HESI Comprehensive Review for the NCLEX-RN Examination 6th Edition (2019)

Name: HESI Comprehensive Review for the NCLEX-RN Examination 6th Edition (2019)
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Author: John Wilson

HESI Comprehensive Review for the NCLEX-RN Examination 6th Edition (2019) is the ultimate study tool to help you pass your exam on the first try.

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Table of Contents
Cover image
Title page
Copyright
Contributing Authors
Preface
1. Introduction to Test-Taking Strategies and the NCLEX-RN®
Test-Taking Strategies
The NCLEX-RN
Job Analysis Studies
The NCLEX-RN Computer Adaptive Testing
Gentle Reminders of General Principles
2. Leadership and Management: Legal Aspects of Nursing
Legal Aspects of Nursing
Prescriptions and Health Care Providers
Review of Legal Aspects of Nursing
Leadership and Management
Maintaining a Safe Work Environment
Communication Skills
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Review of Leadership and Management
Disaster Nursing
Ebola
Review of Disaster Nursing
3. Advanced Clinical Concepts
Respiratory Failure
Respiratory Failure in Children
Review of Respiratory Failure
Shock
Disseminated Intravascular Coagulation (DIC)
Review of Shock and DIC
Resuscitation
Management of Foreign Body Airway Obstruction (FBAO)
Review of Resuscitation
Fluid and Electrolyte Balance
Review of Fluid and Electrolyte Balance
Electrocardiogram (ECG)
Review of Electrocardiogram (ECG)
Perioperative Care
Review of Perioperative Care
HIV Infection
Pediatric HIV Infection
Review of HIV Infection
Pain: Fifth Vital Sign
Review of Pain
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Death and Grief
Review of Death and Grief
4. Medical-Surgical Nursing
Communication
Health Promotion and Disease Prevention
Teaching/Learning
Spiritual Assessment
Cultural Diversity
Complementary and Alternative Interventions
Respiratory System
Review of Respiratory System
Renal System
Review of Renal System
Cardiovascular System
Review of Cardiovascular System
Gastrointestinal (GI) System
Review of Gastrointestinal System
Endocrine System
Review of Endocrine System
Musculoskeletal System
Review of Musculoskeletal System
Neurologic System
Review of Neurologic System
Hematology and Oncology
Review of Hematology and Oncology
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Reproductive System
Review of Reproductive System
Burns
Review of Burns
5. Pediatric Nursing
Growth and Development
Pain Assessment and Management in the Pediatric Client
Review of Child Health Promotion
Respiratory Disorders
Review of Respiratory Disorders
Cardiovascular Disorders
Review of Cardiovascular Disorders
Neuromuscular Disorders
Review of Neuromuscular Disorders
Renal Disorders
Review of Renal Disorders
Gastrointestinal Disorders
Review of Gastrointestinal Disorders
Hematologic Disorders
Review of Hematologic Disorders
Metabolic and Endocrine Disorders
Review of Metabolic and Endocrine Disorders
Skeletal Disorders
Review of Skeletal Disorders
6. Maternity Nursing
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Anatomy and Physiology of Reproduction
Antepartum Nursing Care
Review of Anatomy and Physiology of Reproduction and Antepartum Nursing Care
Fetal and Maternal Assessment Techniques
Review of Fetal and Maternal Assessment Techniques
Intrapartum Nursing Care
Review of Intrapartum Nursing Care
Normal Puerperium (Postpartum)
Review of Normal Puerperium (Postpartum)
The Normal Newborn
Review of the Normal Newborn
High-Risk Disorders
Review of High-Risk Disorders
Postpartum High-Risk Disorders
Review of Postpartum High-Risk Disorders
Newborn High-Risk Disorders
Effects on the Neonate of Substance Abuse
7. Psychiatric Nursing
Therapeutic Communication
Coping Styles (Defense Mechanisms)
Treatment Modalities
Review of Therapeutic Communication and Treatment Modalities
Anxiety and Related Disorders
Anxiety Disorders, Obsessive-Compulsive and Related Disorders, and Traumatic and
Stressor Related Disorders
Review of Anxiety Disorders, Obsessive-Compulsive and Related Disorders, and
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Traumatic and Stressor Related Disorders
Somatic Symptom Disorder and Related Disorders
Review of Somatic Symptom Disorder and Related Disorders
Dissociative Disorders
Review of Dissociative Disorders
