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 chiatric–mental 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 174/92 mm Hg
Heart rate 120 to 130 beats/min, irregular
O2 saturation 94% on room air
Respiratory rate 30 to 34 breaths/min
Temperature 99.8° F (37.7° C) (oral)
CASE STUDY 2
Blood pressure 154/92 mm Hg
Heart rate 118 beats/min
O2 saturation 88% on 1 L/min oxygen by nasal cannula
Respiratory rate 38 breaths/min
Temperature 100.9° F (38.3° C) (oral)
CASE STUDY 3
CASE STUDY 4
Blood pressure 162/96 mm Hg
Heart rate 88 beats/min
O2 saturation 91% on room air
Respiratory rate 28 breaths/min
Temperature 97.8° F (36.6° C)
CASE STUDY 5
Blood glucose level (fingerstick) 685 mg/dL
Blood pressure 100/60 mm Hg
Heart rate 120 beats/min
Respiratory rate 32 breaths/min
Temperature 100.8° F (38.2° C)
CASE STUDY 6
CASE STUDY 7
CASE STUDY 8
Aldosterone level 3 ng/dL (low)
Cortisol level 2 mcg/dL (low)
Potassium level 3.7 mEq/L
Sodium level 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 42%
Hemoglobin level 12.6 g/dL
Platelet count 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 1.5 mEq/L
Potassium level 4.1 mEq/L
Sodium level 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) 65 mm Hg
Bicarbonate (HCO3− ) 22 mEq/L
O2 saturation 88%
pH 7.30

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 (35.6°C) (axillary)

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

Heart rate 50 to 56 beats/min (sinus bradycardia)
ICP 22 mm Hg
O2 saturation 93%
Respiratory rate 14 breaths/min (ventilator controlled)
Temperature 97.4° F (36.3° C) (axillary)
Paco2 25 mm Hg
PaO2 110 mm Hg
HCO3− 20 mEq/L
O2 saturation 100%
pH 7.54
CASE STUDY 14
 Blood pressure 102/38 mm Hg
Heart rate 102 beats/min
O2 saturation 76%
Respiratory rate 40 breaths/min
Temperature 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 104/56 mm Hg

Heart rate 104 beats/min (atrial fibrillation)
O2 saturation 95%
PA systolic pressure 15 mm Hg (normal = 15 to 30 mm Hg)
PA diastolic pressure 2 mm Hg (normal = 4 to 12 mm Hg)
PA wedge pressure 2 mm Hg (normal = 6 to 12 mm Hg)
Respiratory rate 26 breaths/min
Temperature 101.6° F (38.7° C) (rectal)
Hematocrit 32%
Hemoglobin level 10.9 g/dL
Platelet count 96,000/mm3
White blood cell count 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
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 3 mm Hg
Respirations 24 breaths/min
Temperature 102.1° F (38.9° C)
CASE STUDY 18
CASE STUDY 19
CASE STUDY 20
CASE STUDY 21
Blood pressure 140/90 mm Hg
Heart rate 88 beats/min
Respiratory rate 24 breaths/min
Temperature 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: Psychiatric–mental 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 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 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: Psychiatric–mental 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 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 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