2015 Do not replicate or reproduce without permission. - NCLEX

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©2015 Do not replicate or reproduce without permission.
Kramer-Kile, M.L. (2015). A Study Guide for Canadian Educated Graduates Rewriting the NCLEXRN® (1st ed.) Kimberley, BC: Kramer-Kile Nurse Education Consultants Ltd. Registration No. 1122832.
NCLEX® and NCLEX-RN®are registered trademarks of the National Council of State Boards of Nursing
Copyright © 2015 by Kramer-Kile Nurse Education Consultants Ltd. All rights reserved. No part of this
electronic document may be loaned, shared, reproduced, stored in a retrieval system, or transcribed,
in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without
permission of the publisher.
Study Guide Design by Perpetual Notion, Edmonton, AB.
THE FOLLOWING IS A PREVIEW OF THE TRANSITIONING TO THE NCLEX-RN®: A STUDY GUIDE
FOR CANADIAN-EDUCATED NURSING GRADUATES. THE TOTAL STUDY GUIDE IS 300 PAGES IN
LENGTH AND IS POSTED ON THE WEBSITE IN A PDF DOCUMENT IN FOUR SEPARATE PARTS.
THE STUDY GUIDE IS MEANT TO HELP DIRECT AND WORK YOU THROUGH IMPORTANT
CONTENT FOR THE NCLEX-RN® IT IS DESIGNED ACCORDING TO THE 2013-2016 TEST PLAN
AND HIGHLIGHTS KEY AREAS FOR REVIEW. THIS IS A DOCUMENT THAT EXPECTS YOU TO FILL
IN YOUR KNOWLEDGE GAPS, THE ANSWERS ARE NOT PROVIDED TO YOU. THE PURPOSE OF
THIS GUIDE IS TO PROVIDE YOU WITH A SET STRUCTURE FOR PREPARATION.
ON THE WEBSITE YOU WILL ALSO FIND STUDY MAPS DESIGNED TO HELP YOU ORGANIZE
BASIC INFORMATION RELATED TO PATHOLOGY SO YOU CAN USE YOUR TIME TO LEARN
CONTENT IN DEPTH.
PHARMACOLOGICAL PRINCIPLES AND DRUGS ARE A MAJOR CHALLENGE FOR THIS EXAM.
YOU WILL FIND THIS CONTENT INTEGRATED THROUGHOUT THIS GUIDE.
IF YOU HAVE ANY SPECIFIC INQUIRES RELATED TO THE GUIDE PLEASE CONTACT US VIA THE
WEBSITE.
BEST WISHES FOR SUCCESS!
About the Author
Marnie Kramer-Kile is a nursing faculty member at the College of the Rockies in Cranbrook,
British Columbia. An experienced nurse educator and national speaker on RN registration exam
preparation, Marnie has expertise in creating practical study approaches using exam
competency frameworks and test plans as a guide. She has extensive experience in preparing
Canadian graduates to write the previous Canadian Registered Nurse Exam (CRNE) and has also
given much of her time to assisting and guiding repeat writers. Marnie is committed to helping
Canadian nursing graduates transition to the NCLEX- RN®.
Legal Disclaimer: This study guide is presented solely for educational purposes. While best
efforts have been used in preparing this guide, the author and publisher make no
representations or warranties that this study guide will ensure success on the NCLEX- RN®.
Neither the author nor the publisher shall be held liable or responsible to any person or
entity with respect to any failure to the NCLEX- RN® or misinterpretation of the intent and/or
use of the study guide. The author does not write or review questions for the NCLEX- RN®.
This study guide is not to be reproduced without the permission of the author or publisher.
Author’s Foreword
Six years ago, I became involved in helping Canadian-educated graduates prepare for the
Canadian Registered Nurse Examination (CRNE). I was on the development team for the CRNE
Preparation Course through the Centre for Professional Development at the University of
Toronto and subsequently lectured in the course from 2009-2014. My involvement in this
course exposed me to a variety of CRNE candidates from Canadian nursing programs. As our
course grew and expanded, it became evident that there were more repeat writers of the CRNE
attending. This concerned me as an educator and I started looking into some of the challenges
that repeat writers were experiencing. Eventually, I started a volunteer CRNE repeat writer’s
support group. I wrote my first study guide “Countdown to the CRNE: A Comprehensive Study
Guide for the 2010-2015 Blueprint of the CRNE” in 2012 after realizing that many repeat writers
needed a more structured approach to their studying. I based this study guide on the Canadian
Nurses Association 2010-2015 CRNE Competency Framework and my knowledge of Canadian
Nursing Curricula.
In late 2012, there were rumors that the CRNE would be discontinued and the NCLEX-RN®
would be the new registration exam in Canada. At this time, the regulatory bodies for the
provinces and territories had not contacted any nursing education stakeholders regarding this
potential change. In 2013, it was made public by the Canadian Nurses Association (the current
holder of the CRNE) that their contract for the CRNE would not be renewed in 2015. The
provincial and territorial nursing colleges had come together to make the decision that NCLEXRN® would be the new national registration exam. This decision was made without any input
from Canadian nursing educators. Since the current test plan for the NCLEX-RN® exam was
implemented in 2013, the next test plan (which is set to include input from Canadian practice
consultants and Canadian reviewers) will not be implemented until after March 31, 2016. More
to the point, Canadian educated graduates in 2015 and early 2016 will be writing the current
American NCLEX-RN® exam.
This has caused some anxiety for Canadian-educated nursing graduates. There is a general
concern that their nursing programs have not prepared them to write the NCLEX-RN® in 2015.
As an experienced educator who has taught in several undergraduate nursing programs, I
would like to dispel this anxiety. Canadian nursing graduates have been exposed to key nursing
content and theory required for the NCLEX-RN® in their nursing programs. However, some of
this content may need to be studied more extensively than other areas for this exam. This
study guide will point you towards key content identified on the NCLEX-RN® 2013-2016 test
plan and identify potential knowledge gaps or areas for review that often challenge Canadian
educated nurses on registration exams in general.
There is a common perception amongst some Canadian-educated nursing students that we
should tailor our Canadian nursing curriculum to the NCLEX-RN®. While I agree that there
should be transitional supports available in nursing programs to help prepare students for this
exam, I would like to express my commitment to Canadian undergraduate nursing curricula and
its focus on primary health care as well as public and community health approaches.
For those of you using this guide after failing the NCLEX-RN®, being unsuccessful on a high
stakes registration exam like the NCLEX-RN® is a stressful experience. It will test your
commitment to becoming a registered nurse and challenge you physically, mentally and
emotionally. I can tell you that repeat writers who have achieved success have a different
appreciation for their nursing practice and experience clinical practice in a new way, further
informed by their new nursing knowledge. Keep this in mind as you work through this long
process of achieving success. For first time writers, it may help you to read the repeat writer
section in order to learn from some of the mistakes others have made in their preparation and
to understand the process of writing the NCLEX-RN® in Canada. Understanding and using the
2013-2016 NCLEX-RN® test plan effectively is key to your future success. I hope you find this
study guide useful in your exam preparation.
Sincerely,
Marnie Kramer-Kile, RN, PhD
Author
Table of Contents
Part One: Addressing the Repeat Writer Experience- Lessons Learned
Chapter 1: Advice for Repeat Writers
Introduction
Step 1: Coming to terms with your situation
Advice for Repeat Writers Failing for the 1st, 2nd or 3rd Time
Step 2: Find healthy strategies to reduce your stress & mentally prepare to write again
Step 3: Be strategic about when you write again
Step 4: Prepare to re-group and change your study approach
Conditions that May Influence Computer Adaptive Testing Abilities
Part Two: Structuring your Study Approach for the NCLEX-RN®
Chapter 2: Getting Started
Introduction
Organizing your study resources
Chapter 3: Understanding the Role of the 2013-2016 NCLEX-RN® Plan for Organizing your
Content Review
Four major Client Needs Areas
Integrated processes on the NCLEX-RN®
Nursing Process
Caring
Documentation
Teaching and Learning
Part Three: Client Needs Areas for Review
Chapter 4: Content Review for Safe & Effective Care Management Client Need Area
I.
Management of Care
Delegation
Advance Directives
Case Management
Collaboration with Interdisciplinary Team
Establishing Priorities
Performance Improvement (Quality Improvement)
Legal Rights and Responsibilities
Problematic Substance Abuse in Nurses
Privacy and Confidentiality (Information Security)
Client Rights and Informed Consent
Conflict Resolution
Approved Medical Abbreviations
Concepts of Management and Leadership
Information Technology
Continuity of Care
II.
Safety and Infection Control
Accident/Error/Injury Prevention
Emergency Response Plan
Ergonomic Principles
Handling Hazardous and Infectious Materials
Home safety
Reporting of incident/event/irregular occurrence/variance
Safe use of equipment
Standard precautions/transmission-based precautions/surgical asepsis
Use of restraints/safety devices
Chapter 5: Content Review for Health Promotion and Maintenance Client Need Area
Growth and development stages/aging process
Ante/Intra/Postpartum and Newborn Care
Health Assessment
Chapter 6: Psychosocial Integrity
Abuse/Neglect
Chemical and Other Dependencies/Substance Use Disorder
Crisis Intervention
End-of-Life Care
Family Dynamics
Grief & Loss
Spiritual Health
Therapeutic Communication
Chapter 7: Physiological Integrity
I.
Basic Care & Comfort
Assistive Devices
Elimination
Mobility/Immobility
Non-pharmacological Comfort Interventions
Nutrition and Oral Hydration
Personal Hygiene
Rest and Sleep
II.
Pharmacological & Parental Therapies
Adverse Effects/Contraindications/Side Effects/Interactions
Blood and Blood Products
Central Venous Access Devices
Dosage Calculator
Expected Outcomes
Medication Administration
Parental/Intravenous Therapies
Pharmacological Pain Management
Total Parental Nutrition
III.
Reduction of Risk Potential
Changes/Abnormalities in Vital Signs
Diagnostic Tests
Potential for Complications of Diagnostic Tests/Treatments/Procedures
Laboratory Values
Potential for Complications from Surgical Procedures & Health Alterations
System Specific Assessments
Therapeutic Procedures
IV.
Physiological Adaptation
Radiation Therapy
Phototherapy
Invasive Therapies
Peritoneal Dialysis
Suctioning
Wound Care
Ostomy Care and Education
Pulmonary Hygiene
Post-operative Care
Fluid and Electrolyte Imbalances
Hemodynamics
Critical Care Content
i. Mechanical Ventilation
ii.
Temperature Regulation
iii.
Hemodialysis
iv. Pacing Devices
v.
Telemetry
vi. Emergency Care Procedures
Part Four: Study Tools and Strategies to Approach NCLEX-RN® Exam Questions
Chapter 8: Study Maps
Instructions for Study Mapping
List of Study Maps Posted on Website
Chapter 9: Decision-Making Process for Approaching NCLEX-RN® Exam Questions
Review of NCLEX-RN® Question Formats
Strategies for Preparing for Varying Question Formats
Strategies for Approaching Questions
References
Symbol Key
Study Tips: These boxes contain helpful information on how to
approach a content area and list pertinent strategies for studying and
resources
Essential Areas for Review: These are areas that are central to the
NCLEX-RN® Test Plan and require a deep understanding of concepts
because they are applied to all the client need areas
Areas expected to challenge Canadian-Educated Writers: Areas of
content that are not covered in detail in Canadian nursing programs,
common areas of weakness on registration exams, or areas that apply
specifically to a US context are identified with this symbol.
Terminology
Health Care Provider: Physicians and nurse practitioners will be referred to as
health care providers on the NCLEX-RN®- if you require an order or directive you
will seek it from a health care provider in the context of this exam.
Printable Content Available
This study guide cannot be printed. However, the exercises in this guide have
been compiled into a printable document on the website. You will find these
resources under the “Study Maps and Exercises” tab. Please do not distribute
these tools to other students, they are copyrighted.
Chapter 1: Advice for Repeat Writers of the NCLEX-RN®
Introduction
For the past six years I have worked with Canadian-educated repeat writers of nursing
registration exams. Finding out that you have failed your registration exam is an isolating
experience. There is the embarrassment of having to tell your family and friends, especially
your nursing peers who were successful. A sense of panic also sets in if you have been given a
new graduate position that is conditional on your ability to register with your provincial or
territorial nursing college. Mostly, there is the daunting task of starting over again in your study
preparation. Adding to this pressure is the knowledge that in Canada you are given just three
chances to pass the exam in order to be eligible to obtain your registration as a nurse.
Many candidates who have been unsuccessful on registration exams go back to their nursing
programs for help. However, they are no longer students of the program and help is often
limited. As a result, candidates are forced to rely extensively on publisher’s resources for
NCLEX-RN® preparation rather than find guidance in gaining an understanding of high stakes
exam preparation and of the specific content gaps Canadian educated nurses often have in the
context of the current 2013-2016 NCLEX-RN® Test Plan.
The purpose of this study guide is to help you start over and get back on track with your
preparation. Re-preparing for the NCLEX-RN® involves more than just sitting down to study
again. You need to mentally prepare to rewrite the exam, ensure your health through your
preparation, and find new strategies to work with. In my work with repeat writers I have found
that there is a five step process required prior to re-writing the exam:
Step 1: Come to terms with your situation.
Step 2: Find healthy strategies to reduce your stress and mentally prepare to start again
Step 3: Be strategic about when you write again
Step 4: Prepare to re-group and change your study approach
Step 5: Make a formal plan for success
This study guide will help to move you through this process. However, it is important for you to
understand that this study guide will not replace the work of studying, rather it will provide you
with a more targeted approach that will save you time, increase your depth of studying and
direct you towards the concepts outlined on the 2013-2016 NCLEX-RN® Test Plan.
Part Two
Structuring your Study Approach for the
NCLEX-RN®
Chapter 2: Getting Started
Introduction
It is often overwhelming to think about where to start your studying for this exam. How do you review
an entire four year nursing program in a matter of months? Many graduates look for resources to do the
work of content review for them, hoping that they will just be able to memorize information for the
NCLEX-RN®. Success on nursing registration exams is contingent on candidates’ abilities to combine a
variety of supports. These include nursing program textbooks, practice questions, clinical experience and
study tools. This study guide is designed to direct you toward specific content you should study and to
integrate a variety of study tools for this exam. I will use an approach focused on the content gaps and
areas of focus required for Canadian-educated repeat writers.
NCSBN NCLEX-RN® 20132016 Test Plan
Practice Questions
recommend NCSBN
Learning Extension
Integrated
Content Review
Nursing Textbooks
Test-taking Strategy
Resources
Figure 2.1 Integrating your Study Resources for the NCLEX-RN®
Canadian nursing programs responded to the transition to the NCLEX-RN® in differing ways. The primary
response focused on exposing students to NCLEX-RN® type questions. Some institutions bought
publisher resources such as Prep-U®, ATI®, HESI® etc…, or developed their own online exam. While these
approaches are beneficial for students, the breadth of content addressed on the NCLEX-RN® may also
pose challenges to Canadian-educated graduates. This chapter will outline how to organize your
approach to studying content for the NCLEX-RN® and provide examples for reviewing information using
the 2013-2016 NCLEX-RN® Test Plan as a framework.
Organizing your Study Resources
Task 1: Gather your Nursing Textbooks
Many of my nursing students ask if they need to buy American textbooks for NCLEX-RN®
preparation, and the answer is no. The textbooks you already have from your nursing program
are great resources. The only recommendation I might make is that if you do not have a
textbook in each of the subject areas identified below that you find a current copy (in the last 5
years). As a note, if your nursing program textbooks are now older than 5 years and you just
recently graduated you do not need to buy new ones at this time. Chances are, these texts were
used on the current test plan. If you did not have a maternal-newborn or pediatric course in
your program you need to find a textbook that will address this content, since it will be
addressed in detail on the NCLEX-RN®. It is important that you study from your nursing
textbooks for two primary reasons:
1. The NCLEX-RN® questions are written from nursing textbooks. Each question, when it is
developed, will have two nursing textbooks referenced for the answer. Though there
are American and Canadian versions of these textbooks, the concepts tested are
transferable. This study guide will point out specific information that may be absent or
addressed differently in your Canadian textbooks. You will not need to buy American
resources to prepare for the NCLEX-RN®.
2. Using your nursing textbooks encourages you to learn content in detail. Furthermore,
nursing textbooks will also utilize the nursing process when presenting information.
Students are often drawn to review guides, summary PowerPoints, and prep courses to
do the work of information summary for them. Remember that these resources are
supplementary resources. In order to retain information you need to find ways to
successfully apply it to an exam context. A first step in this regard is to determine a
system of information management from your nursing textbooks. There are tools in this
study guide (i.e., study maps) to help you sort through this information and make the
best use of your nursing textbooks.
The following list identifies key nursing textbooks to help you study for the NCLEX-RN®. Each
Canadian nursing program will choose different resources—listed below are the most common
resources used in Canadian curricula that are beneficial for NCLEX-RN® preparation. If your
program used a book that is not on the list, please don’t be concerned, because it will still be
effective. I have simply listed the books that are the most popular.
1. Canadian Nursing Fundamentals Textbooks
Ross-Kerr, J.C., Woods, M.J., Astle, B.J. & Duggleby, W. (2014). Canadian fundamentals
of nursing (5th ed.). St. Louis: Mosby Elsevier.
Ross-Kerr, J.C. & Woods, M.J. (2010). Canadian fundamentals of nursing (Revised 4th
ed.). St. Louis: Mosby Elsevier.
Kozier, B.J., Erb, G., Bermen, A.J., Snyder, D., Raffin Bouchal, S., Hirst, S.P., Yiu, L.,
Leseberg Stamler, L. & Buck, M. (2009). Fundamentals of Canadian nursing:
Concepts, process, and practice (2nd ed.). Toronto, ON: Pearson Education
Canada.
Kozier, B.J., Erb, G., Bermen, A.J., Snyder, Buck, M., Yiu, L., Lesseberg Stamler, L. (2013).
Fundamentals of Canadian nursing: Concepts, process, and practice (3 rd ed.).
Toronto, ON: Pearson Education Canada.
2. Medical-Surgical Nursing Textbooks
Black, J.M. & Hokansen Hawks, J. (2009). Medical-surgical nursing: Clinical Management
for positive outcomes (8th ed.). St. Louis: Elsevier Saunders.
Day, R., Paul, P., Williams, B., Smeltzer, S., & Bare, B. (2009). Brunner & Suddarth’s
textbook of medical-surgical nursing (2nd Canadian ed.). Philadelphia: Lippincott
Williams & Wilkins.
Paul, P., Day, R. & Williams, B. (2015). Brunner & Suddarth’s textbook of medical-surgical
nursing (3rd Canadian ed.). Philadelphia: Lippincott Williams & Wilkins.
Mantik Lewis, S.L., McLean Heitkemper, M.M., Ruff Dirksen, S., Barry, M.A.,
Goldsworthy, S. & Goodridge, D. (2009). Medical-surgical nursing in Canada:
Assessment and management of clinical problems. (2nd Canadian ed.). Toronto,
ON: Mosby.
Mantik Lewis, S.L., McLean Heitkemper, M.M., Ruff Dirksen, S., Barry, M.A.,
Goldsworthy, S. & Goodridge, D. (2014). Medical-surgical nursing in Canada:
Assessment and management of clinical problems. (3rd Canadian ed.). Toronto,
ON: Mosby.
3. Pharmacology Textbooks
Adams, M.P., Holland, L.N., Bostwick, P.M., & King, S.L. (2010). Pharmacology for nurses:
A pathophysiologic approach (3rd ed.). Toronto, ON: Pearson Prentice Hall.
Lehne, R.A. (2010). Pharmacology for nurses (7th ed.). St. Louis: Elsevier Saunders.
Lehne, R.A. (2012). Pharmacology for nurses (8th ed.). St. Louis: Elsevier Saunders.
Lilley, L.L., Harrington, S., Snyder, J.S., Rainforth Collins, S., Snyder, J. & Swart, B. (2010).
Pharmacology and the nursing process in Canada (2nd ed.). St. Louis: Elsevier
Mosby.
*Although many candidates for the NCLEX-RN® also have “Nursing Drug Guides,” it is
better to return to your nursing pharmacology textbook because it is more detailed and
drugs can be studied according to human systems/pathologies, which make them easier
to review and retain.
4. Pediatric Nursing Textbooks
Ball, J.W. Bindler, R.C. & Cowen, K. (2010). Child health nursing: Partnering with families
(e-book) (2nd ed.). Upper Saddle River, NJ: Pearson Education.
Hockenberry, M.J. & Wilson, D. (2014). Wong’s nursing care of Infants and children (10th
ed.). St. Louis: Elsevier Mosby.
Hockenberry, M.J. & Wilson, D. (2010). Wong’s nursing care of Infants and children (9th
5. Family Newborn Nursing Textbooks
Evans, R., Evans, M., Brown, Y., & Orshan, S. (2009). Canadian maternity, newborn, &
women’s health nursing (1st Canadian ed.). Philadelphia: Lippincott Williams &
Wilkins.
Hockenberry, M.J. & Wilson, D. (2014). Wong’s nursing care of infants and children (10th
Hockenberry, M.J. & Wilson, D. (2010). Wong’s nursing care of infants and children (9th
Chow, J., Ateah, C.A., Scott, S.D., Scott Ricci, S. & Kyle, T. (2013). Canadian maternity and
pediatric nursing. Toronto: Lippincott Williams & Williams.
6. Mental Health Nursing Textbooks
Austin, W. & Boyd, M (2014) Psychiatric and mental health nursing for Canadian
practice. Philadelphia: Lippincott, Williams and Wilkins.
Stuart, G.W. (2012). Principles and practice of psychiatric nursing (10th ed.). St. Louis:
Elsevier Mosby.
Halter, M.J. (2013). Varcarolis’ foundations of psychiatric mental health nursing: A
clinical approach (7th ed.). St. Louis: Elsevier Saunders.
7. Communication and Collaborative Practice Nursing Textbooks
Arnold, E.C. & Underman Boggs, K.U. (2010). Interpersonal relationships: Professional
communication skills for nurses (6th ed.). St. Louis: Elsevier Saunders.
Arnold, E.C. & Underman Boggs, K.U. (2015). Interpersonal relationships: Professional
communication skills for nurses (7th ed.). St. Louis: Elsevier Saunders.
Gottlieb, L.N., & Feeley, N. (2006). The collaborative partnership approach to care: A
delicate balance. Toronto: Mosby.
8. Diagnostic Textbooks (often the Medical Surgical Textbooks will also contain this
information as well)
Van Leeuwen, A. M., Kranpitz, T.R., & Smith, L. (2011). Davis’s Comprehensive Handbook
of Laboratory and Diagnostic Tests with Nursing Implications (4th ed.).
Philadelphia: F.A. Davis Company.
Van Leeuwen, A. M., Kranpitz, T.R., & Smith, L. (2015). Davis’s Comprehensive Handbook
of Laboratory and Diagnostic Tests with Nursing Implications (5th ed.).
Philadelphia: F.A. Davis Company.
Task 2: Organize your NCLEX-RN® Preparation Resources
It is important to begin by differentiating a review guide from a preparation guide in the context of
NCLEX-RN® preparation. A review guide is a resource that summarizes nursing content while a
preparation guide is a resource that contains practice questions. Both have a place in NCLEX-RN®
preparation and may also offer tips for answering practice; it is important, however, to use these
resources as tools in your toolkit, rather than rely on them as primary study tools.
In this section, I will identify some popular preparation and review guides for the NCLEX-RN® and
provide some strategies for using these resources. The NCLEX-RN® 2013-2016 Test Plan will be
identified and explained. I will also recommend online practice questions from the NCSBN website and
show you new ways to approach your content review.
Test-Taking Strategy Textbooks
These resources are designed to help your approach to NCLEX-RN®-type questions. This will
include tips on how best to study, explanations of the different types of exam questions (e.g.,
Multiple Choice and alternate format questions), how to use the nursing process and other
strategies for prioritization for test-taking, as well as advice on how to break apart questions to
better understand them. Three primary resources include:
Silvestri, L.A. & Silvestri, A. (2014). Saunders 2014-2015
strategies for test success: Passing nursing school and
the NCLEX exam. St. Louis: Elsevier.
Comments: This resource identifies strategies for approaching
the multiple-item formats for questions on the NCLEX-RN®,
prioritizing questions, and applies topic areas such as
managing, delegating, communication, medications, and
calculations to questions. It also includes eight practice tests.
Nugent, P.M. & Vitale, B.A. (2012). Test success: Test-taking
techniques for beginning nursing students. Philadelphia:
FA Davis.
Comments: This book is essential for understanding how
nursing exam questions are constructed, the role of the nursing
process in multiple-choice exam writing, and test-taking
techniques. It is an American textbook and applies directly to
the NCLEX-RN®
Lipe, S.K. & Beasley, S. (2004). Critical thinking in nursing: A
cognitive skills workbook. Philadelphia: Lippincott Williams
& Wilkins.
Comments: This book focuses on basic fundamental cognitive
skills in nursing practice including problem solving, decision
making, priority setting and critical thinking. All of these skills are
then applied to the Nursing Process. This book has been
extensively cited in this study guide because it provides excellent
strategies to apply to NCLEX-RN® preparation.
Review Guides
A review guide contains a summary of a wide range of information and practice questions. The
purpose of a review guide is to expose you to as much content as possible in one resource. Key
aspects of a good NCLEX-RN® review guide include:
1.
2.
3.
4.
Information presented using the Nursing Process
Book is well-referenced throughout
Helpful diagrams, tables and figures to help with information presentation
Addresses the client needs areas of the NCLEX-RN® test plan
However, there are some drawbacks to this type of resource. A review guide should NOT be
your primary source for information; you need to refer back to your nursing program textbooks
to ensure all the information is covered. Review guides can also get you in the habit of
memorizing instead of understanding information. In this study guide, I will show you how to
use the information in review guides in a more helpful way through a study mapping exercise.
Below I have listed some review guides that I have found helpful for preparation. Please note
that this is not representative of all the guides on the market and there are other excellent
resources outside of what I have listed. These are the books I have worked with so far.
Hogan, M. (2012). Comprehensive review for NCLEX-RN: Pearson
reviews and rationales (2nd ed.). New Jersey: Prentice Hall.
Comments: This review guide provides a comprehensive review
of foundational content identified on the current NCLEX-RN®,
even though it was published in 2012. It works as a complement
to this study guide and provides helpful strategies for organizing
information.
Silvestri, L.A. (2014). Saunders comprehensive review for the NCLEXRN® Examination. St. Louis: Elsevier.
Comments: This review guide is aligned with the current NCLEX-RN®
Test Plan. The Saunder’s publications use a comprehensive
approach to exam preparation, recognizing the importance of testtaking strategies, review, questions and online review. The review
guide provides excellent tables and summaries of key content.
Zerwekh, J. (2013). Illustrated study guide for the NCLEX-RN® (8th
ed.). St. Louis: Elsevier.
Comments: This review guide is a bit more condensed than the
other guides, but it does a good job of representing some
complex concepts in a simplified way and contains diagrams,
tables, and pictures, which work well for visual learners.
Upchurch, S., Henry, T., Pine, R. & Rickles, A. (2014). HESI
comprehensive review for the NCLEX-RN® examination (4th ed.).
St. Louis: Elsevier.
Comments: This is a condensed review guide as well; it contains
helpful information and summaries but does not go into a lot of
depth. It works as an adjunct to your nursing textbooks.
Preparation Guides
A preparation guide typically is focused on practice questions. Aspects of the Test Plan may be
uncovered but the focus is on questions and rationales. Preparation guides are a useful tool
after you have completed enough content review. Keep in mind that the best practice
questions are ones that are created by the licensing body who runs the exam because these are
often old exam questions. Sometimes, the practice questions in publishers’ guides may not be
levelled to the difficulty of the NCLEX-RN®. Also, you shouldn’t get in the habit of memorizing
answers to questions; instead you should be focused on strategies to piece apart and read the
question in more detail.
Hargrove-Huttel, R.A. & Cadenhead-Colgrove, K. (2014). Prioritization,
delegation & management of care for the NCLEX-RN exam.
Philadelphia: F.A. Davis.
Comments: This is an excellent resource for questions in the client
need area of management of care. The questions cover more than just
key principles, a varied approach is taken to integrate multiple layers of
content in the context of the management of care section.
Nug Nugent, P.M., Pelikan, P.K., Green, J.S. & Vitale, B.A. (2011). Mosby’s
review questions for the NCLEX-RN® examination (7th ed.). St.
Louis: Mosby Elsevier.
Comments: This resource is written by Patricia Nugent, the lead author
of Test Success for Beginning Nurses. This resource provides
opportunities to practice applying strategies to exam questions. The
questions are well-formulated and supportive of the NCLEX-RN® test
plan.
Billings, D.M. & Hensel, D. (2013). Lippincott’s Q&A review for NCLEXRN® (11thed.). Philadelphia: Lippincott Williams & Wilkins.
Comment: This is a popular resource recommended by many nursing
students.
National Council of State Boards of Nursing (NCSBN) Resources
One of the most helpful resources I have found in my research on NCLEX-RN preparation is the
Learning Extension from the National Council of State Boards of Nursing (NCSBN). Here is a link
to the website:
https://learningext.com/students/default.aspx
You can decide for how long you would like to have access to the site. The site does contain a
list for content review, which is helpful, but it is only in bullet points. It does not provide depth
like a review guide or your nursing textbooks would. However, the practice exams are helpful
for preparation. The questions on the site are from previous NCLEX-RN® exams so they should
be similar in structure and in difficulty when compared to what you will find on the actual
exam. I found it helpful to work through the practice tests and write down any of the content I
had difficulty with, as well as the client need areas that I needed more work in.
NCLEX-RN® Review Courses in Canada
Centre for Professional Development University of Toronto:
https://bloomberg.nursing.utoronto.ca/pd/exam-preparation/nclex
I have taught with the University of Toronto Lawrence S. Bloomberg Faculty of Nursing Centre
for Professional Development since 2009. This review course is two days and focuses on key
areas from the NCLEX-RN® Test Plan. Areas such as critical care, maternity, pediatrics,
pharmacology and study strategies are covered. There are no practice tests in this course, but
each lecture integrates practice questions in multiple formats. I would recommend that you
complete this study guide before attending this course. It will help you to better engage in the
content.
*There are other NCLEX-RN® courses offered in differing parts of Canada by both private
vendors and publishers. I have not offered any feedback on these courses because it would not
be appropriate for me to do so, since I teach in a similar type of program. Please research these
courses via your internet search engine and use the feedback given from other attendees to
make your decision regarding taking preparation courses. It is important to note that facilitators
with a background in nursing education and an understanding of Canadian nursing curricula are
best suited to facilitate these sessions. Do your research and ensure that you are being taught
by a nursing education expert.
Task 3: Make a Solid Study Plan and Download the 2013-2016
Educator’s Version of the NCLEX-RN® Test Plan.
This study guide is designed to help you organize your study notes and provide ways to help you apply
and think critically with the content you study. It is important when you are studying to address all 4 of
the client needs areas addressed on the 2013-2016 NCLEX-RN® test plan. Use the order presented in the
chapters of this study guide to help build your knowledge for the NCLEX-RN®. It is helpful to take a large
binder and divide it into the four client needs areas. Print off the educator’s version of the 2013-2016
NCLEX-RN® Test Plan and put it in the front of your binder so you can reference it as needed (linked
below).
NCSBN (2013). Detailed test plan for national council licensure examination: Item writer/item
reviewer/nurse educator version. Chicago: Author. Retrieved from
https://www.ncsbn.org/1287.htm
It is important to provide yourself with enough time to study. Strategies that may have worked for you
during your nursing program (e.g., leaving your studying until the last minute, memorizing content,
going into an exam unprepared) will not help you prepare for the NCLEX-RN®. This study guide provides
you with a program to follow and guides you towards content outlined on the 2013-2016 NCLEX-RN®
test plan. When you are constructing your study plan consider the following:
1. Identify your strengths and weaknesses with content (e.g., was there content you struggled with
during your program such as pathophysiology, or did the design of your nursing program not
allow for detailed review of content such as maternal-newborn nursing?)
2. Determine your ability to understand and apply pathophysiological concepts to disease
management.
3. Start with reviewing foundational nursing content.
4. Find a way to study information that engages you and helps you to apply and critically think with
nursing content.
Task 4: Think of New Ways to Study Nursing Content
I. Content Mapping as a Study Strategy (use for content you know that you need
to expand on or study in more detail)
This chapter focuses on strategies to help develop your abilities to apply and think critically through the
content you have just spent time reviewing. The following section outlines a simple, but effective,
content mapping exercise. Content mapping is a strategy you can use to test your knowledge and to
find ways of reading for and understanding information you do not know or content you are not strong
in. Content mapping can be effective for any of the four client needs areas. However, candidates often
find it the most helpful for addressing content when studying disease management. The following
content mapping exercise will test how much information you actually know and help you to fill in the
blanks in a way that will encourage the retention of this knowledge.
There is no correct way to “content map”. You will find a strategy that works the best for you. Below is
a model for helping you to organize your topic. This will ensure that you approach concepts using the
nursing process. It will also help you to jog your memory of the different areas of knowledge needed for
the NCLEX-RN®. It is helpful to use the following structure to content map nursing content. If you are a
more linear thinker you can use the same topic areas in columns for this exercise:
Lab tests,
diagnostic tests
How would
someone with this
condition present
on assessment?
Remember to include:
Pharmacology
Diagnosis
Nutrition
Nursing
Focused
Assessment
Interventions
Pathophysiology
of Condition
Symptom
recognition is
key: focus on
identifiable
symptoms of
the condition
Symptoms
Evaluation
Expected Treatments
Specific nursing
education
Expected Outcomes for
care
Figure 2.2 Structure for organizing content and study mapping
HOW TO USE CONTENT MAPPING WHILE STUDYING:
1. Pick a topic. For example start with a topic like tuberculosis.
2. Take a large sheet of paper and using the structure provided above write down everything
you can from memory about the topic. For example, what would a nurse assess for in a client
with this condition? What tests should the nurse anticipate to confirm diagnosis? What should
the nurse be planning for? What are expected interventions (this can be treatment, medication,
or specific nursing interventions related to education). How does a nurse evaluate the success
in his/her interventions?
3. Now go into your study notes, textbook, and documents linked throughout this guide and fill
in (with a different coloured pen) all of the content that you missed. Think about what you
missed and why it is important.
4. Take a look at the concepts listed on your map. Can you explain the relationships between
them? It is helpful to take your completed concept map to a study group and have the group
members test each other about the different connections within the document.
II. Study Mapping as a study strategy (for new content).
This study guide also provides “study maps” for common pathologies noted in the NCLEX-RN®
2013-2016 Test Plan and other NCLEX-RN® preparation/review resources. You can use these
maps in the same way that you content map. Use the content and study mapping structure
outlined on the previous page to complete your study maps. In this guide you will note that
some study maps have been made for you. This is to lessen your time organizing information
and to provide you an opportunity to use the maps to explore content in more detail. For
example, look at the study maps and make notes related to any of the terminology, treatment
or medications that you are unfamiliar with on the map itself. You can also use these maps
alongside any practice questions covering the topic on the map. Use the back of the map to
take additional notes. A detailed description of how to use this strategy is presented in Chapter
8 of this study guide.
III. Building Case Studies (to help integrate, apply and remember content)
Case studies can be used to increase your memory retention and recall while taking the exam. It
is helpful to create your own case studies for concepts that you may be struggling with or
having difficulty remembering. Here are the main components of building a case study for
studying purposes:
 Build your own case study from your notes or a study map
 Use a client name of someone who is close to you or relates to the disease condition
 Build in key concepts or information that may difficult to remember
 Make the story memorable and as short as possible
Here is an example of a case study focused on neuroleptic malignant syndrome:
Ned Neuroleptic, 23 years old, has been taking Haldol for the past two weeks to treat his
symptoms of schizophrenia. He was initially concerned about taking Haldol due to his longstanding history of taking lithium for his bipolar disorder.
Ned has had recurrent mania the past two days and is physically exhausted and dehydrated.
The ambulance brought Ned to the ER with a high fever (41°C), paired with muscle rigidity and
tremors in his hands. Initially, Ned was confused but now he is unresponsive. He has high CPK
levels, low serum ferritin and leukocytosis. The Health Care Provider has stopped his Haldol. Ned
is now intubated and mechanically ventilated, with a cooling blanket, antipyretics and NS IV
boluses to preserve his renal function and keep his urine alkaline. It is expected that with
supportive care he will leave the hospital in 1-2 weeks.
Do you see how risk factors, symptoms and treatment are all linked in the case study? Use
these strategies to help you remember information, you will be surprised what you will
remember when you use a story or case study to help you.
These strategies will help you as you move through the remaining content review sections of
this guide. It is important that you take the time to implement new strategies for your studying
purposes.
Chapter 3: Understanding the Role of the 2013-2016
NCLEX-RN® Test Plan for Organizing your Content
Review
Four Major Client Needs Areas
The content on the NCLEX-RN 2013-2016 Test Plan is organized into four major client needs areas
(NCSBN, 2013a).
1.
2.
3.
4.
Safe and Effective Care Environment
Health Promotion and Maintenance
Psychosocial Integrity
Physiological Integrity
The following table highlights these four areas and the themes/areas of content classified in each area
as listed in the NCSBN Item Writer/Item Reviewer/Nurse Educator Version listed on their website
(www.ncsbn.org). These areas have been listed in this chapter for your reference only. This study
workbook will deal with each of these four client needs areas individually in order to help you
organize your content review. There will also be areas of content in some of the client needs areas
that will require more time and detail than others. These areas are identified in this study guide. For
now please take time to look at the content highlighted in the four client needs areas in order to gain
familiarity with some of the potential topic areas on the 2013-2016 NCLEX-RN Test Plan.
Management of Care
Safety and Infection Control
Related content, but not limited to:













Advanced Directives
Advocacy
Assignment Delegation & Supervision
Case management
Client rights
Collaboration with Interdisciplinary team
Concepts of Management
Confidentiality/Information Security
Continuity of Care
Ethical Practice
Informed Consent
Information Technology










Accident/error/injury prevention
Emergency response plan
Ergonomic principles
Handling hazardous and infectious
materials
Home safety
Reporting of incidents
Security plan
Standard precautions/Transmissionbased precautions/surgical asepsis



Quality Improvement
Referrals




Aging process
Ante/Intra/Postpartum and newborn care
Developmental stages and transitions
Health promotion/disease prevention





Health Screening
High risk behaviours
Lifestyle choices
Self-Care
Techniques of physical assessment









Abuse/Neglect
End of Life Care
Family dynamics
Grief and Loss
Mental health concepts
Religious and Spiritual Influences on Health
Sensory/Perceptual Alterations
Stress management
Support systems








Therapeutic communication
Therapeutic environment
Behavioural interventions
Chemical and other dependencies
Substance abuse disorders
Coping mechanisms
Crisis intervention
Cultural Awareness/Cultural Influences
on Health
Reduction of Risk Potential




Basic Care and Comfort







Assistive devices
Elimination
Mobility/Immobility
Non-pharmacological comfort interventions
Nutrition and oral hygiene
Personal hygiene
Rest and sleep




Pharmacological and Parenteral Therapies









Adverse effects/contraindications/side
effects/interactions
Blood and Blood Products
Central Venous Access Devices
Dosage Calculation
Expected Action/Outcomes
Medication Administration
Parenteral/Intravenous Therapies
Pharmacological Pain Management
TPN
Changes/abnormalities in vital signs
Diagnostic tests
Laboratory values
Potential for alterations in body
systems
Potential for complications of
diagnostic tests/treatments/procedures
Potential for complications form
surgical procedures and health
alterations
System specific assessments
Therapeutic procedures
Physiological Adaptation







Alterations in body systems
Fluid and electrolyte imbalances
Hemodynamics
Illness management
Medical emergencies
Pathophysiology
Unexpected response to therapies
Integrated Processes on the NCLEX-RN Test Plan
The NCLEX-RN® 2013-2016 test plan identifies four fundamental processes for nursing practice threaded
through the entire exam. These areas are referred to as Integrated Processes and include:
1.
2.
3.
4.
The Nursing Process
Caring
Communication and Documentation
Teaching/Learning
This chapter speaks to these topics and provides strategies for studying and applying this information
within the context of the NCLEX-RN®.
Part 3: Client Needs Areas for Review
The remaining chapters of this study guide are organized according to the Client Needs areas
outlined in the 2013-2016 NCLEX-RN® Test Plan. Information for review on the test plan, which
has been covered in Canadian nursing programs, will be outlined and key resources for
preparation will be identified. The following content will be covered in more detail:
1. Areas of content that are not covered in detail in Canadian nursing programs
2. Anticipated content areas that students may have difficulty with
3. Content that is contingent on your knowledge of American contexts.
For ease of review the content of this guide will be structured according to:
I.
II.
III.
IV.
Figure 3.2 Distribution of Content for the NCLEX-RN® Test Plan
Source: (NCSBN, 2013a)
Chapter 4: Content Review for Safe and Effective Care Management
Client Need Area
The Client Needs area pertaining to Safe and Effective Care Environments are made up from
two major topic areas:
1. Management of Care
2. Safety and Infection Control
In this chapter primary areas for study in each of these two areas will be identified. A topic
review sheet will accompany each topic area, along with links to pertinent resources. While the
worksheets will identify key areas for general review, the focus will rest on aspects of these
topic areas that may be specific to American nursing settings. More specifically, important
pieces of information, differing terms, and clinical decision-making process that may be
different from a Canadian context will be identified. I recommend the following resource to
complement the content review in this section. Just remember that these practice questions do
integrate aspects of the other client needs areas as well.
Hargrove-Huttel, R.A. & Cadenhead-Colgrove, K. (2014).
Prioritization, delegation & management of care for the
NCLEX-RN exam. Philadelphia: F.A. Davis
Topic Worksheets
The following outline below is the structure used in this chapter for review of content related to Safe
and Effective Care Environments. Each Related topic area for review has its own worksheet listing the
following:
Topic for Review
Related Activity Statement from 2011 Practice Analysis:
The most recent activity statement from the 2011 RN Practice Analysis of Newly Licensed Registered
Nurses in the U.S and Member Board Jurisdictions will be identified in this area.
- This information is used to build exam questions. Think about what the major focus is in the
activity statement and use it to guide your studying.
Key Information Transferable between Canadian and American Contexts
This section will include core information or concepts related to the topic presented. These concepts are
foundational and can be transferred between Canadian and American contexts.
Information specific to the American Context
In this section you will find specific information related to American contexts. This information is
different than what you have covered in your Canadian Nursing program. It is important to use this
information when answering practice questions for the 2013-2016 NCLEX-RN Test Plan.
REVIEW QUESTIONS: If appropriate to the content area, review questions will be posed to help guide
you through Related or important information. The answers are not provided to these questions,
instead they are a strategy to help you to probe your understanding. If you already know an answer to a
question or feel confident with the content do not spend time in this section.
STUDY TIPS: Key pieces of information or tips for studying or applying content will be listed in this
section.
STUDY RESOURCES: This section will include a list of resources pertaining to the topic area. These
resources will help you to answer the questions posed above. If a link is broken please use the article
title to access the online pdf or link.
Applying the concept with a practice question:
Some of the sections will have practice questions as appropriate
Content for Review
Part One: Management of Care
The following topics will be covered in this chapter. The first list of topics will be focused on the
Management of Care section. This topic area focuses on providing direct nursing care with the purpose
of enhancing care delivery as well as protecting clients and health care personnel (NCSBN, 2012, p.4).
Some of the topics listed below relate directly to the NCSBN 2013-2016 Test Plan, while others focus on
American-specific topics related to this content area that may challenge Canadian writers. Topics
covered directly in this section include:






Advanced Directives
Advocacy
Delegation
Case Management
Collaboration with Interdisciplinary Team
Confidentiality/Information Security





Ethical Practice
Performance Improvement (Quality
Improvement)
Pattern for reporting narcotic or substance
abuse in nurses
Delegation (NCSBN, 2013a, p.11)
 Assign and supervise care provided by others (e.g. LPN or LVN, assistive personnel, other
RNs)
May also include:
 Identify tasks for delegation based on client needs
 Ensure appropriate education, skills and experience of personnel performing delegated tasks
 Assign and supervise care provided by others (e.g. LPN or LVN, assistive personnel, other
RNs)
 Communicate tasks to be completed and report client concerns immediately
 Organize workload to manage time effectively
 Utilize the 5 rights of delegation
 Evaluate delegated tasks to ensure correct completion of activity
 Evaluate ability of staff members to perform assigned tasks for the position (i.e. job
description, scope of practice, training, experience)
 Evaluate effectiveness of staff member time management skills
According to Duncan (2014) Delegation refers to the “transferring of responsibility for the performance
of an activity or task while retaining accountability for the outcome” (p.134).
Key Information Transferable between Canadian and American Contexts
Both Canadian and American nursing programs cover delegation. However, there appears to be some
differences in aspects of terminology to describe the group of providers being delegated to, as well as
the scope of the actual tasks being delegated by the RN to other nursing roles.
5 Rights of Delegation(Stockert et al., 2010,p.141; NCSBN, 1995)
Right Task
Right
Circumstances
Right Person
Right Direction or
Communication
Right Supervision
Focus on delegating tasks that are repetitive, require little supervision and
relatively non-invasive.
Use your clinical decision making when deciding which tasks to delegate. For
example is the client appropriate, are resources in place and are other
Related factors considered?
The nurse should delegate the right task to the right person (i.e. UAP) to be
performed on the right client.
The RN must provide a clear description of the task, its objective, limits and
expectations should also be given. Communication needs to be ongoing
during the shift (reporting findings and following up on care)
The RN provides monitoring, evaluation, intervention as needed and
feedback to the UCP. The relationship should be one whereas the UAP is
comfortable asking questions and seeking assistance.
Differences in Terminology
Canadian: Unregulated Care Provider (UCP).
 In provinces such as British Columbia UCPs are referred to Home Support/Resident Care
Attendants (HSRCAs). HSRCAs undergo a six month certification program
 In Alberta UCPs are not required to have educational preparation and are referred to as patient
care attendants (PCAs)
American: Unlicensed Assistive Personnel (UAP) or Certified Nursing Assistant (CNA)
The term UAP refers to any unlicensed person, regardless of title who performs tasks delegated by a
nurse. Just as we have differing types of UCP programs in Canada, you will see the terminology shift in
the American context to include CNAs, patient care technicians (PCTs), state tested nursing assistants
(STNA), nursing assistants-registered (NA/Rs) or certified medication aides/assistants (MA-Cs). Expect
the term UAP, as an umbrella term, to refer to all of these classes in the context of the NCLEX-RN 20132016 Test Plan. For example, on the 2010-2015 CRNE Blueprint UCP was used to encompass HSRCAs,
PCAs etc.. The NCLEX-RN will assess your ability to delegate tasks properly utilizing the 5 rights of
delegation. The table below highlights key areas for delegation.
Canadian: Licensed Practical Nurse (LPN) may also be referred to as Registered Practical Nurse (RPN)
American: Licensed Practical Nurse (LPN) may also be referred to as Licensed Vocational Nurse (LVN)
The LPN role is similar between Canada and the US. LPNs complete a practical nursing program and
then are registered/certified by the provincial regulatory body/state board. However, the scope of
practice of LPNs may differ within an American context. It is important to note that some states will
certify LPNs to do IV initiation and in some cases administer IV direct medications. The table provided
below will give you some basic guidelines surrounding delegation to LPNs, however you must always
check back with the five rights of delegation first.
The following link will provide definitions for the following additional nursing roles:
Definitions of Nursing Roles (NCSBN website) https://www.ncsbn.org/2731.htm
Advanced practice registered nurse (APRN)
Certified medication aide/assistant (MA-C)
Information specific to American Context




Common question theme is what skills or tasks are appropriate for a RN to delegate
Each state has its own Nurse Practice Act, which outlines the scope of practice for RNs, LPNs,
UAPs and CNAs.
The skills listed for a LPN, UCP and CNA are different than in Canada. Use the table below for
your studying purposes.
Always take the following into account when delegating (Smith, 2009, p.17):
i.
Client diagnosis (delegate tasks for stable clients)
ii.
Legal limits of delegation (scope of practice of person being delegated to)
iii.
Amount of judgement and experience needed to perform task or skill
iv.
Predictability of outcome or task
v.
Whether the person is capable of performing the task
Summary of Tasks in Various Health Care Roles within a US Context (Smith, 2009)
Nursing Role
Information specific to the role and delegation
Registered Nurse
As determined by the basic premise of the Nursing Practice Act the RN scope of
practice includes:
 Provide direct and indirect client care services
 Perform and deliver basic healthcare services
 Implement testing and prevention procedures
 Observe signs and symptoms of illness
 Administer treatments per physicians order
 Observe treatment reactions and responses
 Administer medications per physicians order
 Observe medication responses and any side effects
 Observe general physical and mental conditions of individual clients
 Provide client and family teaching
 Act as a client advocate when needed
 Document nursing care
 Supervise allied nursing personnel
 Coordinate members of the healthcare team (p.14)
The following tasks are only to be done by a RN, they cannot be delegated to
another health care member (Smith, 2009, p.16).
The RN must always:
Complete initial health assessments
Complete any referral for additional services
Complete pain management activities
Epidural narcotic analgesia only done by RN
Check advance directives in a client chart
Complete discharge teaching plan (please note this is different than completing
discharge teaching from an established plan)
After a RN has delegated a task to another health care member he or she must:
Complete data entry into the client chart
Check to see if care plan objectives are met
Review all data obtained by other health team members
Identify parameters to delegated member as to when the nurse is to be notified
Licensed Practical
Nurse (LPN)
Intravenous parameters vary by state:
Depending on the state LPNs may be able to initiate IVs (with certification), give
IV direct (push) and IV piggyback medications
LPNs may add vitamins or minerals to IVs in most states
LPNs may not initiate client teaching with exception of using standard care plan
LPNs may reinforce client teaching
Unlicensed Assistive
Personnel (UAP)
Certified Nursing
Assistant (CNA)
Duties commonly delegated to UAP by RN:
Take vital signs
Obtain height and weight
Assist a client to bed
Escort a client out of hospital
Bathe and make beds
Daily care activities
Personal hygiene activities
Move and turn clients and reposition
Transfer clients
Assigned to clients requiring infection control precautions
Record drainage from NG tube
Serve a food tray and feed a client
Provide oral care
Obtain specimens that are nonsterile and noninvasive
Monitor specific gravity
Check urine glucose
Administer disposable enema or tap water enema
Apply elastic hosiery
Perform range-of-motion exercises
Initiate CPR or perform Heimlich maneuver (with CPR certification)
Work with a dying client
Give post-mortem care
REVIEW QUESTIONS
1. What are the principles of delegation?
2. Is the nurse responsible for the care he/she delegates?
3. What is the difference between delegation and a nursing assignment?
4. Define the terms reserved acts, restricted activities, and controlled acts to describe
activities the nurse does under his/her scope of practice. Notes these terms are used in
a Canadian context and all refer to the same thing.
5. What is the difference between a nurse (RN), licensed practical nurse (LPN) and an
Unregulated Care Provider (UCP) in regards to: who they are, what they do, educational
preparation, and who they are accountable to?
6. How does the scope of the LPN differ in an American context? Does this change the
basic principles related to delegation? Why or why not?
7. When would a nurse take over patient care from a UCP or LPN?
STUDY TIPS
When approaching test questions always (Duncan, 2014,p.134-135):
1. Assess the knowledge & skills of the delegate
2. Match tasks to delegate skills
3. Communicate clearly and directly to the delegate (instructions, time for completion of
task, make the member feel like part of the team)
4. Listen attentively (ensure delegate is comfortable and competent to do task)
5. Provide feedback (always give feedback regardless of outcome)
Take time to understand the differences in scope of practice for RNs, LPNs, and UCP in an
American context. The majority of questions should focus on the application of the basic
principles, scope of practice, tasks and evaluation.
Remember the RN is responsible for any task he/she delegates!
Thinking through the concept with a practice question:
Example 1: Thinking about an appropriate client
Which of the following clients would be the most appropriate for the nurse to assign to the
unlicensed assistive personal (UAP) on shift?
1.
2.
3.
4.
A client 24 hours post myocardial infarction
A client with end-stage cancer in pain awaiting transfer to hospice
A client with regular post-procedure vital signs
A client with a suspected evolving stroke
Example 2: Thinking about an appropriate task
Which of the following nursing interventions would be the most appropriate for the nurse to
delegate to the Licenced Practical Nurse working with her for the shift?
1.
2.
3.
4.
To complete a referral for the client to physiotherapy
To confirm the presence of advance directives in the client chart
To complete post-operative vital signs on a newly admitted client
To administer an IV antibiotic due at this time
Example 1: Answer 3
Example 2: Answer 4
STUDY RESOURCES
Duncan, S.M. (2014). Nursing leadership, management and collaborative practice. In J.C. RossKerr & M.J. Wood (Eds.), Potter & Perry’s Canadian Fundamentals of Nursing (5th ed.)
(pp.125-139). Toronto: Elsevier: Canada.
National Council of State Boards of Nursing (1995). Delegation: Concepts and decision-making
process. Chicago: IL: Author
National Council of State Boards of Nursing (1997). The five rights of delegation. Chicago, IL:
Author.
*Please note that there are many helpful documents available via Canadian Nursing Colleges on
delegation. However, for the purpose of studying for this specific NCLEX-RN® and the way
delegation is conceptualized in a US context it is recommended that you do not access them to
study at this time.
Stockert, P.A. & Duncan, S.M. (2010). Nursing leadership, management and collaborative
practice. In J.C. Ross-Kerr & M.J. Wood (Eds) Canadian Fundamentals of Nursing (Revised
4th edition). Toronto, ON: Mosby, Elsevier
Part Two: Safety and Infection Control
The second list of topics will be focused in the Safety and Infection Control section. This topic area is
aimed at protecting clients and health care personnel from health and environmental hazards (NCSBN,
2012, p.5). As these are foundational concepts from Canadian Nursing programs with not much
variance between Canadian and American contexts, these sections will be structured differently to help
with your review. Information will be provided to help clarify specific aspects of content, but most of
this section will be structured with review questions, helpful documents and study resources.
The complexity of this section in regards to the NCLEX-RN test plan is on the application of this content.
Strategies for application for some key topic areas will be discussed. However, remember in order to
apply knowledge you must first attain it.
Topic List from NCLEX-RN Test Plan






Accident/Error/Injury Prevention
Emergency Response Plan
Ergonomic Principles
Handling Hazardous and Infectious
Materials
Home safety
Reporting of incident/event/irregular
occurrence/variance



Standard precautions/transmissionbased precautions/surgical asepsis
Chapter 5: Content Review for Health Promotion and Maintenance
Client Need Area
This content area tests the nurse’s ability to provide and direct nursing care of the client in the
context of growth and development principles, prevention and/or early detection of health
problems, physical assessment and strategies to achieve optimal health (NCBSN, 2013).
Canadian programs are strong in health promotion education and risk reduction. However,
there are three major sections in this client need area that I feel repeat writers need to focus
on:
1. Review of growth and development stages/aging process
2. Ante/Intra/Postpartum and Newborn Care
3. Review of health assessment and applying principles of health assessment to the NCLEXRN.
Please refer directly to the Item Writer/Educator 2013-2016 Test Plan (pp.18-21) for extra
content reviewed in this area. Outlined in the table below are other content subjects in this
client need area that require review but are NOT covered in this chapter of the study guide:





Assess and teach clients about health
risks based on family, population,
and/or community characteristics
Assess client’s readiness to learn,
learning preferences and barriers to
learning (see table in Chapter 2
Integrative Processes)
Plan and/or participate in health
education
Provide information about health
promotion and maintenance
recommendations
Perform targeted screening
assessments







Provide information for prevention and
treatment of high risk health
behaviours
Assess client ability to manage care in
home environment and plan care
accordingly
Health promotion/disease prevention
Health screening
High risk behaviours
Lifestyle choices
Self-Care
Aging Process and Developmental Stages (NCSBN, 2013a, p.19)
 Provide care and education for the newborn less than 1 month old through the infant or
toddler client through 2 years
 Provide care and education for the preschool, school age and adolescent client ages 3 to 17
years
 Provide care and education for the adult client ages 18 through 64 years
 Provide care and education for the adult client ages 65 through 85 years and over
May also include:
 Assess client’s reactions to expected age-related changes
It is important to understand the impact of developmental transitions on clients, and to review
developmental age periods and common developmental theories when you are studying for
the exam. Clients may undergo role changes or developmental transitions that could
potentially affect their coping during health and illness. Transitioning between developmental
stages and role changes may actually become a developmental crisis for some clients; some
may be able to advance through the crisis while others may regress as a result of how the crisis
is managed (Baier & Hegadoren, 2010, p.477). For example, a new mother may find it
challenging to adjust to being a parent and could be experiencing a loss of her previous role(s).
A clinical example of a developmental transition could include children living with cystic fibrosis
transitioning from pediatric to adult health clinics. Regardless of the type of developmental
transition a client is experiencing, the role of the nurse is to support the client through these
changes.
In order to choose an appropriate nursing intervention for a client experiencing role change or
a significant developmental transition, you must know what common developmental theories
and developmental age periods are. On this worksheet, I have highlighted Erikson’s theory
because it can be applied to a number of different contexts. Often, most nursing fundamentals
textbooks have charts or tables summarizing Erikson’s Eight Stages of Life. Remember that it is
important that you understand these stages and know how to apply them to different nursing
contexts. Think about some signs of a developmental crisis in clients. Always look for an answer
that best supports the developmental stage of the client. This topic area is also pertinent to
chronic disease management. You may find that exam questions relate not only to role
changes, but also to how illness disrupts role functioning as well.

Growth and Development: Study biological changes, vital signs, gross and fine motor
development, nutrition, sleep, dental, immunizations, safety, play, reactions to illness
and hospitalization and appropriate teaching and learning strategies in the following
areas. I have highlighted in yellow key areas that Canadian-educated graduates often
need more targeted review in (8 key developmental stages):
1.
2.
3.
4.
5.
6.
7.
8.
Infancy: birth to one year of age
Toddler: one to three years of age
Preschool: three to six years of age
School: six to twelve years of age
Adolescence: twelve to eighteen years of age
Young Adulthood
Middle Adulthood
Older Adulthood

Examine the most common safety issues and injury prevention strategies related to
each of the 8 key developmental stages

Development of therapeutic relationships with children and adolescents

Teaching and learning strategies for children according to developmental stage
I recommend that you develop a table highlighting the eight stages and use your Fundamentals
of Nursing textbook to organize it. Then, use this table alongside any practice questions you
come across that address developmental stages. It is helpful to gain experiencing not only
accumulating but in applying this information.
EXERCISE
Erikson’s
Stage
Normal
Vital Sign
Ranges
Immunizations/ Appropriate
Examples of
Vaccinations
Teaching/Learning Appropriate
Strategies
Nursing
Interventions
Birth to 1
year
1-3 years
3-6 years
6-12 years
12-18 years
Young
Adulthood
Middle
Adulthood
Older
Adulthood
This next section focuses specifically on content related to Child Health.
Sources for Studying: Use the Child Health textbook selected for your nursing program, the
study checklist and the documents linked below. Important areas for study have been
highlighted in red.
There are no specific competencies that relate only to child health. However, themes such as
health promotion, illness prevention, immunizations, safety, developmental stages,
developmental transitions, responding to rapidly changing health situations, nutrition, etc., can
all be applied to pediatric populations. There will be differences in assessment criteria for
children, nursing interventions and teaching/learning strategies will be geared towards the
child’s developmental stage, and family-centered care (although it is significant to all areas of
nursing) will also become an area of focus for the nurse. The following study table highlights
some of these key areas.
Child Health Content Study Checklist:
Content for Review in this subject area:
Basic Concepts for Review:
 Family influences on child health: Family structure, Family Function, Parenting

Explore diversity, potential biases, and culturally competent care related to family
composition (nuclear, blended, extended, single-parent, binuclear, gay & lesbian),
adoption (local and international) foster families, as well as other configurations and
considerations

Describe how to complete a family assessment (ecomaps and genograms as tools for
assessment)

Family centered care principles

Discuss major childhood developmental theories including: psychosexual (Freud),
Erikson (psychosocial), cognitive (Piaget), moral (Kohlberg), and resiliency

Describe family development theory and stages

Explore children’s rights within the healthcare system including assent and consent, and
confidentiality

Examine local and provincial resources related to health
Applied Concepts for Review and Concepts you may be asked to Think Critically with:

Major theories of Childhood development

Growth and Development: Study biological changes, vital signs, gross and fine motor
development, nutrition, sleep, dental, immunizations, safety, play, reactions to illness
and hospitalization and appropriate teaching and learning strategies in the following
areas (5 key developmental stages):
9. Infancy: birth to one year of age
10. Toddler: one to three years of age
11. Preschool: three to six years of age
12. School: six to twelve years of age
13. Adolescence: twelve to eighteen years of age

Examine the most common safety issues and injury prevention strategies related to
each of the 5 key developmental stages

Development of therapeutic relationships with children and adolescents

Teaching and learning strategies for children according to developmental stage

Pediatric and Adolescent pain management: physiological measures of pediatric pain,
developmental characteristics of children’s responses to pain, pain assessment tools,
nonpharmacological strategies for pain management in children, pharmacological
strategies for pain management in children

Role of determinants of health in children and their families

Discuss safety related to environment including home, school, hospital, rural and urban
settings

Explore management of childhood emergency scenarios, including underlying issues
related to fluid & electrolytes

Discuss children’s emerging role as partners in self-care

Explore advocacy and capacity building with children

Explore unique features and determinants of health related to children cared for at local
clinical placements including acute care, school health and other healthcare programs
Common Pediatric Pathologies (Therapeutics and Nursing considerations should be included;
use the nursing care plan to organize each pathology, the pathologies highlighted in red are
important areas for study) It is helpful to make study maps for any conditions you do not
know or need further review in:
 Pediculosis capitis (lice)
 Dermatitis
 Burns
 Communicable diseases of childhood: measles, varicella, pertussis, rubella, mumps
 Fluid and Electrolyte Imbalances
 Dehydration
 Fever
 Febrile Seizures
 Diarrhea
 Sepsis
 Meningitis
 Psychosocial and mental health changes: child maltreatment, suicide, ADHD, school
phobia, autistic spectrum disorders, anorexia nervosa
 Developmental stages and reactions to end of life
 SIDS
 Ear dysfunction
 Respiratory dysfunction: upper respiratory infection, pneumonia, atypical pneumonia,
asthma, RSV, bronchiolitis, laryngotracheobronchitis, epiglottitis, cystic fibrosis
 Childhood obesity
 Gastrointestinal system disorders: cleft lip and palate conditions, gastroesophageal






reflux, hypertrophic pyloric stenosis, intussusceptions, appendicitis, constipation and
encopresis, hirschsprung’s disease, celiac, hernias and hydroceles
Cardiac system disorders- congenital heart defect, acyanotic cardiac conditions, cyanotic
cardiac conditions, congestive heart failure
Hematological and Immunological System disorders: iron deficiency anemia, sickle cell
anemia, thalassemia, hemophilia, ITP, HIV and AIDS, cancer, leukemia (ALL), brain
tumours
Endocrine system disorders: diabetes mellitus, new emergence of type 2 diabetes
mellitus in children
Renal system dysfunction: UTI, vesicoureteral reflux, nephritic syndrome, acute
glomerulonephritis, enuresis, etc.
Musculoskeletal and neuromuscular dysfunction: developmental dysplasia of the hip,
Cerebral Palsy, duchenne muscular dystrophy, scoliosis, osteomyelitis
Neurological Cognitive Dysfunction: increased ICP, seizure disorders, neural tube
defects, hydrocephalus, head injury, intellectual disability
ADDITIONAL STUDY RESOURCES
Canadian Nurses Association (October, 2005). Children’s health and nursing: A summary of the
issues. Ottawa: Author. Retrieved from http://www2.cnaaiic.ca/CNA/documents/pdf/publications/BG2_Childrens_Health_and_Nursing_e.pdf
Registered Nurses Association of Ontario (2010). Enhancing healthy adolescent development: A
summary of recommendations. Author: Toronto. Retrieved from
http://rnao.ca/bpg/guidelines/enhancing-healthy-adolescent-development
Registered Nurses’ Association of Ontario (2004). Promoting asthma control in children: A
summary of recommendations. Toronto: Author. Retrieved from
http://rnao.ca/bpg/guidelines/promoting-asthma-control-children
Registered Nurses’ Association of Ontario (2005). Primary prevention of childhood obesity.
Toronto: Author. Retrieved from http://rnao.ca/bpg/guidelines/primary-preventionchildhood-obesity
Registered Nurses’ Association of Ontario (2012). Safe sleep practices for infants. Toronto:
Author. Retrieved from http://rnao.ca/bpg/guidelines/safe-sleep-practices-infants
Ante/Intra/Postpartum and Newborn Care (NCSBN, 2013a, p.19)
 Provide prenatal education
 Provide care to client in labor
 Provide post-partum care and education
May also include:
 Assess client’s psychosocial response to pregnancy (e.g. support systems, perception of
pregnancy, coping mechanisms)
 Assess client for symptoms of postpartum complications (e.g. hemorrhage, infection)
 Recognize cultural differences in childbearing practices
 Calculate expected delivery date
 Check fetal heart rate during routine prenatal exams
 Assist client with performing/learning newborn care (e.g. feeding)
 Provide discharge instructions (e.g. post-partum and newborn care)
 Evaluate client’s ability to care for the newborn
 Identify signs of potential prenatal complications
This content area has the most potential to challenge Canadian-educated candidates on the
exam. Depending on your nursing program, you may or may not have had a course or focused
practice time in maternal/child settings. Canadian-educated graduates tend to be stronger on
concepts such as prenatal education and post-partum care in community settings. A significant
content gap exists in care of the client in labour and ante/intrapartum complications. For this
area of review I have proposed a different approach for your studying. Below you will see a
table with content areas listed on it. I have aligned these areas using the activity statements
listed above. One of the challenges of learning or reviewing content that is not as familiar to
you is developing the ability to move towards critically thinking with the content. It is helpful to
have a strategy for preparation where you can see the difference between a knowledge,
application and critical thinking question. Use the questions posed below to guide your study
notes for this section. If you do not have a specific maternal-newborn textbook, you may also
find this information in your NCLEX-RN® review guides.
Care of the Intra and Post-Partum Client
Knowledge
Identify ways to calculate
expected delivery date (EDD)
Application
Prenatal Care
Create two scenarios based on
two differing methods of EDD
What are some psychosocial
responses to pregnancy?
Outline an assessment for a
client based on these responses
Outline a normal fetal heart rate
during pregnancy
Describe how to conduct a fetal
heart rate during a prenatal
exam
Describe the importance of
prenatal vitamins and folic acid
Identify key nutrients, vitamins
or supplements required by
pregnant women
Define gestational diabetes
Define common pregnancyrelated complications:
premature rupture of
membranes, prolapsed umbilical
cord, supine
hypotension,abruption
placentae, placenta previa,
gestational hypertension, preeclampsia, eclampsia, HELLP
(study mapping is a useful tool
for this information)
Define Rh Incompatibility
Outline the diagnosis tests for
this condition
Explain to the mother what
gestational diabetes is
Outline symptoms of each of
these types of complications
Explain why Rh –ve mothers with
Rh +ve mothers need to be
monitored
Care of the Client in Labor
Identify the premonitory signs of Explain what each of these signs
labor
would indicate
Define true labor
Outline the characteristics of
Define false labor
true vs. false labor
Critical Thinking
A mother is unsure of when her
last menstrual period was or
when the baby was conceived.
How else can EDD be calculated?
What are some strategies to
support a mother who has
limited support systems or
coping strategies?
Outline the client teaching for a
mother whose fetus has a high
heart rate or a low heart rate
Create a meal plan for a
pregnant woman in order to
meet her required nutritional
needs
Describe which types of antihyperglycemic medications a
mother can take and outline if
insulin therapy is indicated in
this condition
Using the nursing process as a
guide- study map each of these
possible complications and
outline the treatment for them
Describe why a mother who
receives WinRho must not be
previously “sensitized”
Teach a client to recognize these
signs
Differentiate between true and
false labor in a client
Outline the four stages of labor
Explain what happens in each
stage of labor
Name the 5 P’s: Critical Factors
Affecting Labor
Explain which each of the 5 P’s
refers to: refer to the slides for
the areas of focus for each of the
5 P’s
What measurements are used to
determine dilation and
effacement?
What would the nurse do for a
low fetal heart rate?
What would the nurse do for a
high fetal heart rate?
Define cervical dilation
Define cervical effacement
Identify the normal ranges for
fetal heart rate during pregnancy
and labor
Define complications that may
occur during labor: preterm
labor, dystocia, amniotic fluid
embolism, fetal distress,
intrauterine fetal demise,
rupture of the uterus, uterine
inversion
occur during the postpartum
period: infection, bleeding
postpartum blues, postpartum
depression, postpartum
psychosis
Outline the components of a
post-partum assessment for a
mother
What are expected discharge
instructions for post-partum
care?
Outline the focus of assessment
for the newborn at birth
Identify the role of vitamin K in
the body
Define the causes of Jaundice
(hyperbilirubinemia) in
Postpartum Period
Describe the importance of
measuring fundal height and
other complications the nurse
should monitor for
Outline critical assessments or
findings that should be reported
immediately if the mother
experiences them
Newborn Assessment
Identify why APGAR scoring is
used
Outline the normal ranges for
vital signs
Explain to a new mother why a
vitamin K injection is necessary
for the infant
Evaluation is indicated when
serum levels are greater than
Outline specific nursing
interventions Related to each
stage of labor
Include Related assessments for
each of the 5 P’s of labor
How do these measurements
define the first and second stage
of labor?
Review deceleration patterns
and be able to define: early
decelerations, late decelerations,
variable decelerations
What are critical findings in postpartum assessment that should
be acted on immediately?
Construct a discharge plan for a
post-partum mother
Complete an APGAR score on a
new baby (you do not need to
memorize the table- but
understand how to apply it)
Outline the dose and method of
administration for vitamin K
Outline a care plan for an infant
experiencing jaundice.
newborns
12mg/dL in a term newbornwhat would be some other
significant assessment findings?
Identify abnormal assessment
findings
Outline the components of a
newborn assessment
What are expected discharge
instructions for the newborn?
occur in the newborn:
respiratory distress syndrome,
meconium aspiration syndrome,
transient tachypnea of the
newborn, erythroblastosis
fetalis, sepsis, TORCH infections,
fetal alcohol syndrome, newborn
of mother with HIV,
hypoglycemia
Outline the most important
areas to cover
How would you know if they
were at risk for complications?
Link abnormal findings to
potential conditions influencing
newborn health
Construct a discharge plan for a
newborn
The following section outlines the general nursing management of the client in labor and is intended to
help you focus on specific interventions and care in your notes, rather than on a general summary of the
content. Use this table to help you grow your notes and list more detailed information.
Nursing
Management During
1st Stage of Labour
(pp.400-401; 432438)
•
•
•
•
•
•
Prenatal history
Vital signs
Temperature
Fetal Heart Rate
Vaginal examination
Behaviour/psychological
Nursing
Management During
2nd Stage of Labour
(p.401-403;438-442)
•
•
•
•
•
•
•
Vital signs q 5-15 min
Fetal heart rate
Contractions
Comfort care (pain relief)
Re-positioning
Setting up delivery instruments
Helping with bearing down and
pushing
Crowning
•
•
•
•
•
•
•
•
•
Birth
•
•
•
•
Encouraging partner
participation
Providing clear fluids
Comfort measures
Breathing techniques
Change bed linens
Keeping perineum dry
Bladder status
Report deviations from
normal (p.437-438).
Baby born, suction mouth
then nares with bulb syringe
Double clamp umbilical cord
and cut between
Receiving newborn,
transporting them to warm
environment
Providing initial care and
•
•
•
Nursing
Management During
3rd Stage of Labour
(p. 403-404; 444445)
•
Nursing
Management During
the 4th Stage of
Labour (p. 404;445446)
•
•
•
•
•
•
•
Assess amniotic fluid for colour
Perineal lacerations
Assist with episiotomy (if
required)
Skin to skin contact with mom
and baby
Monitor placental separation
Assess for perineal trauma
Instruct mom to push when
placental separation is apparent
After placenta is expelled and
last up to 4 hours after birth
Close observation for
hemorrhage
Comfort measures
Promotion of family attachment
assessment of the newborn
•
•
•
•
Assess vaginal bleeding
Vital signs q15 min
Assess uterine fundus
Record birthing statistics
•
-
Assessment includes:
Lochia amount
Bladder status
Vital signs
Temperature
Fundal height
Perineum (swelling)
Reference: Chow, J., Ateah, C.A., Scott, S.D., Scott Ricci, S. & Kyle, T. (2013). Canadian maternity and
pediatric nursing. Toronto: Lippincott Williams & Williams.
EXERCISE
Medications Administered During Labor (Hogan, 2012, p.123, 837,838).
Medication
Nursing Assessment/Implications (identify routes of administration and
any critical side effects or assessments required with the drug therapy)
Pain Management during Labor
Intravenous Opioids
Intraethecal Opioids
Lumbar Epidural Block
Paracervical Block
Pundendal Block
Local Tissue Infiltration
Induction of Labor
Oxytocin (Pitocin)
Misoprostol (Cytotec)
Prostaglandin gel (PGE2)
Pre-Term Labor (tocolytics- to stop contractions)
Ritodrine (Yutopar)
Terbutaline (Brethine)
Magnesium sulfate
In the Event of PostPartum Hemorrhage
Oxytocin (Pitocin)
Methylergonovine
maleate (Methergine)
Ergonovine maleate
(ergotrate)
Prostaglandin (Hemabate)
Post-partum Infections
The type of anti-infective
used will depend on the
organism causing the
infection. See the
Antibiotic Study Map
posted on the website.
Reproductive tract infections (i.e. metritis, parametrial cellulitis,
peritonitis, septic pelvic thrombophlebitis, bacteremia and septic shock),
wound infections, breast infections, urinary tract infections
The following link identifies common antibiotics that can be given during
breastfeeding. However, if a mother’s infection requires an antibiotic that
may harm the baby through breastfeeding she may need to stop.
http://www.drugs.com/drug-safety-breastfeeding.html
STUDY RESOURCES
Registered Nurses’ Association of Ontario (2003). Breastfeeding best practice guideline for
nurses. Author: Toronto. Retrieved fromhttp://rnao.ca/bpg/guidelines/breastfeedingbest-practice-guidelines-nurses
Registered Nurses’ Association of Ontario (March, 2004). Breastfeeding—The best start: Health
education fact sheet. Author: Toronto. Retrieved from http://rnao.ca/bpg/factsheets/breastfeeding-best-start
Registered Nurses’ of Ontario (2005). Interventions for postpartum depression. Author: Toronto.
Retrieved from http://rnao.ca/bpg/guidelines/interventions-postpartum-depression
EXERCISE:
Meghan Hann, 38 years old, has been admitted to the maternity unit at a rural hospital. Her
physician suspects that Meghan may be at risk for severe Pre-Eclampsia. Refer to the following
chart information for Meghan in order to answer the following questions:
Admission History
38 yo primapara admitted
with increasing hypertension.
Gestational period is 38
weeks.
Healthy prior to admission, no
co-morbid conditions
Admission weight: 55 kg
Physician Orders
Vital signs q 1 h
Send urinalysis
Insert Foley Catheter
Fetal Heart Rate Monitoring
Place client on bedrest
Assessment Findings
BP 160/112 mmHg
RR 20 breaths/min
HR 100 btts/min
SaO2 92% on Room Air
Temp 36.7 degrees Celsius
Weight: 61 kg
Lungs clear on auscultation
S1 and S2 noted, no murmurs, no rubs
Alert and orientated, complains about feeling
“anxious”
FHR- 145 btts/min, no distress noted
Lab Test (Serum Blood
Test)
Client
result
Reference Range Normal Values
SI Units
Creatinine
Urea nitrogen (BUN)
Sodium
Potassium
Chloride
Calcium
Magnesium
Platelets
Hemoglobin
123
7.1
135
3.5
100
2.30
0.82
130
117
62-124 unit mol/L
3.6-7.2 mmol/L
135-145 mmol/L
3.5-5 mmol/L
97-107 mmol/L
2.15-2.55 mmol/L
0.62-0.95 mmol/L
181-521 X 10(9)L
132-173 mmol/L (Males)
117-155 mmol/L (Females)
AST (Liver Enzyme)
46
0-35U/L
Bilirubin
2.3
0.3-1.0 mg/dL
Urinalyisis
(24 hr urine collection)
Urine Protein
Urine Ph
Glucose
Completed
6g
7
No traces
More than 5 g in 24 hrs considered high
5.0-9.0
Based on the information provided above and your knowledge of pre-eclampia, outline the
three most significant pieces of information provided in the chart data above and provide
rationale for your choices.
Chapter 6: Psychosocial Integrity
This client needs area focuses on the provision and direct nursing care promoting emotional,
mental and social well-being of the client experiencing stressful events, as well as clients with
acute or chronic mental illness (NCSBN, 2013, p.22). I will only target a few key areas in this
section and will refer you to the Item Writer/Reviewer 2013-2016 Test Plan to cover the
following topic areas not directly addressed in this section but on the test plan (p.22-26).





Behaviour interventions (p.23)
Coping mechanisms (p.23)
Cultural Awareness/Cultural Influences on Health (p.24)
Stress management (p.25)
Support systems (p.25)
The remaining section focuses directly on the remaining topic areas in the Psychosocial
Integrity client needs area in the NCLEX-RN® Test Plan.
Abuse/Neglect (NCSBN, 2013a, p.22)
 Assessing for Abuse or neglect and intervenes as appropriate
May also include:
 Identify risk factors for domestic, child, elder abuse/neglect and sexual abuse
 Plan interventions for victims/suspected victims of abuse
 Counsel victims/suspected victims of abuse and their families on coping strategies
 Provide a safe environment for the abused/neglected client
 Evaluate client response to interventions
There are different situations of abuse that could be tested on the NCLEX-RN®. To begin with,
this might involve the nurse being able to recognize and take action in situations of potential or
actual abuse of the client. This could occur from domestic violence or elder abuse from the
family or significant others, as well as potential abuse of the client from other health-care
professionals. The nurse must also take action to protect her/himself and colleagues from
abusive clients or other abusive situations. The CNA identifies situations such as aggression,
bullying, and workplace incivility as potential sources of abuse and encourages the new
graduate to reflect on non-abuse policies (CNA, 2010).
American Specific Contexts in Reporting Abuse (Child Welfare Information Gateway, 2014):





Reporting of abuse needs to occur in the state in which the abuse occurred
Nurses are mandated reporters (have to report suspected abuse)
Reports are made when the reporter suspects or has reason to believe that a child has
been abused or neglected
Privileged communication between client and nurse is restricted in this case- the nurse
can break confidentiality
Identity of the person reporting the abuse is protected
REVIEW QUESTIONS
The following review questions were designed to help direct your studying towards central
concepts related to abuse. You will find the answers to these questions in your nursing
fundamentals textbook, as well as in the “Study Resources” linked on this worksheet. Start by
printing off the documents under the additional resources section and highlight the key
information in them. Many of the review questions below focus on the content in these
important documents. You may also access your nursing fundamentals textbook for any
answers that are not addressed in the linked documents.
Abuse of Vulnerable Populations
(Domestic, Elder, Physical, Sexual, Substance abuse)
1. What is one of the most important things for the nurse to provide a client who has
experienced or is experiencing abuse?
2. What are nursing priorities when interviewing a client who has been potentially abused?
3. What resources could a nurse provide to a client who is not willing to speak to the nurse
about their abuse?
4. List potential physical and behavioural findings indicative of domestic abuse.
5. List potential physical and behavioural findings indicative of elder abuse. Explain the
different types of elder abuse.
6. List potential physical and behavioural findings indicative of sexual abuse
7. What are some red flags for possible substance abuse?
8. What are the Registered Nurses’ Association of Ontario (RNAO) best practice guidelines
surrounding abuse in women? (Hint: these guidelines will help you to prioritize nursing
interventions related to abuse and are linked below in the study resources section).
9. What are the parameters for universal and routine screening for abuse in women
according to the RNAO?
10. What skills should nurses practice in order to facilitate an environment of disclosure?
11. Why is it important that nurses develop abuse screening that takes individual
differences into account, based on race, ethnicity, class, religious/spiritual beliefs, age,
ability or sexual orientation?
12. How do nurses use the process of reflective practice and/or values clarification to
examine how their own beliefs, values and experiences influence the practice of
screening?
13. What should nurses document when screening for and responding to abuse?
14. What are the nurse’s legal obligations when a disclosure of abuse is made?
STUDY TIPS
You may find that your nursing fundamentals textbook only contains a brief
description of this issue, but start by reading your nursing fundamentals textbook
(find the term abuse in the index) to refresh your memory of this content before moving
on to the articles on this worksheet. You will find that you will require an understanding of the
content described in the Study Resources linked below in order to answer the review questions.
Best practice guidelines are a great place to start. Linked on this worksheet is a summary of
Women Abuse: Screening, Identification, and Initial Response Best Practice Guideline. Any time
a Summary of Best Practice Guidelines/Recommendations is presented in this study guide, it is
to be used as a way to organize your nursing priorities. Think of the summary recommendations
as the Related focal points of and steps in dealing with a clinical practice issue.
Chapter 7: Physiological Integrity
The client need area of Physiological Integrity has four major areas for content review:
I.
Basic Care and Comfort: Whereas the nurse provides comfort and assistance in the
performance of activities of daily living (NCSBN, 2013, p.27).
II.
Pharmacological & Parental Therapies: Nursing care of medication administration,
pharmacological concepts and parental therapy (NCSBN, 2013, p.31).
III.
Reduction of Risk Potential: Nursing care is focused on reducing the likelihood of
complications or health problems related to existing conditions, treatments or
procedures (NCSBN, 2013, p.35).
IV.
Physiological Adaptation: The nurse manages and provides care for clients with acute,
chronic or life threatening physical health conditions.
This chapter will address each of these areas in turn, using the activity statements from the
2013-2016 NCLEX-RN® Test Plan.
Section One: Basic Care and Comfort
The majority of this content will be familiar to you and you should not have to review it in great
detail. There are some sections in this client need area that I think need some explanation and
links to resources. I would recommend that you use your practice question resources alongside
this content review area to help you probe the content in more depth.
Assistive Devices (NCSBN, 2013a, p.27)
 Assist client to compensate for a physical or sensory impairment (e.g. assistive devices,
positioning, compensatory techniques)
May also include:
 Assess the client for actual/potential difficulty with communication and speech/vision/hearing
problems
 Assess the client’s use of assistive devices or prostheses (e.g. eating utensils,
telecommunication devices, dentures)
 Evaluate the correct use of assistive devices by client
Start by reviewing the mobility/immobility chapter in your fundamentals of nursing textbook.
Areas of focus will most likely be crutch walking, prosthesis, canes, and walkers when looking at
mobility devices. Review the charts and diagrams on the different forms of crutch walking. In
regards to sensory devices, review the care of hearing aids and other telecommunication
devices. Remember that sensory impairment can increase risks for confusion and sensory
overload. Evaluation of assistive devices is based on signs and symptoms of improved mobility
status or successful use of sensory devices, it is important to assess the client’s perception of
mobility status and if the client’s expectations are being met.
REVIEW QUESTIONS
1. Identify two types of crutches.
2. How does the nurse measure for crutches.
3. Explain to the client the difference between a two-point gait, a three-point gait and
swing through gait.
4. Explain to your client how to climb stairs with crutches and how to sit in a chair with
crutches
5. Which side of the body should the cane be kept on? (stronger or weaker side?)
6. What are the three steps used with a straight-legged and quad cane?
7. Explain how the care and use of hearing aids (typically in the hygiene chapter of your
Nursing Fundamentals text).
8. Explain how to put in and remove dentures. What type of care and assessment is
involved?
9. Review the common bed positions (Fowler’s, Semi-Fowler’s, Trendelenburg’s, Reverse
Trendelenburg’s, Flat).
STUDY TIPS
The majority of interventions with assistive devices occur in clients who have had a
cerebral vascular accident (CVA). Therefore, it is important to review common stroke deficits.
The chart below will help you to work through this content. Complete the exercise below to
help you with this content. The following resource outlines tips for living with stroke and its
associated deficits.
Heart and Stroke Foundation Resources:
http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.8485305/k.6AAA/Living_With_Strok
e_Tips.htm#communication-tab
EXERCISE
Complete the following table outlining the potential assistive devices used with a client who has
a completed CVA.
Deficit
Hemiparesis
Assistive Devices and Nursing Interventions Used
Hemiplegia
Dysarthria
Dysphagia
Homonymous
Hemianopsia
STUDY RESOURCES
Gill, D. & Tritak, A.B. (2014). Mobility and Immobility. In J.C. Ross-Kerr, M.J. Wood, B.J. Astle, &
W. Duggleby Canadian Fundamentals of Nursing (5th ed)(pp-1195-1249). Toronto: Elsevier.
Registered Nurses’ Association of Ontario (2005). Stroke assessment across the continuum of
care. Toronto: Author. Retrieved from http://rnao.ca/bpg/guidelines/strokeassessment-across-continuum-care
Section Two: Pharmacological and Parenteral Therapies
On the website under the tab “Study Maps” you will find a collection of Drug Maps. These
maps are organized per body system and other prominent themes (i.e. antibiotics). These maps
will provide you with a head start in organizing your information regarding medications. The
maps cover:
1.
2.
3.
4.
5.
6.
7.
Respiratory drugs
Cardiovascular drugs
Renal drugs
Hepatic drugs
Neurological drugs
Antibiotics
Pain medication
Your focus, then, after reviewing each drug map should be on extending your knowledge and
addressing the critical thinking questions appended to each map. Once you have completed
the maps, move to the study maps outlining various disease processes. These maps will list
common drug classes used to treat specific pathologies. If there are any drugs on these maps
that you are not familiar with, ensure you take time to study them in detail paying close
attention to the nursing assessments and interventions required for each drug. The NCLEX-RN®
will test your knowledge on medication administration in detail so it is important that you are
strong on your knowledge of pharmacology.
The remainder of this section will directly address the other activity statements in the
Pharmacological and Parental Therapies section in the NCLEX-RN® test plan.
Medication Administration (NCSBN, 2013a, p.32-33)
Related Activity Statements from 2011 Practice Analysis:
 Educate the client about medications
 Prepare and administer medications, using rights of medication administration
 Participate in medication reconciliation process
 Evaluate appropriateness and accuracy of medication order for the client
 Titrate dosage of medication based on assessment and ordered parameters (e.g. giving insulin
according to blood glucose levels, titrating medication to maintain a specific blood pressure)
May also include:
 Educate client on medication self-administration procedures
 Review pertinent data prior to medication administration (e.g. contraindications, lab results,
allergies, potential interactions)
 Mix medications from two vials when necessary (e.g. insulin)
 Administer and document medications given by common routes (e.g. oral, topical)
 Administer and document medications given by parenteral routes (e.g. intravenous,
intramuscular, subcutaneous)
 Dispose of unused medications according to facility/agency policy
REVIEW QUESTIONS
1. Outline the rights of medication administration. Remember that these rights will be applied
in an exam context, so think about how each applies to client care.
2. Review medication administration for all routes: PO, IM, SC, ID, IV, intathecal or epidural,
etc…
3. Review how to mix and administer insulin
4. Think about the key aspects of insulin self-administration for clients and develop a teaching
plan.
5. What is medication reconciliation? What is the role of the nurse in this process?
EXERCISE
Titrating Dosages of Medication Based on Assessment and Ordered Parameters.
The following case study has been created to help you apply some of the concepts identified in
the activity statements above. In this case a 67 year old married male, has been admitted to the
Emergency Department after a weeklong stomach flu. He is severely dehydrated and has a
complex medical history. As a result of his flu he was unable to take his regular medications; as a
result of not taking his diabetes medications pair with dehydration it has been found that he is
in a Hyperosmolar Hyperglycemic State. Read over the client chart and answer the questions
below.
Admission History
67 yo male admitted for
Hyperosmolar Hyperglycemic
State to Emergency
Department this morning.
Five day period of stomach flu
leading to dehydration.
Medication not taken for 3
days.
Assessment Findings
BP 80/50 mmHg
RR 24breaths/min
HR 130 btts/min
SaO2 90% on Room Air
Temp 36.3 degrees Celsius
Lungs clear on auscultation
S1, S2, S3 noted
Disorientated to place and time
Hx: COPD, Type 2 Diabetes,
CAD, MI 3 years ago (with
angioplasty to LCA and stent
insertion)
Admission weight: 90 kg
Physician Orders
Ramipril 5 mg po bid
Metoprolol 25 mg po daily
Atvorastatin 40 mg po daily
Salbutamol puffer (pts. Own
supply- q 2-4 hrs and prn)
Metformin 500mg po bid
ASA 81 mg po daily
Normal Saline at 125 cc/hr
Fluid bolus with Normal Saline
(1 L) if MAP less than 60
mmHg
Insulin infusion IV- use
hospital protocol
Lab Test (Serum Blood
Test)
Client
result
Reference Range Normal Values
SI Units
Creatinine
Urea nitrogen (BUN)
Sodium
Potassium
Chloride
Calcium
Magnesium
Platelets
Hemoglobin
140
8.0
132
2.5
100
2.15
0.83
120
150
62-124 unit mol/L
3.6-7.2 mmol/L
135-145 mmol/L
3.5-5 mmol/L
97-107 mmol/L
2.15-2.55 mmol/L
0.62-0.95 mmol/L
181-521 X 10(9)L
132-173 mmol/L (Males)
117-155 mmol/L (Females)
Urine ketones
negative
Serum Osmolarity
320
285-295 mOsm/kg
Random Glucose
(on admission)
61
4-6 mmol/L
The following link highlights the care of a client in a hyperglycemic hyperosmolar state
Medscape: http://emedicine.medscape.com/article/1914705-overview
Case Study Questions
1.
2.
Based on the client’s vital signs are there any drugs that you would put on hold at this
time?
The client is started on an IV insulin nomogram. See the health care provider orders
above and explain how to mix, hang and what rate to start the infusion at. Refer to the
following nomogram: www.cdha.nshealth.ca/system/.../insulin-infusion-intensive-careunit.pdf
3.
4.
5.
The next blood glucose level is due and it is 17mmol/L. Titrate the infusion.
What are some factors influencing the client’s blood pressure at this time?
What are your priorities for medication administration based on this case?
STUDY TIPS
It is helpful to review the Teaching and Learning section in Chapter 2 of this study guide. The
information in this section is very straightforward. Remember that certain drugs require you to
research lab values (i.e. coagulation studies, renal or hepatic function, blood levels of the drug
etc...). There are many potential interactions with drugs. It is almost impossible to study them
all. Think about common drugs and potentially fatal drug-to-drug interactions. As you work
through your pharmacology textbook or drug guide write down any that you find and create a
table for review.
STUDY RESOURCES
CRNBC Dispensing Medications:
https://www.crnbc.ca/Standards/PracticeStandards/Pages/dispensing.aspx
CRNBC (October, 2014). Dispensing medications decision tree. Vancouver: CRNBC. Retrieved
from https://www.crnbc.ca/Standards/PracticeStandards/Pages/dispensing.aspx
Kaasalainen, S. & Hall, A.M. (2014). Medication administration. In J.C. Ross-Kerr, M.J. Wood, B.J.
Astle, & W. Duggleby Canadian Fundamentals of Nursing (5th ed)(pp. 662-750). Toronto:
Elsevier.
Registered Nurses’ Association of Ontario (2004). BPG for subcutaneous administration of
insulin in adults with type 2 diabetes. Author: Toronto. Retrieved from
http://rnao.ca/bpg/guidelines/bpg-subcutaneous-administration-insulin-adults-type-2diabetes
Section Three: Reduction of Risk Potential
In this client need area the focus is on the nurse’s ability to reduce the likelihood of
complications or health problems related to existing conditions, treatments or procedures. It is
helpful to integrate the information brought forward in this section onto your study maps
focused on disease processes. Chapter 8 will provide a discussion of how to study map and will
show you how to integrate, apply and critically think with the concepts outlined in this section.
Begin by completing this section so your underlying knowledge of how to predict and interpret
clinical signs of decompensation is strong. Then move to specific disease conditions and ensure
that you are able to apply this information in new situations.
In this section you will review basic concepts, but the majority of the focus will be practicing
integrating the concepts in case studies.
Changes/Abnormalities in Vital Signs (NCSBN, 2013a, p.35)
 Assess and respond to changes in client vital signs
May also include:
 Apply knowledge needed to perform related nursing procedures and psychomotor skills when
assessing vital signs
 Apply knowledge of client pathophysiology when measuring vital signs
 Evaluate invasive monitoring data (e.g. pulmonary artery pressure, intracranial pressure)
REVIEW QUESTIONS
1.
2.
3.
4.
Review the formula for calculating Mean Arterial Pressure. This will help you to
determine the severity of hypotension when you are given a blood pressure on the
exam. Remember that MAP should be 65 mmHg or greater.
What are possible conditions that would cause a high or low heart rate?
What is the optimal level for SaO2 monitoring? What else should the nurse assess when
a client has a low SaO2 level?
What other clinical data or assessments would support that a client is symptomatic with
a low or high blood pressure?
EXERCISE
A 21 year old client was involved in a severe snowmobiling accident. He was riding at high
altitude on a mountain when his snowmobile flipped and pinned him. He sustained multiple
lower limb fractures, a fractured pelvis, as well as, first and second degree burns to his left
buttock from the snowmobile’s exhaust pipe.
Due to his high levels of post-operative pain and also from the burns, the anesthetist inserted
an epidural catheter for pain management. The client currently has an epidural infusion
running with fentanyl and bupivacaine 0.125% infusion.
The client develops severe hypotension (78/45 mmHg). Outline the three possible causes for the
hypotension based on the case study and outline the expected interventions to correct each
cause:
1st potential cause:
2nd potential cause:
3rd potential cause:
Elements of hemodynamic monitoring including pulmonary artery pressure and intracranial
pressure will be covered in the Critical Care content section of this chapter.
Diagnostic Tests (NCSBN, 2013a, p.36)
 Perform diagnostic testing (e.g. electrocardiogram, oxygen saturation, glucose monitoring)
 Monitor the results of diagnostic testing and intervene as needed
May also include:
 Apply knowledge of related nursing procedures and psychomotor skills when caring for clients
undergoing diagnostic testing
 Compare client diagnostic findings with pre-test results
 Perform fetal heart monitoring
 Monitor results of maternal and fetal diagnostic tests (e.g. non-stress test, aminocentesis,
ultrasound)
EXERCISE
Common Diagnostic
Tests
What is this test
for?
(in general terms)
What are the nursing
considerations for this
test?
(e.g. preparation for,
assessments during and
after).
CT Scan
MRI
PET Scan
Ultrasound
Radiography (e.g. chest
x-rays)
Angiography
Scopes (colonoscopy,
endoscopy,
laparoscopy,
bronchoscopy)
Biopsy
12 Lead ECG
When would this test be
abnormal?
(common reasons why
test results may be out of
the normal range)
Laboratory Values (NCSBN, 2013a, p.36)
 Obtain blood specimens peripherally or through a central line
 Obtain specimens other than blood for diagnostic testing (wound, stool, urine)
May also include:
 Identify laboratory values for ABGs (pH, PO2, PCO2, SaO2, HCO3), BUN, cholesterol (total),
glucose, hematocrit, hemoglobin, glycosylated hemoglobin (HgbA1C), platelets, potassium,
sodium, WBC, creatinine, PT, PTT & APTT, INR
 Compare client laboratory values to normal laboratory values
 Educate client about the purpose and procedure of prescribed laboratory tests
 Monitor client laboratory values (e.g. glucose testing results for the client with diabetes)
 Notify primary health care provider about laboratory test results
REVIEW QUESTIONS
1.
2.
3.
4.
5.
Outline the procedure for drawing blood from a central line
Outline the procedure for drawing blood from a peripheral line
Interpret the following arterial blood gases.
What is the process for obtaining a stool sample?
What is the process for obtaining a urine sample while voiding and with a client with a
urinary catheter in situ?
6. How should a specimen be collected from a wound? Which part of the wound should be
swabbed?
STUDY TIPS
The current NCLEX-RN® should have Canadian lab values on the exam. However, reference
ranges will not be provided (as a note they never have been on the Canadian Registration
exam), so this means that you will have to learn high and low values for various lab tests. The
best way to approach this endeavour is to memorize the most common lab tests. They are
provided in the chart below. Also, think about the implications of the test. For example, liver
enzymes are of most concern when they are elevated- so just learn the top values. Potassium,
on the other hand, is clinically significant when it is low or high- so you will need to know both.
Remember that the majority of questions containing lab values will have other pieces of clinical
information in the question stem. Think about what the question is asking and the other
information included, this will help to lead you to the best answer.
EXERCISE
Review Table for Lab and Diagnostic Tests (Van Leeuwen et al., 2010).
Lab Tests
What is the
reference range for
this test?
What are the nursing
considerations for this
test? (e.g. preparation for,
assessments during and
after)
Renal Panel
Creatinine
Urea nitrogen (BUN)
Electrolytes
Potassium
Sodium
Magnesium
Calcium
Liver Enzymes
Alkaline Phosphatase (ALP)
Alanine Aminotransferase
(ALT)
Total Bilirubin
Albumin
When would this test be
abnormal?
(common reasons why test
results may be out of the
normal range)
Coagulation Studies
Partial Thromboplastin Time
(PTT)
International normalized
ratio (INR) also referred to
as Prothrombin Time (PT)
D-Dimer
Complete Blood Count
(CBC)
Hemoglobin (Adults)
MCV
MCHC
MCH
Basophils
Eosinophil
Ferritin
Platelets (platelet count)
Hematocrit
White Blood Cells
Diabetic Diagnostic Studies
Fasting blood glucose levels
Random blood glucose levels
Glycosated Hemoglobin
Levels (Hg A1C)
Glucose Tolerance Testing
Cholesterol Studies
Total Cholesterol
LDL
Triglycerides
HDL
Cardiac Testing
Troponin
Creatine Kinase
Tests for Inflammation
ESR
C-reactive protein
Other lab tests:
Urine Ketones
Culture and Sensitivity
STUDY RESOURCES
Your medical-surgical nursing textbook will have a full list of lab values in the back. Often,
candidates are frustrated because reference ranges for lab results can be different between
resources. Do not let this add to your stress. Work with the reference ranges that you have and
remember that the exam is testing your ability to think with an abnormally high or low level.
The questions should not be testing with borderline results.
Therapeutic Procedures (NCSBN, 2013a, p.37)
 Provide preoperative and postoperative education
 Provide preoperative care
 Provide intraoperative care
 Manage client during and following a procedure with moderate sedation
May also include:
 Assess client response to recover from local, regional or general anesthesia
 Apply knowledge of related nursing procedures and psychomotor skills when caring for clients
undergoing therapeutic procedures
 Educate client about home management of care (tracheostomy and ostomy)
 Use precautions to prevent further injury when moving a client with a musculoskeletal
condition (e.g. log-rolling, abduction pillow)
 Monitor the client before, during, and after a procedure/surgery (e.g. casted extremity)
 Monitor effective functioning of therapeutic devices (e.g. chest tube, drainage tubes, wound
drainage devices, continuous bladder irrigation)
Potential for Complications from Surgical Procedures and Health
Alterations (NCSBN, 2013a, p.37)
There is not a specific activity statement for this content area
May also include:
 Apply knowledge of pathophysiology to monitoring for complications (e.g. recognize signs of
thrombocythopenia)
 Evaluate the client’s response to post-operative interventions to prevent complications (e.g.
prevent aspiration, promote venous return, promote mobility)
This section covers content related to Perioperative care concepts.
REVIEW QUESTIONS
Part One: Pre-operative Care
1. Outline what is in a focused preoperative nursing assessment and provide examples of
potential questions the nurse should ask a client prior to surgery.
2. What are key laboratory and diagnostic tests that should be completed prior to surgery?
3. Outline CRITICAL factors to assess prior to surgery using the chart below:
Critical Factor to
Assess
BMI- obesity
Rationale for Assessment. Identify the surgical risk for each
critical factor.
Smoking
Bleeding risk
Over 60 years of age
Recent pneumonia
Recent myocardial
infarction
Hx of narcotics,
street drugs,
sedatives
7. What is the difference between general and ambulatory surgery?
8. Informed consent must be obtained prior to non-emergent surgery why?
9. Provide examples of preoperative medications that:
a.
b.
c.
d.
e.
f.
g.
h.
Provide analgesia
Prevent nausea and vomiting
Promote sedation and amnesia
Decrease anaesthetic requirements
Facilitate the induction of anaesthesia
Relieve apprehension and anxiety
Prevent autonomic reflex response
Decrease respiratory and gastrointestinal secretions
Part Two: Intra-Operative Care
1. What is the role of the Registered Nurse in the intra-operative context?
2. How does the nurse maintain the sterile field in the operating room?
3. Match the following intraoperative client positions with the appropriate surgery (Shoup,
Sheridan, & Clendinneng, 2014, p.446).
Surgical Position
Answer Description
1. Supine Position
a. Pelvic surgery
2. Lithotomy
Position
b. Abdominal surgery
3. Lateral
Decubitus
Position
c. Abdominal perineal resection
4. Prone Position
d. Thoracic surgery
5. Trendelenburg
position
e. Spinal surgery
Answers: 1b, 2c,3d, 4e, 5a
4. Outline the nursing management for the following emergent events in the operating
room:
a. Anaphylactic reactions
b. Malignant hyperthermia
c. Major blood loss
EXERCISE
This exercise covers general anaesthesia, using your medical-surgical textbook and/or drug
guide outline why each of these drugs are given and the nursing implications for each.
Medication
Pre-operative agents:
Lorazepam
Midazolam
Induction agents:
Propofol
Ketamine
Inhalation Gases:
Nitrous Oxide
Volatile Liquids:
Isoflurane
Desflurane
Sevoflurane
Induction: Depolarzing
Muscle Relaxant:
Succinylcholine
Induction;
Nondepolarizing
Muscle Relaxants:
Rocuronium
Pancuronium
Reversal: Cholinergic
Agent:
Neostigmine bromide
Anticholinergics
Atropine sulfate
Glycopyrrolate
Edrophonium
Opioids:
Fentanyl
Morphine Sulphate
Sufentanil
Benzodiazepines:
Midazolam
Diazepam
Lorazepam
Indication or Use
Nursing Implications
Antiemetics:
Ondansetron
Metoclopramide
Dimenhydrinate
Promethazine
Droperidol
Part 3: Post-Operative Care
REVIEW QUESTIONS
1.
2.
Outline the focused assessments required for a post-operative client:
a. Respiratory system:
b. Cardiovascular system:
c. Renal system:
d. Neurological system:
e. Musculoskeletal system:
f. Temperature control:
g. Integumentary system:
h. GI system:
i. Fluid and electrolyte balance:
j. Pain management:
What are the required assessments for a surgical wound? How long should the dressing
stay on prior to being changed?
EXERCISE
The following table summarizes potential post-operative complications. Outline the assessment
findings and expected interventions for each complication.
Post-Operative Complications (Silvestri, 2014)
Complication
Assessment Findings
Expected Interventions (prioritize
interventions)
Pneumonia
Atelectasis
Hypoxemia
Pulmonary
Embolism
Hemorrhage
Shock
Thrombophlebitis
Urinary retention
Constipation
Paralytic ileus
Wound infection
Wound
dehiscence
Wound
evisceration
STUDY TIPS
General post-operative care and complications are concepts that you are most likely already
strong in. Spend your time going over medications, surgeries you are not familiar with, and
practice recognizing specific complications for individual surgeries. The exercises in this section
have been created with this goal in mind. Focus in on how to recognize and handle emergent
and/or life threatening events in a surgical client.
Common Surgeries to Review
-ectomy: excision/removal
-otomy: cutting into/incision
-oscopy: looking into
-plasty: repair/reconstruction
-ostomy: creation of an opening into
(Neil & Clendinneng, 2014, p.421)
All surgeries require pain management, wound assessment for infection, dehiscence, or
evisceration, monitoring for fever or low temperatures, kidney function (urine output),
constipation from narcotics, paralytic ileus from anesthesia, teaching to prevent the
formation of blood clots and assessment of level of consciousness. This list encompasses some
specific assessments/nursing interventions for common surgeries. Information has been
provided directly for some of the surgeries in the table, while other surgeries may contain
helpful links, articles or resources as they provide a more comprehensive overview. If any of the
links are broken please see the “Updated Links” tab on the webpage.
Type of Surgery
General Surgeries
Appendectomy
Colostomy
Tracheotomy
Mastectomy
Cholecystectomy
Tonsillectomy and
Adenoidectomy
Gastrectomy
Amputation (lower limb)
Specific assessments to make or nursing interventions
after surgery
Fever, can ambulate day of surgery, DAT, discharged POD 1 or 2,
report persistent nausea or absence of bowel sounds
Client’s ability for self-care, stoma (colour, perfusion, effluent), peristomal skin, bowel sounds
Fresh tube and obturator at bedside, call bell for client, inner cannula
removed q1-2hrs and cleaned for first 48 hrs, suction q30 minutes on
first day, humidify oxygen.
No BP on operative side, monitor for lymphedema, seroma
(collection of blood)
Performed most commonly via laparoscopy- should be d/c from day
surgery or on POD 1- report any onset of jaundice immediately,
increased abdominal pain or distention, persistent nausea &
vomiting, persistent cough or SOB, purulent or abnormal drainage
from wound.
Increased fluids (drinking), no food restrictions (soft diet
recommended), N&V should only last first 24 hrs report if persists,
watch for dehydration (decreased u/o, crying with no tears), low
grade fever normal, report high fever over 38.5 C, snoring/mouth
breathing common 10-14 days after surgery, scabs form on tonsils fall
off 5-10 days after (cause bad breath, white in colour), report any
bright red bleeding immediately, suppositories may be used for pain
control.
IVs, urinary catheter, NG tube will be inserted, if entire stomach
removed it will be in small intestine- in place until BS return, a bowel
movement indicates healing. Clear fluids when BS return titrate to
DAT, will require B12 injections if entire stomach removed, can get
up day after surgery
Elevate stump first 24-48 hrs, turn ct. slowly to prevent muscle
spasms, may have soft or rigid (cast) dressing. Lying prone helps
prevent hip contractures, avoid pillows between legs or under back.
Unwrap stump dressing q 4-6 hrs for first 2 post-operative days and
then at least once daily. Assess site for infection, skin irritation or
breakdown, colour, temperature, most proximal pulse before rewrapping, compare findings to collateral extremity. Re-wrap stump
when it is elevated to prevent edema & venous stasis.
Section Four: Physiological Adaptations
The focus of this client need area is on the management and care for clients with acute, chronic
or life threatening physical health conditions. Key areas in this section will be identified in this
chapter, however, the majority of disease specific content will be on the study maps posted on
the website. On the second page of each study map, there will be questions or exercises to help
you work through important content.
Fluid and Electrolyte Imbalances (NCSBN, 2013a, p.41)
 Manage the care of the client with a fluid and electrolyte imbalance
May also include:
 Identify signs and symptoms of client fluid and/or electrolyte imbalance
 Apply knowledge of pathophysiology when caring for the client with fluid and electrolyte
imbalances
 Evaluate the client’s response to interventions to correct fluid or electrolyte imbalance
This content often challenges graduates because they do not spend time learning the clinical
presentations of fluid and electrolyte imbalances. The symptoms of these imbalances are very
important because they can help you determine the severity of abnormal lab values. In this
section the focus will be on determining fluid imbalance and reviewing common electrolyte
imbalances.
Fluid Volume
Disturbance
Hypovolemia
Pathophysiology
Clinical
Manifestations
Hypervolemia
Assessment and Diagnostic
Findings
It is important to differientate dehydration from hypovolemia. Both conditions are due to a
lack of circulating fluid volume. Dehydration will manifest with increased HCT and sodium,
whereas hypovolemia is due to frank volume loss (i.e. bleeding).
Two prominent causes of hypervolemia are renal disease and heart failure. This is why people
with these conditions are often fluid restricted. However, in some instances hypervolemia can
occur in a healthy person if they receive too much intravenous fluid (fluid overload) or drink too
much water (water intoxication). Therefore pharmacological treatment of hypervolemia may
vary between case. However, diuretic therapy is the most common treatment for hypervolemic
states. Remember that clients with hypervolemia will often have low sodium levels, in this case
fluid restriction is often warrented to slowly bring the sodium levels back up (i.e. heart failure)it is not common practice in these situations to give more sodium to the client because once
the their fluid status is balanced their sodium levels will normalize.
Intravenous Fluid Therapy
Fluid replacement therapy for hypovolemia may be given orally (for example in mild cases of
dehydration or fluid loss due to gastrointestinal losses) or intravenously in more severe cases.
Intravenous fluid therapy is typically categorized in one of two major categories. A crystalloid is
an aqueous solution composed of mineral salts or other water-soluble molecules (i.e. 9% NaCl,
Lactated Ringer’s solution), while a colloid solution is used as a volume expander for the
intravascular part of extracellular fluid (i.e. blood, albumin).
Integrating the Nursing Process into your client care:
Construct a nursing care plan for a client experiencing hypovolemia.
Construct a nursing care plan for a client experiencing hypervolemia.
Take into account the following questions when making your care plan:




What would you focus your assessments on?
How would these conditions be diagnosed? What other issues would the client be at risk
for?
What interventions would you expect? (This includes Related physician orders to
implement, specific assessments to make (i.e. physical assessment, vital signs,
appropriate lab results to check), appropriate fluid to give (if applicable), Related
teaching for the client.
How would you evaluate that your interventions have been successful? (i.e. that the
client’s condition is stabilizing)
Electrolyte Imbalance
EXERCISE
Electrolyte
Imbalance
Clinical Manifestations
Assessment and
Diagnostic
Findings
Medical and Nursing
Management
Hyponatremia
Hypernatremia
Hypokalemia
Hyperkalemia
Hypocalemia
Hypercalemia
Hypermagnesmia
Hypomagnesmia
Hyperphosphatemia
Hypophosphatemia
REVIEW QUESTIONS
1. What are specific nursing considerations for sodium replacement? (Adams et al., 2010,
p.634).
2. What are specific nursing considerations for potassium replacement? (Adams et al.,
2010, p.635).
3. What changes in nutritional intake may help to restore balance in electrolytes?
4. What are the normal serum levels for potassium and sodium?
5. Why does Furosemide (Lasix) cause hypokalemia?
STUDY TIPS
Advanced content in this area may include electrocardiographic changes in electrolyte
imbalance (i.e. hyperkalemia- peaked t-waves), dehydration in children, postoperative fluid
losses, and symptoms of electrolyte imbalance. Electrolyte replacement has special
assessments required, it is important to know common doses of electrolytes given, preferred
routes and any dangers associated with giving the electrolyte (i.e. magnesium sulfate &
hypotension). Also, remember that fluid replacement may be complicated by other co-morbid
factors such as heart or renal failure. It is important to read exam questions in full and to think
through all the information provided to you.
As an undergraduate nursing educator I will admit that I found the amount of critical care
content on the 2013-2016 NCLEX-RN® Test Plan surprising. There are concepts on the test plan
that are not covered in detail (or in some cases not at all) in Canadian nursing curricula. There
are reasons for this because ICU and ER nursing are considered specialized areas in Canadanurses entering into these areas must have strong generalist skills and relevant experience.
Although, some students will consolidate in these areas or enter them after graduate, it is an
expectation that they complete a formal critical care course appropriate to their clinical area.
In this section, I will deal with important critical care concepts directly and provide helpful ways
to come to understand them. Before you start this section I would like you to remember that
you have the knowledge to address this content. Critical care nursing is about taking
foundational aspects of assessment, pharmacology, and nursing interventions and applying
these skills to more complex clients. A client is typically admitted to a critical care setting
because they are:
1.
2.
3.
Hemodynamically compromised (low BP due to trauma, myocardial infarction,
dysrhythmias, hypertension, etc…)
Require advanced airway management
Require organ support (i.e. dialysis)
In this section I will speak to these three major areas and provide the related activity
statements and content areas identified on the test plan. Remember, every strong critical care
nursing has a solid foundation in medical-surgical nursing- take the time to ensure that you
understand pharmacology and treatment of disease conditions so you can anticipate potential
complications and decline in the client.
Hemodynamics (NCSBN, 2013a, p.41)
 Manage the care of client with alteration in hemodynamics, tissue perfusion and hemostasis
(e.g. cerebral, cardiac, peripheral)
 Monitor and maintain arterial lines
 Manage the care of a client with a pacing device (e.g. pacemaker)
 Manage the care of a client on telemetry
May also include:
 Assess client for decreased cardiac output (e.g. diminished peripheral pulses, hypotension)
 Identify cardiac rhythm analysis strip abnormalities (e.g. sinus bradycardia, premature
ventricular contractions, ventricular tachycardia, fibrillation)
 Apply knowledge of pathophysiology to interventions in response to client abnormal
hemodynamics
 Provide client with strategies to manage decreased cardiac output (e.g. frequent rest periods,
limit activities)
 Intervene to improve client cardiovascular status (e.g. initiate protocol to manage cardiac
arrhythmias, monitor pacemaker function)
Maintaining adequate hemodynamic status in a client is all about ensuring oxygenation at a
cellular level. Hypoxia leads to cell death and ischemia. Hypoxemia at a systemic level can lead
to death. There are many pathologies and bodily states that can lead to cellular hypoxia. Below
are some examples:





Blockage or rupture of arteries or blood vessels (i.e. CVA, MI, ruptured aneurysms)
Acute bleeding leading to hypovolemic states
Respiratory dysfunction leading to hypoxemia in the blood
Dysrhythmias or cardiac arrest
Shock states (cardiogenic, neurogenic, anaphylactic, hypovolemic)
As in all emergent situations airway, breathing and circulation are paramount in critical care
contexts. The client’s airway is always stabilized, oxygen delivery is initiated and circulation is
maintained to ensure perfusion to all organs.
REVIEW QUESTIONS
1. Define the following terms: cardiac output, preload, afterload, cardiac index, stroke volume
and ejection fraction.
2. How do you determine Mean Arterial Pressure (MAP)? What is the formula and what is a
normal MAP?
3. What are signs of decreased cardiac output?
The following YouTube video by Janis Provinse provides the answers to the questions above:
https://www.youtube.com/watch?v=vEGx99SU0sI
Hemodynamic monitoring is either non-invasive (readings are taken outside the body) or
invasive (readings are from inside the body). Examples of non-invasive hemodynamic
monitoring are blood pressure monitoring with a cuff and telemetry. Invasive monitoring
includes central venous pressure (CVP), pulmonary artery pressure (PAP), pulmonary artery
wedge pressure (PAWP), and arterial lines. In this section I will focus directly on:
1.
2.
Central Venous Pressure (CVP)
Arterial Lines
Invasive hemodynamic monitoring takes readings from inside the body and displays the
measurement on the cardiac monitor. In order to do this the line must be inserted into a large
blood vessel, artery or in the heart (depending on the type of monitoring being used). Special
pressurized tubing is used with a transducer attached in order to display a waveform on the
monitor. Pressurized tubing is important, particularly in arterial lines, as it prevents blood from
backing up the tubing. Anytime a nurse cares for a client who is monitored it is important to
always assess the client first and then the monitor. This principle is also important in the
context of the NCLEX-RN®, always think about the information that has been provided to you in
the exam question and what you are being tested on.
Central Venous Pressure
Central venous pressure or right atrial pressure measurement, measures right ventricular
preload. The most common method of catheter insertion is using a central venous catheter
placed in the internal jugular or subclavian vein. If the central venous catheter has multiple
ports CVP monitoring should be connected on the distal port. CVP is measured as a mean
pressure at the end of expiration (Bucher, Seckel & Goldsworthy, 2014).
The normal range for CVP is 2-8 mmHg (Bucher et al., 2014), you will also see 0-10 mmHg as a
common reference range as well.
High CVP= Right ventricular failure or volume overload
Low CVP= Hypovolemia
Arterial Line Monitoring
Arterial line monitoring is indicated for clients who are hemodynamically unstable, require
frequent arterial blood gas monitoring or frequent blood sampling. The reference ranges are
the same used for taking non-invasive blood pressures. It is important to note that a noninvasive blood pressure reading will typically be slightly higher than an arterial line. The
catheter for arterial lines (20 gauge, 5.1 cm needle, nontapered Teflon cannula over-the-needle
is used to cannulate a peripheral artery) is inserted in the radial, brachial or femoral artery.
Risks of arterial lines include: hemorrhage, infection, thrombus formation or neurovascular
impairment (Bucher et al., 2014, p.1930-1931).
Both CVP monitoring and arterial lines are leveled to the phelbostatic axis (4th intercostal space,
mid-axillary line).
REVIEW QUESTIONS
1.
2.
3.
Outline the process for obtaining a CVP measurement.
Which port on a central venous catheter is the CVP attached to?
A client has hypervolemia due to renal failure, should the CVP be high or low?
4.
5.
When would an arterial line be indicated for a client?
What are potential complications associated with arterial lines? How does the nurse
recognize and treat these potential complications?
EXERCISE
Medications to Help Maintain Stable Hemodynamic Status
The following medications are commonly administered via continuous IV to help maintain
hemodynamic status. Included are inotropic medications which increase the force of
myocardial contraction and cardiac output resulting in increased: stroke volume, cardiac
output, blood pressure and coronary artery perfusion and vasodilators which decrease
afterload and treat hypertension. It is important to have an understanding of these
medications, their uses and adverse effects. They are given via the IV route, typically using
continuous infusions (except in some emergent situations i.e. epinephrine for exam is given IV
direct).
Drug
Inotropic medications
Dopamine
Epinephrine
Norepinephrine
Dobutamine
Vasodilators
Nitrates
Nitroprusside Sodium
Hydralazine
Receptors Stimulated
Treatment/Adverse Effects
STUDY TIPS
The following YouTube video shows you the process of setting up CVP monitoring, it will help
familiarize you with some of the equipment.
CVP Video HD 720p
https://www.youtube.com/watch?v=Rj8HM4P7VMA
This YouTube video is an excellent summary on how to read CVP and arterial waveforms.
CVP and Arterial Line Waveform Interpretation
https://www.youtube.com/watch?v=8xpKr1t7YQE
STUDY RESOURCES
Bucher, L., Seckel, M. & Goldsworthy, S. (2014). Nursing management: Critical care
environment. In M.A. Barry, S. Goldsworth & D. Goodridge Medical-Surgical Nursing in Canada:
Assessment and management of clinical problems (3rd Can ed). (pp.1922-1958). Toronto:
Elsevier.
*If you have a different medical-surgical textbook please use the index to look up this content.
The videos linked in this section do cover the majority of this content.
STUDY TIPS
A common testing approach to dysrhythmia management is to display the rhythm and then ask
a question regarding nursing management of the rhythm. For example:
A client is exhibiting the following cardiac rhythm:
What is the nurse’s first action in this situation?
1.
2.
3.
4.
Assess the client’s airway, breathing and circulation
Call a code blue
Prepare for defibrillation
Administer epinephrine
Answer: 1- this question pertains to a first action on finding this rhythm, in this case it is
assessment for the ABCs- always assess the client when observing a dysrhythmia first.
Students often ask if they will be required to measure pr intervals, qrs intervals, qt intervals
etc… I would suggest that this may be too advanced for the test plan and that there is not
technology to support this in the CAT testing framework. My advice is to become familiar with
identifying basic rhythms and to be knowledgeable regarding their treatment. I did not include
heart blocks, junctional rhythms, pulseless electrical activity, unstable tachyarrhythmias such as
SVT or wide-complex tachycardia in this section because these concepts are more advancedfocus in on the basic rhythms for now in your studying.
STUDY TIPS
Principles related to mechanical ventilation can be overwhelming if you have never cared for a
client on a ventilator. When you are studying this content take a general approach to nursing
care. Focus in on potential complications of mechanical ventilation. When reviewing blood
gases for a client on mechanical ventilation focus on PaCO2 (respiratory acidosis will be
contingent upon this) and PaO2 levels. Remember the RR rate and minute volume on the
ventilator will help to control PaCO2 levels, while FiO2 will control PaO2 levels.
The following resource may be helpful for your preparation:
Strong, E. (2011, November, 11). Mechanical ventilation lecture 1 [Video File]. Retrieved from
https://www.youtube.com/watch?v=NP0Gb1a61Ug
Southern Union State Community College (2014, August, 14). Mechanical Ventilation [Video
File]. Retrieved from https://www.youtube.com/watch?v=04BNnFBst9w
Part 4: Study Tools and Strategies to Approach NCLEXRN® Exam Questions
Chapter 8: Study Maps
The purpose of the study maps created for this guide is to help you organize basic nursing
content related to pathology and pharmacology so you can concentrate on the learning content
in depth. Each study map will contain additional strategies to help guide you through essential
information for the NCLEX-RN®. The study maps aim to cover information that may not be as
familiar to you. At present the website has 20 study maps on the website, new ones will be
added each week. For now, a list has been created of pathology/disease processes that you
should address in your studying using a systems approach. Please note that I have not covered
individual cancers on this list. A larger study map to oncology and antineoplastic therapy will be
provided on the website. When approaching this broad and somewhat overwhelming content
review do the following:
1.
Go through the list below and check off areas of disease/pathology that you feel
knowledgeable in. Do not start with these areas; leave them for a few weeks prior to the
exam in order to build your confidence. You could also use the content mapping
strategy identified earlier in this guide to test your knowledge.
2.
Highlight any areas that you have never heard of or are unfamiliar with on the list
below. Start with these areas for your preparation.
3.
Prioritize the areas for review that you are unfamiliar with- which systems do you think
are going to be the most important?
4.
Think about how you are going to address the pharmacology introduced on each map.
You will need to know more than just the types of medications given for a condition, it is
important that you find a way to understand common side effects and nursing
interventions for each medication.
5.
Think about writing a case study for each study map that highlights key information
from the map, drug information and treatment. This will help you to remember the
information during the actual exam. Keep them short, interesting and memorable.
Study Map Topic Areas
Respiratory
Chronic Obstructive
Pulmonary Disorder
Asthma
Pneumonia
Pulmonary Edema
Pleural Effusion
Pulmonary Fibrosis
Influenza
Sinusitis
Tuberculosis
Pneumothorax
Cor Pulmonale
Cystic Fibrosis
Pulmonary Embolus
Gastrointestinal
GERD
Gastritis
GI Bleed
Peptic Ulcer Disease
Hiatal Hernia
IBS
Peritonitis
Ulcerative Colitis
Crohn’s Disease
Viral Hepatitis
Cirrhosis
Pancreatitis
Cholelithiasis
Reproductive
STIs
Infertility
Therapeutic Abortion
Pelvic Inflammatory Disease
Endometriosis
Uterine Prolapse
Sexual Assult
Benign Prostatic Hyperplasia
Hematology
Anemia
Thalassemia
Hemochromatosis
Polycythemia
Thrombocytopenia
Hemophilia
Disseminated Intravascular
Coagulation
Neutropenia
Myelodysplastic Syndrome
Leukemia
Hodgkin’s Lymphoma
Non-Hodgkin’s Lymphoma
Multiple Myeloma
Genitourinary
Urinary Tract Infection
Glomerulonephritis
Renal Calculi
Urinary Incontinence
Urinary Retention
Acute Kidney Injury
Chronic Renal Failure/End
Stage Renal Disease
Cardiovascular
Hypertension
Coronary Artery Disease
Stable Angina
Acute Coronary Syndrome
Heart Failure
Infective Endocarditis
Valvular Heart Disease
Cardiomyopathy
Peripheral Arterial Disease
Chronic Venous Ulcers
Aortic Aneurysm
Venous Thrombosis
Nervous System
Increased Intracranial
Pressure
Head Injury
Viral/Bacterial Meningitis
Stroke
Epilepsy
Multiple Sclerosis
Parkinson’s Disease
Myasthenia Gravis
Huntington’s Disease
Musculoskeletal
Intervertebral Disc Disease
Osteomalacia
Osteoporosis
Rheumatoid Arthritis
Lyme Disease
Gout
Systemic Lupus
Erythematosus
Polymyositis
Dermatomyositis
Endocrine
SIADH
Diabetes Insipidus
Hypothyroidism
Hyperthyroidism
Cushing’s Syndrome
Addison’s Disease
Type 1 Diabetes Mellitus
Type 2 Diabetes Mellitus
Integumentary
Malignant Melanoma
Burns
Alzheimers
Deliruim
Dementia
Guillian-Barre Syndrome
Tetanus
Spinal Cord Injury
Shock
Systemic Inflammatory
Response Syndrome (SIRS)
Multiple Organ-Dysfunction
Syndrome (MODS)
Acute Respiratory Distress
Syndrome (ARDS)
Fibromyalgia
Chronic Fatigue Syndrome
As the study maps are developed they will include other helpful resources, questions, and
summarizes for areas that may pose difficulty for you. Please note that I do not provide
answers to the questions posed, however, I will create a blog site for the study maps so you can
pose wider questions and we can have group discussions on key concepts.
Chapter 9: Decision Making Process for Addressing Practice Questions
One of the differences with NCLEX-RN test plan -based questions is that they operate on a hierarchy for
clinical decision making. The hierarchy is not made explicitly evident in the test plan, but there are
common nursing models for decision-making used in American nursing education. The most common is
by Rubenfeld and Scheffer (1999) who identify 4 levels of priority:
Priority 1: Life-threatening illness
Priority 2: Safety
Priority 3: Patient priorities
Priority 4: Nursing priorities
I will use this structure to help you develop an approach for your practice questions. It is important to
note that what you choose for an answer will be contingent upon the information presented in the
question stem. It is helpful to use this approach alongside the nursing process to help clarify what
exactly the question is asking.
Before I expand on a proposed hierarchy for addressing the NCLEX-RN questions it is important to
note that you must have the underlying content knowledge in order to answer a question correctly.
There is no “trick” to deciphering practice questions without doing the work of content review. You
are integrating what you know within a clinical situation and coming up with the most appropriate
answer. Take the information provided to you in this chapter as an additional “tool” or “approach” to
your NCLEX-RN preparation not as a steadfast rule for every question that you will see on the exam.
Lipe and Beasley (2004) propose examining the following content in each of Rubenfeld and Scheffer’s
levels of nursing priorities .
Priority 1: Life-threatening
situation
Priority 2: Safety issues
If appropriate start with the CAB’s of care: circulation, airway,
breathing. However, ensure that the question is asking if you
recognize these priorities first. Read the question carefully there
may be another key piece of clinical data you are being tested on.
Look for responses that protect the client from injury
This also involves nursing care within the Scope of Practice of a
Registered Nurse
Maintaining professional competence
Knowing when to notify the physician (when you are out of scope or
the client is unstable or at risk)
Prioritizing two safety issues- for example patient is unstable and
confused- unstable status is priority (Lipe & Beasley, p.65)
Risk for Injury for Clients (not listed in priority):
A- Age
B- Blindness
Priority 3: Patient priorities
Priority 4: Nursing priorities
C- Consciousness
D- