
(Table 1.4).
Table 1.5 provides Exercises 1.3 to 1.8, which are examples of NCLEX-RN types of
multiple-choice questions at each level of Bloom’s taxonomy.

TABLE 1.4 Blooms’s Revised Taxonomy
Creating

Generating new ideas, designing, constructing, planning, and producing

Evaluating

Justifying a decision or course of action, checking

Analyzing

Breaking information into parts to explore understandings and relationships

Applying

Implementing, carrying out, using, executing

Understanding

Explaining ideas or concepts, interpreting, summarizing, explaining

Remembering

Recalling information, recognizing, listing, describing

TABLE 1.5 Example Questions Using Bloom’s Taxonomy
Level of Bloom’s
Revised Taxonomy

Creating
EXERCISE 1.3

NCLEX-RN® Type of Multiple-Choice Question

A group of outpatients with thyroid dysfunction are being taught about their
disease. One patient is on levothyroxine (Synthroid) and states that he does not
understand the reason. The patient tells the group that he takes the medication
inconsistently. The nurse should:
A. Tell the patient to go to his doctor
B. Talk to the patient after class
C. Re-adjust the teaching to emphasize correct medication administration
D. Tell the class that this is incorrect and suggest that the patient has
individual class sessions
(continued )


CHAPTER 1

|

Strategies for Studying and Taking Standardized Tests

TABLE 1.5 Example Questions Using Bloom’s Taxonomy
Level of Bloom’s
Revised Taxonomy

Evaluating
EXERCISE 1.4

Analyzing
EXERCISE 1.5

Applying
EXERCISE 1.6

Understanding
EXERCISE 1.7

Remembering
EXERCISE 1.8

7

(continued )

NCLEX-RN® Type of Multiple-Choice Question

A patient who is taking levothyroxine (Synthroid) tells the nurse that he feels

very anxious and has occasional palpitations. Which action by the nurse would
be appropriate?
A. Checking the patient’s laboratory results
B. Taking the patient’s blood pressure
C. Palpating the patient’s thyroid
D. Administering the patient’s antianxiety medication
The nurse is assessing a patient who has been taking levothyroxine (Synthroid) for
5 weeks. The patient’s heart rate is 90 beats per minute, weight has decreased
4 lb, T3 and T4 have increased. Which action by the nurse would be appropriate?
A. Hold the medication
B. Request a repeat T3 and T4
C. Assess the blood pressure
D. Administer the medication
A patient taking levothyroxine (Synthroid) tells the nurse that he feels well and
some days cannot remember whether he took his medication. The nurse should:
A. Tell the patient to come off the medication
B. Tell the patient to take his medication every day
C. Tell the patient this is not an appropriate way to take any medication
D. Help the patient to develop a system to remember to take the medication
The nurse provides discharge instructions for a patient who is taking
levothyroxine (Synthroid). Which of these statements, if made by the patient,
would indicate correct understanding of the medication?
A. “I will discontinue the medication when my symptoms improve.”
B. “I will take the medicine each day before breakfast and at bedtime.”
C. “I will feel more energetic after taking the medication for a few weeks.”
D. “I will probably gain some weight while taking this medicine.”
The nurse is administering levothyroxine (Synthroid) to a patient with
hypothyroidism. The nurse recognizes that the medication is prescribed to:
A. Replace the thyroid hormone
B. Stimulate the thyroid gland

C. Block the stimulation of the thyroid gland
D. Decrease the chances of thyrotoxicosis
The answer can be found on page 19

Another approach that is often used to decide how to answer a question is Maslow’s
theory of the hierarchy of needs, as shown in Figure 1.1 (Maslow, 1943). Exercise 1.9
is an NCLEX-RN type of question that can be answered by applying Maslow’s theory.