Personality Disorders (DSM-5 Criteria)
Review of Personality Disorders
Eating Disorders
Review of Eating Disorders
Mood Disorders
Review of Mood Disorders
Schizophrenia Spectrum and Other Psychotic Disorders
Review of Thought Disorders
Substance Abuse Disorder
Substance Use Disorder
Review of Substance Abuse Disorder
Abuse
Review of Abuse
Neurocognitive Disorder (DSM-5)
Review of Neurocognitive Disorders
Childhood and Adolescent Disorders
Review of Childhood and Adolescent Disorders
8. Gerontologic Nursing
Theories of Aging
Neurocognitive Disorder (NCD): Dementia
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Contributing Authors
Safa’a Al-Arabi, PhD, RN, MSN, MPH , Associate Professor and Master’s Track
Administrator, University of Texas Medical Branch, Galveston, Texas
Karen Alexander, PhD, RN , Program Director at University of Houston Clear Lake,
Pearland, Texas
Joanna Cain, BSN, BA, RN , President and Founder, Auctorial Pursuits, Inc., Austin,
Texas
Lucindra Campbell-Law, PhD, ANP, PMHNP, BC , Professor, Carol and Odis Peavy
School of Nursing, University of St. Thomas, Houston, Texas
E. Tina Cuellar, PhD, WHNP, PMHCNS, BC , Director of Live Review,
Elsevier/Education/HESI, Houston, Texas
Claudine Dufrene, PhD, RN-BC, GNP-BC, CNE , Assistant Professor, Carol and Odis
Peavy School of Nursing, University of St. Thomas, Houston, Texas
Sandra Jenkins, PhD, RN , Visiting Professor, University of Houston Clear Lake,
Pearland, Texas
Shatoi King, MSN, RN , Instructor, University of Houston Clear Lake, Pearland, Texas
Necole Leland, MSN, RN, PNP, CPN , Instructor, School of Nursing, University of
Nevada, Las Vegas, Las Vegas, Nevada
Katherine Ralph, EdD, RN , Nurse Manager Curriculum, Review and Testing,
Elsevier/Education/HESI, Houston, Texas
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Preface
Welcome to HESI Comprehensive Review for the NCLEX-RN ® Examination with online study
exams by HESI.
Congratulations! This outstanding review manual with online study exams is designed to
prepare nursing students for what is very likely the most important examination they will
ever take—the NCLEX-RN Licensing Examination. HESI Comprehensive Review for the
NCLEX-RN ® Examination allows the nursing student to prepare for the NCLEX-RN
licensure examination in a structured way.
• Organize previously learned basic nursing knowledge.
• Review content learned during basic nursing curriculum.
• Identify deficits in content knowledge so that study effort can be focused
appropriately.
• Develop test-taking skills to demonstrate application of safe nursing practice.
• Reduce anxiety level by increasing predictability of ability to correctly answer
NCLEX-type questions.
• Boost test-taking confidence by being well prepared and knowing what to expect.
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Organization AND PREPARING TO TAKE TESTS
Chapter 1 , Introduction to Test-Taking Strategies and the NCLEX-RN ® , gives an
overview of the NCLEX-RN Licensing Examination history and test plan for the
examination. Reviews of the nursing process, client needs, and strategies for employing
clinical judgement to prioritize nursing care are also presented.
Chapter 2 , Leadership and Management, reviews the legal aspects of nursing,
leadership and management, and disaster nursing.
Chapter 3 , Advanced Clinical Concepts, presents nursing assessment, analysis, and
planning and intervention, using clinical judgment at the highest level of practice. Topics
reviewed include respiratory failure, shock, disseminated intravascular coagulation,
resuscitation, fluid and electrolyte balance, intravenous therapy, acid–base balance,
electrocardiogram, perioperative care, HIV, pain, and death and grief.
Chapters 4 through 8 , Medical-Surgical Nursing, Pediatric Nursing, Maternity
Nursing, Psychiatric Nursing, and Gerontologic Nursing, are presented in traditional
clinical areas. Each clinical area is divided into physiologic components, with essential
knowledge about basic anatomy, growth and development, pharmacology and medication
calculation, nutrition, communication, client and family education, acute and chronic care,
leadership and management, complementary and alternative interventions, cultural and
spiritual diversity, and clinical decision making threaded throughout the different
components.
Open-ended questions with the answers appear at the end of each chapter, which
encourage the student to think in depth about the content that is presented throughout the
particular chapter. When a variety of learning mechanisms are used, students have the
opportunity to comprehensively prepare for the NCLEX exam; these strategies include:
• Reading the manual
• Discussing content with others
• Answering open-ended questions
• Practicing with study exams that simulate the licensure examination
These learning experiences are all different ways that students should use to prepare for
the NCLEX-RN exam. The purpose of the open-ended questions appearing at the end of the
chapter is not a focused practice session on managing NCLEX-style questions, but rather a
learning approach that allows for more in-depth thinking about specific topics in the
chapter. Practice with multiple-choice questions alone cannot provide the depth of critical
thinking and analysis that is made possible by the short-answer questions at the end of the
chapter. In addition, the open-ended questions presented at the end of the chapter provide
a summary experience that helps students focus on the main topics that were covered in the
chapter. Teachers use open-ended questions to stimulate the critical-thinking process, and
HESI Comprehensive Review for the NCLEX-RN ® Examination facilitates the critical-thinking
process by posing the same type of questions the teacher might ask.
When students need to practice multiple-choice questions, the online study exams on
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Evolve offer extensive opportunities for practice and skill building to improve their test-
taking abilities. The online study exams include six content-specific exams (Medical-
Surgical Nursing, Pharmacology, Pediatrics, Fundamentals, Maternity, and Psychiatric-
Mental Health Nursing) and two comprehensive exams patterned after categories on the
NCLEX-RN exam. The online study exams on Evolve can be accessed as many times as
necessary, and the questions from one study exam are not contained on another study
exam. For instance, the Medical-Surgical study exam does not contain questions that are on
the Pediatrics study exam. The purpose of the study exams is to provide practice and
exposure to the critical thinking–style questions that students will encounter on the
NCLEX-RN exam. However, the study exams should not be used to predict performance
on the actual NCLEX-RN exam. Only the HESI Exit Exam, a secure, computerized exam
that simulates the NCLEX-RN test plan and has evidence-based results from numerous
research studies indicating a high level of accuracy in predicting NCLEX success, is offered
as a true predictor exam. Students are allowed unlimited practice on each online study
exam so that they can be sure to have the opportunity to review all of the rationales for the
questions.
Here is a plan for a student to use with the online study exams:
• Step 1: Take the RN study exam without studying for it to see where your
strengths and weaknesses are.
• Step 2: After going over the content that relates to the study questions in a
particular clinical area (e.g., Pediatrics, Medical-Surgical, or Maternity), review
that section of the manual and take the test again to determine whether you have
been able to improve your scores.
• Step 3: Purposely miss every question on the exam so that you can view the
rationales for every question.
• Step 4: Take the exam again under timed conditions at the pace that you would
have to progress in order to complete the NCLEX-RN exam in the time allowed
(approximately 1 minute per question). See if being placed under time constraints
affects your performance.
• Step 5: Put the exam away for a while and continue review and remediation with
other textbooks, resources, and results of any HESI secure exams that you have
taken at your school. Then, take the study exams again to see if your performance
improves after in-depth study and following a few weeks’ break from these
questions.
Step 5 represents a good activity in preparation for the HESI Exit Exam presented in your
final semester of the nursing program, especially if you have not used the online study
exams for several weeks. Repeated exposure to the questions, however, will make them less
useful over time because students tend to memorize the answers. For this reason, these tests
are useful only for practice and not for prediction of NCLEX-RN success. The tendency to
memorize the questions after viewing them multiple times falsely elevates a student’s score
on the study exams.
Additional assistance for students studying for the NCLEX-RN Licensing Examination
can be obtained from a variety of online products in the Elsevier family. Many nursing
schools have also adopted the following:
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• HESI Examinations—A comprehensive set of examinations designed to prepare
nursing students for the NCLEX exam. They include customized electronic
remediation from current Elsevier textbooks and multimedia, as well as additional
practice questions. Each student is given an individualized report detailing exam
results and is allowed to view questions and rationales for items that were
answered incorrectly. The electronic remediation, a complementary feature of the
specialty and exit exams, can be filed by the student for later study.
• HESI Practice Test—This is the ideal way to practice for the NCLEX exam. With
more than 1200 practice questions included in this online test bank, nursing
students can access practice exams 24 hours a day, 7 days a week. HESI Practice
Test questions are written at the critical-thinking level so that students are tested
not for memorization but for their skills in clinical application. Students select a
test option (either a clinical specialty or a comprehensive exam), and HESI Practice
Test automatically supplies a series of critical-thinking practice questions. NCLEX
exam–style questions include multiple-choice and alternate-item formats and are
accompanied by correct answers and rationales.
• HESI RN Case Studies—These prepare students to manage complex patient
conditions and make sound clinical judgments. These online case studies cover a
broad range of physiologic and psychosocial alterations, plus related
management, pharmacology, and therapeutic concepts.
• HESI Patient Reviews—These are designed to teach and assess students’ retention
of core nursing content. These online interactive reviews provide a firsthand look
at safe and effective nursing care.
• HESI Live Review—A live review course is presented by an expert faculty member
who has additional instruction in working with students who are preparing to
take the NCLEX exam. Students are presented with a workbook and practice
NCLEX-style questions that are used during the course.
• Evolve eBooks—Online versions of all of the Mosby, Saunders, and Elsevier
textbooks used in the student’s nursing curriculum are presented. Search across
titles, highlight, make notes, and more—all on your computer.
• Elsevier Simulations—Virtual versions simulate the clinical environment. These
multilayered, complex, supplemental simulations enable students to experience
clinical assignments without the need for actual clinical space.
• Elsevier Courses—These are created by experts using instructional design
principles. This interactive content engages students with reading, animation,
video, audio, interactive exercises, and assessments.
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Next Generation NCLEX and Clinical Judgment
Starting in July of 2017, the National Council of State Boards of Nursing (NCSBN) began
including a special research section to select candidates after they complete the exam.
The data collected from this section is used to help determine new item types that may
be included in a future version of the NCLEX, known as Next Generation NCLEX
(NGN). (More information can be found at ( http://www.ncsbn.org/next-generation-
nclex.htm. ) An important piece of the NGN is the clinical judgment model. Clinical
judgment is important for all nurses, and this book helps nursing students by reviewing
information and skills that nurses must master to practice clinical judgment.
Additionally, NCLEX practice questions on the Evolve website written at higher levels of
Bloom’s taxonomy help students practice applying their clinical judgment knowledge.
Finally, a Clinical Judgment Scenario with practice NGN questions is included in
Chapter 4 to familiarize students with these types of questions .
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Introduction to Test-Taking Strategies and
the NCLEX-RN®
Congratulations! You have made the wise decision to prepare, in a structured way, for the
NCLEX-RN ®.
A. Since you have successfully completed a basic nursing program and are well
acquainted with your test-taking skills and ability to apply your clinical
knowledge, you already have the basic knowledge required to pass the licensing
examination.
B. However, following these general guidelines will help ensure your success.
1. Organize your knowledge.
2. Identify weaknesses in content knowledge to help focus your study
time appropriately.
3. Review the need-to-know content learned in nursing school.
4. Develop strong test-taking skills to demonstrate your knowledge.
5. Reduce your level of anxiety by dissecting test questions and using
your foundational knowledge to arrive at the correct answer.
6. Know what to expect. Remember that knowledge is power. You are
powerful when you are well prepared and know what to expect.
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Test-Taking Strategies
These test-taking strategies help you focus your study so that you can concentrate on what
the exam questions are asking instead of being distracted by extraneous information that is
not needed to answer the questions.
A. The NCLEX-RN tests your knowledge about several core concepts and the ability
to synthesize information to effectively apply, analyze, or evaluate a client’s needs
to provide safe and effective care. For example, a question may appear to be a
medical-surgical or pediatric question, but the question can also cover such topics
as communication, nutrition, growth and development, medication, client and
family education, and safety.
HESI Hint
The most essential element of nursing care is client safety.
B. Understand the question.
1. Determine whether the question is written in a positive or negative
style.
a. A positive style question may ask what the nurse should
do or ask for the best or first nursing intervention to
implement.
H E S I H i n t
Most questions are written in a positive style.
b. A negative style question may ask what the nurse should
avoid, which prescription the nurse should question, or
which behavior indicates the need for reteaching the
client.
HESI Hint
Negative style questions contain key words that denote the negative style.
Examples
1. “Which response indicates to the nurse a need to reteach the client about heart
disease?” (Which information or understanding by the client is incorrect?)
2. “Which medication order should the nurse question?” (Which prescription is unsafe,
not beneficial, inappropriate to this client situation?)
C. Identify key words.
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1. Ask yourself which words or phrases provide the critical information.
2. This information may include the age of the client, the setting, the
timing, a set of symptoms or behaviors, or any number of other factors.
a. For example, the nursing actions for a 10-year-old postop
client are different from those for a 70-year-old postop
client.
D. Rephrase the question.
1. Rephrasing the question helps eliminate nonessential information in
the question to help you determine the correct answer.
a. Ask yourself, “What is this question really asking?”
b. While keeping the options covered, rephrase the question
in your own words.
2. Rule out options.
a. Based on your knowledge, you can most likely identify
one or two options that are clearly incorrect.
b. Physically mark through those options on the test booklet
if allowed. Mentally mark through those options in your
head if using a computer.
c. Differentiate between the remaining options, considering
your knowledge of the subject and related nursing
principles, such as roles of the nurse, nursing process,
ABCs (airway, breathing, circulation), CAB (circulation,
airway, breathing for cardiopulmonary resuscitation
[CPR]), and Maslow’s hierarchy of needs.
E. Implement these guidelines.
1. Consider the content of the question and what specifically the question
is asking.
2. Generally, an assessment of the client occurs before an action is taken,
except in the case of an emergency, for example, if a client is bleeding
profusely, stop the bleeding. Or, if a client is having difficulty
breathing, open the airway then assess the client.
3. Identify the least invasive intervention before taking action.
4. Gather all of the necessary information and complete the necessary
assessments before calling the healthcare provider.
5. Determine which client to assess first (e.g., most at risk, most
physiologically unstable).
6. Identify opposites in the answers.
a. Example: prone versus supine; elevated versus decreased.
b. Read VERY carefully; one opposite is likely to be the
answer, but not always.
c. If you do not know the answer, choose the most likely of
the “opposites” and move on.
7. Take into account a client’s lifestyle, culture, and spiritual beliefs when
answering a question.
F. Use your critical thinking skills.
1. Respond to questions based on
a. Client safety
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b. ABCs
c. CAB for CPR
d. Caring
e. Incorporation of culture and spiritual practices
f. Scientific, behavioral, and sociologic principles
g. Communication (spoken and written [documentation])
with client, family, colleagues, and other members of the
healthcare team
h. Principles of teaching and learning
i. Maslow’s hierarchy of needs
j. Nursing process
k. Focus on what information is in the stem. Do not focus on
information not included in the question. Do not read
more into the question than is already there.
1. NCLEX-RN ideal hospital
2. Basic anatomy and physiology
2. Do not respond to questions based on
a. YOUR past client care experiences or your employer’s
policies
b. A familiar phrase or term
c. “Of course, I would have already”
d. What you think is realistic; perceptions of realism are
subjective
e. Your children, pregnancies, parents, personal response to
a drug, etc.
f. The “what-ifs”
H E S I H i n t
As soon as you are seated in the testing area, use the erasable noteboard to write
down information you’ve memorized (a brain dump). That’s a resource you
may use while testing if you become too stressed to recall information you
memorized.
G. Keep memorization to a minimum.
1. Don’t try to memorize all of the material found in your textbooks
because it isn’t possible. Only memorize core concepts.
a. Growth and developmental milestones
b. Death and dying stages
c. Crisis intervention
d. Immunization schedules
e. Principles of teaching and learning
f. Stages of pregnancy and fetal growth
g. Nurse Practice Act: Standards of Practice and Delegation
h. Ethical practices and standards
i. Commonly used laboratory test values:
1. Review Appendix A.
2. Hemoglobin and hematocrit (H&H)
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3. White blood cells (WBCs), red blood cells
(RBCs), platelets
4. Electrolytes: K+
, Na+
, Ca ++
, Mg++
, Cl − ,
5. Blood urea nitrogen (BUN) and creatinine
6. Relationship of Ca++ and
7. Arterial blood gases (ABGs)
8. SED rate, erythrocyte sedimentation rate
(ESR), prothrombin time (PT),
international normalized ratio (INR),
partial thromboplastin time (PTT),
activated partial thromboplastin time
(aPTT)
H E S I H i n t
Remember not to confuse PT, PTT, and aPTT.
j. Nutrition
1. High or low Na+
2. High or low K+
3. High
4. Iron
5. Vitamin K
6. Proteins
7. Carbohydrates
8. Fats
k. Foods and diets related to
1. Body system disturbances (cardiac,
endocrine, gastrointestinal)
2. Chemotherapy, radiation, surgery
3. Pregnancy and fetal growth needs
4. Dialysis
5. Burns
l. Nutrition concepts
1. Introduce one food at a time for infants
and clients with allergies.
2. Progression to “as tolerated” foods and
diets
H. Understand medication administration.
1. Safe medication administration requires more than knowing the name,
classification, and action of the medication.
a. The Six Rights, including techniques of skill execution
b. Drug interactions
c. Vulnerable organs to medication effects
1. Know what to assess (kidney function,
vital signs).
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The NCLEX-RN
A. The main purpose of the NCLEX-RN is to protect the public.
B. The NCLEX-RN
1. Was developed by the National Council of State Boards of Nursing
(referred to as “the Council” throughout this book)
2. Is administered by the State Board of Nurse Examiners
3. Is designed to test candidates’
a. Capabilities for safe and effective nursing practice
b. Essential entry-level nursing knowledge
c. Ability to problem solve by applying critical thinking
skills
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Job Analysis Studies
A. Essential knowledge that new nurses should know is determined by job analysis
studies.
B. Job analysis studies indicate that newly licensed registered nurses are using all five
categories of the nursing process and that such use is evenly distributed
throughout the nursing process areas. Therefore, equal attention is given to each
part of the nursing process in selecting NCLEX-RN items (Table 1.1).
TABLE 1.1
The Nursing Process
HESI Hint
The Council wants to ensure that the licensing examination measures current entry-level
nursing behaviors. For this reason, job analysis studies are conducted every 3 years. These
studies determine how frequently various types of nursing activities are performed, how
often they are delegated, and how critical they are to client safety, with criticality given
more value than frequency.
Nursing Diagnoses
A. Nursing diagnoses are formulated during the analysis portion of the nursing
process. They give form and direction to the nursing process, promote priority
setting, and guide nursing actions (Table 1.2).
B. To qualify as a nursing diagnosis, the primary responsibility and accountability for
recognition and treatment rest with the nurse.
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C. NCLEX-RN questions regarding nursing diagnosis can take several forms.
1. You may be given the nursing diagnosis in the stem and asked to select
an appropriate nursing intervention based on the stated nursing
diagnosis.
2. You may be asked to select, from among the choices provided, the
most appropriate nursing diagnosis(es) for the described case.
3. You may be asked to choose, from four nursing diagnoses, the one that
should have priority based on the data in the stem.
D. For further information about nursing diagnoses, review a fundamentals text, a
medical-surgical nursing text, or a nursing diagnosis handbook.
HESI Hint
A nursing diagnosis must be subject to oversight by nursing management. It is not a
medical diagnosis. The cause may or may not arise from a medical diagnosis.
Client Needs
A. Job analysis studies have identified categories of care provided by nurses called
client needs. The test plan is structured according to these categories (Table 1.3).
Prioritizing Nursing Care
A. Many NCLEX-RN items are designed to test your ability to set priorities.
1. Identify the most important client needs.
2. Which nursing intervention is most important?
TABLE 1.2
Components of a Nursing Diagnosis
TABLE 1.3
Components of the NCLEX-RN Test Plan
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3. Which nursing action should be performed first?
4. Which response is best?
B. Setting priorities
1. Which action should be performed first or next? Remember, client
safety is paramount.
2. Remember Maslow (Table 1.4).
3. The Five Rights of Delegation (see Chapter 2, p. 16)
HESI Hint
Answering NCLEX-RN questions often depends on setting priorities, making judgments
about priorities, and analyzing the data and formulating a decision about care based on
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The NCLEX-RN Computer Adaptive Testing
A. Computer adaptive testing (CAT) is used for implementation of the NCLEX-RN.
B. The CAT is administered at a testing center selected by the Council.
C. Pearson VUE is responsible for adapting the NCLEX-RN to the CAT format,
processing candidate applications, and transmitting test results to its data center
for scoring.
D. The testing centers are located throughout the United States.
E. The Council generates the NCLEX-RN questions.
TABLE 1.4
Maslow’s Hierarchy of Needs
Need Definition Nursing Implications
Physiologic Biologic needs for
food, shelter, water,
sleep, oxygen,
sexual expression
The priority biologic need is breathing (i.e., an open airway). Review Table
1.3, which lists activities associated with physiologic integrity. If asked to
identify the most important action, identify needs associated with
physiologic integrity (e.g., providing an open airway) as the most
important nursing action.
Safety Avoiding harm;
attaining security,
order, and physical
safety
Review Table 1.3, which lists the activities associated with a safe and
effective care environment. Ensuring that the client’s environment is safe is
a priority (e.g., teaching an older client to remove throw rugs that pose a
safety hazard when ambulating has a greater priority than teaching the
client how to use a walker). The first priority is safety, followed by coping
skills.
Love and
Belonging
Esteem and
Recognition
Giving and
receiving
affection;
companionship;
identification
with a group
Self-esteem and
respect of
others; success
in work;
prestige
Although these needs are important (described in Table 1.3), they are less
important than physiologic or safety needs. For example, it is more
important for a client to have an open airway and a safe environment for
ambulating than it is to assist him or her to become part of a support
group. However, assisting the client in becoming a part of a support group
has higher priority than assisting in the development of self-esteem. The
sense of belonging comes first, and such a sense may help in developing
self-esteem.
Self-
Actualization
Aesthetic
Fulfillment of
unique
potentialSearch for
beauty and spiritual
goals
It is important to understand the last two needs in Maslow’s hierarchy.
They could deal with client needs associated with health promotion and
maintenance, such as continued growth and development and self-care, as
well as those associated with psychosocial integrity. However, you will
probably not be asked to prioritize needs at this level. Remember, it is the
goal of the Council to ensure safe nursing practice, and such practice does
not usually deal with the client’s self-actualization or aesthetic needs.
How CAT Works
A. The NCLEX-RN consists of 75 to 265 multiple-choice or alternative-format
questions (15 of which are pilot items) presented on a computer screen.
B. The candidate is presented with a test item and possible answers.
C. If the candidate answers the question correctly, a slightly more difficult item will
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follow, and the level of difficulty will increase with each item until the candidate
misses an item.
D. If the candidate misses an item, a slightly less difficult item will follow, and the
level of difficulty will decrease with each item until the candidate has answered an
item correctly.
E. This process will continue until the candidate has achieved a definite pass or a
definite fail score. There will be no borderline pass or fail scores because the
adaptive testing method determines the candidate’s level of performance before
she or he has finished the examination.
F. The lowest number of items a candidate can answer to complete the examination is
75; 15 of them will be pilot items and will not count toward the pass or fail score;
60 of them will determine the candidate’s score.
G. The number of the item the candidate is currently answering will appear on the
upper-right area of the screen.
H. When the candidate has answered enough items to determine a definite pass or
fail score, a message will appear on the screen notifying the candidate that he or
she has completed the examination.
I. The greatest number of items a candidate can answer is 265, and the longest
amount of time the candidate can take to complete the examination is 6 hours.
J. Candidates will have up to 6 hours to complete the NCLEX-RN; total examination
time includes a short tutorial, two preprogrammed optional breaks, and any
unscheduled breaks the candidate may take. The first optional break is offered
after 2 hours of testing. The second optional break is offered after 3.5 hours of
testing. The computer will automatically tell candidates when these scheduled
breaks begin.
1. All breaks count against testing time.
2. When candidates take breaks, they must leave the testing room, and
they will be required to provide a palm vein scan before and after the
breaks.
K. If a candidate has not obtained a pass or fail score at the end of the 6 hours and has
not completed all 265 items in the 6-hour limit, but has answered all of the last 60
questions presented correctly, he or she will pass the examination.
L. If a candidate has not obtained a pass or fail score at the end of the 6 hours, has not
completed all 265 items in the 6-hour limit, and has not answered correctly all of
the last 60 questions presented, he or she will fail the examination.
M. A specific passing score is recommended by the Council. All states require the
same score to pass, so that if you pass in one state, you are eligible to practice
nursing in any other state. However, states do differ in their requirements
regarding the number of times a candidate can take the NCLEX-RN.
N. Although the Council has the ability to determine a candidate’s score at the time of
completion of the examination, it has been decided that it would be best for
candidates to receive their scores from their individual Board of Nurse Examiners.
The Council does not want the testing center to be in a position of having to deal
with candidates’ reactions to scores, nor does the Council want those waiting to
take their examinations to be influenced by such reactions.
O. The candidate must answer each question in order to proceed. You cannot omit a
question or return to an item presented earlier. There is no going back; this works
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National Council Licensure Examination

HESI Comprehensive Review for the NCLEX-RN Examination 6th Edition (2019)

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