Practice Exercises for the NCLEX Examination

THIRD EDITION

Outcomes f ocus
Def inition of terms
Assignment process
Delegation and assignment: The f iv e rights
Practice based on research ev idence
Principles f or implementation of prioritization, delegation, and assignment

Pain, pages 11-14

Cancer, pages 15-18

Immunologic problems, pages 19-22

Fluid, electroly te, and acid-base balance problems, pages 23-26

Saf ety and inf ection control, pages 27-30

Respiratory problems, pages 31-34

Cardiov ascular problems, pages 35-40

Hematologic problems, pages 41-44

Neurologic problems, pages 45-48

Visual and auditory problems, pages 49-52

Musculoskeletal problems, pages 53-56

Gastrointestinal and nutritional problems, pages 57-60

Diabetes mellitus, pages 61-64

Other endocrine problems, pages 65-68

Integumentary problems, pages 69-72

Renal and urinary problems, pages 73-76

Reproductiv e problems, pages 77-80

Problems in pregnancy and childbearing, pages 81-84

Pediatric problems, pages 85-90

Emergencies and disasters, pages 91-94

Psy chiatricmental health problems, pages 95-98

Case study 1: Chest pressure, indigestion, nausea, and v omiting, pages 99-100

Case study 2: Dy spnea and shortness of breath, pages 101-102

Case study 3: Multiple clients on a medical-surgical unit, pages 103-104

Case study 4: Shortness of breath, edema, and decreased urine output, pages 105-106

Case study 5: Diabetic ketoacidosis, pages 107-108

Case study 6: Home health, pages 109-112

Case study 7: Spinal cord injury , pages 113-114

Case study 8: Multiple patients with adrenal gland disorders, pages 115-116

Case study 9: Multiple clients with gastrointestinal problems, pages 117-120

Case study 10: Multiple patients with pain, pages 121-124

Case study 11: Multiple clients with cancer, pages 125-128

Case study 12: Gastrointestinal bleeding, pages 129-130

Case study 13: Head and leg trauma and shock, pages 131-134

Case study 14: Septic shock, pages 135-138

Case study 15: Heart f ailure, pages 139-142

Case study 16: Multiple patients with peripheral v ascular disease, pages, 143-144

Case study 17: Respiratory dif f iculty af ter surgery , pages 145-148

Case study 18: Long-term care, pages 149-152

Case study 19: Multiple pediatric clients in a clinic setting, pages 153-156

Case study 20: Multiple patients with mental health disorders, pages 157-162

Case study 21: Childbearing, pages 163-166

PA R T 1

Outcomes focus

Definition of terms

Prioritization

Delegation and assignment

Delegation and supervision

Supervision

Scope of practice for RNs, LPNs/LVNs, unlicensed assistive personnel

Assignment process

Delegation and assignment: The five rights

Right circumstances

Right task

Right person
Licensure, certification, and role description

Strengths and weaknesses

Right direction and communication

Right supervision

Practice based on research evidence

Rationale for maximiz ing nursing leadership skills at the point of care

Principles for implementation of prioritization, delegation, and assignment

References

Recommended resources

PA R T 2

CHAPTER 1

CHAPTER 2

CHAPTER 3

CHAPTER 4

CHAPTER 5

CHAPTER 6

CHAPTER 7

CHAPTER 8

CHAPTER 9

CHAPTER 10

C H AP T E R 11

CHAPTER 12

CHAPTER 13

CHAPTER 14

CHAPTER 15

CHAPTER 16

CHAPTER 17

CHAPTER 18

CHAPTER 19

CHAPTER 20

CHAPTER 21

PA R T 3

CASE STUDY 1

Blood pressure
Heart rate
O2 saturation
Respiratory rate
Temperature

174/92 mm Hg
120 to 130 beats/min, irregular
94% on room air
30 to 34 breaths/min
99.8 F (37.7 C) (oral)

CASE STUDY 2

Blood pressure
Heart rate
O2 saturation
Respiratory rate
Temperature

154/92 mm Hg
118 beats/min
88% on 1 L/min oxygen by nasal cannula
38 breaths/min
100.9 F (38.3 C) (oral)

CASE STUDY 3

CASE STUDY 4

Blood pressure
Heart rate
O2 saturation
Respiratory rate
Temperature

162/96 mm Hg
88 beats/min
91% on room air
28 breaths/min
97.8 F (36.6 C)

CASE STUDY 5

Blood glucose level (fingerstick)

Blood pressure
Heart rate
Respiratory rate
Temperature

685 mg/dL
100/60 mm Hg
120 beats/min
32 breaths/min
100.8 F (38.2 C)

CASE STUDY 6

CASE STUDY 7

CASE STUDY 8

Aldosterone level
Cortisol level
Potassium level
Sodium level

3 ng/dL (low)
2 mcg/dL (low)
3.7 mEq/L
136 mEq/L

CASE STUDY 9

CASE STUDY 10

C AS E S T U D Y 11

CASE STUDY 12

CASE STUDY 13

Hematocrit
Hemoglobin level
Platelet count

42%
12.6 g/dL

200,000/mm3
White blood cell count 7500/mm3

Blood urea nitrogen level 13 mg/dL

Chloride level
102 mEq/L
Creatinine level
0.7 mg/dL
Glucose level
144 mg/dL

Magnesium level
Potassium level
Sodium level

1.5 mEq/L
4.1 mEq/L
133 mEq/L

Blood alcohol level

0.14%
Tetrahydrocannabinol level 15 ng/mL

Arterial partial pressure of carbon dioxide (Paco2) 56 mm Hg

Arterial partial pressure of oxygen (Pao2)
Bicarbonate (HCO3 )

65 mm Hg

O2 saturation

88%

pH

7.30

22 mEq/L

Blood pressure 190/40 mm Hg

Heart rate
40 beats/min (sinus bradycardia)
O2 saturation
92%
Respiratory rate 14 breaths/min (ventilator controlled)
Temperature
96 F (35.6C) (axillary)

Blood pressure
Heart rate
ICP
O2 saturation

112/64 mm Hg (mean arterial pressure [MAP], 80 mm Hg)

50 to 56 beats/min (sinus bradycardia)
22 mm Hg
93%

Respiratory rate 14 breaths/min (ventilator controlled)

Temperature
97.4 F (36.3 C) (axillary)

Paco2

25 mm Hg

PaO2

110 mm Hg
20 mEq/L

HCO3

O2 saturation 100%
pH

7.54

CASE STUDY 14

Blood pressure
Heart rate
O2 saturation
Respiratory rate
Temperature

102/38 mm Hg
102 beats/min
76%
40 breaths/min
102.4 F (39.1 C) (orally)

Arterial partial pressure of carbon dioxide (PaCO2) 62 mm Hg

Arterial partial pressure of oxygen (Pao2)

50 mm Hg

Bicarbonate (HCO3 )

22 mEq/L

O2 saturation

87%

pH

7.23

Blood pressure 86/40 mm Hg

Heart rate
112 beats/min
O2 saturation
93%
Respiratory rate 32 breaths/min
Temperature
103 F (39.4 C) (axillary)

Blood pressure
Heart rate
O2 saturation

104/56 mm Hg
104 beats/min (atrial fibrillation)
95%

PA systolic pressure
PA diastolic pressure
PA wedge pressure
Respiratory rate
Temperature

15 mm Hg (normal = 15 to 30 mm Hg)
2 mm Hg (normal = 4 to 12 mm Hg)
2 mm Hg (normal = 6 to 12 mm Hg)
26 breaths/min
101.6 F (38.7 C) (rectal)

Hematocrit
Hemoglobin level
Platelet count

32%
10.9 g/dL
96,000/mm3

26,000/mm3
Blood urea nitrogen level 56 mg/dL
Creatinine level
2.9 mg dL
Glucose level
330 mg/dL
Potassium level
5.2 mEq/L
Sodium level
140 mEq/L
White blood cell count

CASE STUDY 15

Blood pressure 118/62 mm Hg

Heart rate
86 beats/min
O2
95%
Respiratory rate 24 breaths/min
Temperature
97.8 F (36.6 C)

CASE STUDY 16

CASE STUDY 17

Arterial partial pressure of carbon dioxide (PaCO2) 30 mm Hg

Arterial partial pressure of oxygen (PaO2)

54 mm Hg

Bicarbonate (HCO3 )

20 mEq/L

O2 saturation

88%

pH

7.34

Fraction of inspired oxygen (Fio2) 70%

Mode
Synchronized intermittent mandatory ventilation
Positive end-expiratory pressure 10 cm
Respiratory rate
30 breaths/min
Tidal volume (VT)
400 mL

HCO3

20 mEq/L

O2 saturation 94%
Paco2

47 mm Hg

Pao2

60 mm Hg

pH

7.31

Blood pressure (BP) 100/46 mm Hg

Heart rate
124 beats/min (sinus tachycardia)
O2 saturation
90%
PAWP
Respirations
Temperature

3 mm Hg
24 breaths/min
102.1 F (38.9 C)

CASE STUDY 18

CASE STUDY 19

CASE STUDY 20

CASE STUDY 21

Blood pressure
Heart rate
Respiratory rate
Temperature

140/90 mm Hg
88 beats/min
24 breaths/min
98.6 F (37 C)

Chapter 1: Pain, pages 11-14

Chapter 2: Cancer, pages 15-18

Chapter 3: Immunologic problems, pages 19-22

Chapter 4: Fluid, electrolyte, and acid-base balance problems, pages 23-26

Chapter 5: Safety and infection control, pages 27-30

Chapter 6: Respiratory problems, pages 31-34

Chapter 7: Cardiovascular problems, pages 35-40

Chapter 8: Hematologic problems, pages 41-44

Chapter 9: Neurologic problems, pages 45-48

Chapter 10: Visual and auditory problems, pages 49-52

Chapter 11: Musculoskeletal problems, pages 53-56

Chapter 12: Gastrointestinal and nutritional problems, pages 57-60

Chapter 13: Diabetes mellitus, pages 61-64

Chapter 14: Other endocrine problems, pages 65-68

Chapter 15: Integumentary problems, pages 69-72

Chapter 16: Renal and urinary problems, pages 73-76

Chapter 17: Reproductive problems, pages 77-80

Chapter 18: Problems in pregnancy and childbearing, pages 81-84

Chapter 19: Pediatric problems, pages 85-90

Chapter 20: Emergencies and disasters, pages 91-94

Chapter 21: Psychiatricmental health problems, pages 95-98

Case study 1: Chest pressure, indigestion, nausea, and vomiting, pages 99-100

Case study 2: Dyspnea and shortness of breath, pages 101-102

Case study 3: Multiple clients on a medical-surgical unit, pages 103-104

Case study 4: Shortness of breath, edema, and decreased urine output, pages 105106

Case study 5: Diabetic ketoacidosis, pages 107-108

Case study 6: Home health, pages 109-112

Case study 7: Spinal cord injury, pages 113-114

Case study 8: Multiple patients with adrenal gland disorders, pages 115-116

Case study 9: Multiple clients with gastrointestinal problems, pages 117-120

Case study 10: Multiple patients with pain, pages 121-124

Case study 11: Multiple clients with cancer, pages 125-128

Case study 12: Gastrointestinal bleeding, pages 129-130

Case study 13: Head and leg trauma and shock, pages 131-134

Case study 14: Septic shock, pages 135-138

Case study 15: Heart failure, pages 139-142

Case study 16: Multiple patients with peripheral vascular disease, pages, 143-144

Case study 17: Respiratory difficulty after surgery, pages 145-148

Case study 18: Long-term care, pages 149-152

Case study 19: Multiple pediatric clients in a clinic setting, pages 153-156

Case study 20: Multiple patients with mental health disorders, pages 157-162

Case study 21: Childbearing, pages 163-166

Chapter 1: Pain, pages 11-14

Chapter 2: Cancer, pages 15-18

Chapter 3: Immunologic problems, pages 19-22

Chapter 4: Fluid, electrolyte, and acid-base balance problems, pages 23-26

Chapter 5: Safety and infection control, pages 27-30

Chapter 6: Respiratory problems, pages 31-34

Chapter 7: Cardiovascular problems, pages 35-40

Chapter 8: Hematologic problems, pages 41-44

Chapter 9: Neurologic problems, pages 45-48

Chapter 10: Visual and auditory problems, pages 49-52

Chapter 11: Musculoskeletal problems, pages 53-56

Chapter 12: Gastrointestinal and nutritional problems, pages 57-60

Chapter 13: Diabetes mellitus, pages 61-64

Chapter 14: Other endocrine problems, pages 65-68

Chapter 15: Integumentary problems, pages 69-72

Chapter 16: Renal and urinary problems, pages 73-76

Chapter 17: Reproductive problems, pages 77-80

Chapter 18: Problems in pregnancy and childbearing, pages 81-84

Chapter 19: Pediatric problems, pages 85-90

Chapter 20: Emergencies and disasters, pages 91-94

Chapter 21: Psychiatricmental health problems, pages 95-98

Case study 1: Chest pressure, indigestion, nausea, and vomiting, pages 99-100

Case study 2: Dyspnea and shortness of breath, pages 101-102

Case study 3: Multiple clients on a medical-surgical unit, pages 103-104

Case study 4: Shortness of breath, edema, and decreased urine output, pages 105106

Case study 5: Diabetic ketoacidosis, pages 107-108

Case study 6: Home health, pages 109-112

Case study 7: Spinal cord injury, pages 113-114

Case study 8: Multiple patients with adrenal gland disorders, pages 115-116

Case study 9: Multiple clients with gastrointestinal problems, pages 117-120

Case study 10: Multiple patients with pain, pages 121-124

Case study 11: Multiple clients with cancer, pages 125-128

Case study 12: Gastrointestinal bleeding, pages 129-130

Case study 13: Head and leg trauma and shock, pages 131-134

Case study 14: Septic shock, pages 135-138

Case study 15: Heart failure, pages 139-142

Case study 16: Multiple patients with peripheral vascular disease, pages, 143-144

Case study 17: Respiratory difficulty after surgery, pages 145-148

Case study 18: Long-term care, pages 149-152

Case study 19: Multiple pediatric clients in a clinic setting, pages 153-156

Case study 20: Multiple patients with mental health disorders, pages 157-162

Case study 21: Childbearing, pages 163-166

Definitions

The five rights of delegation

The four cs of communication

Principles for implementation of prioritization, delegation, and assignment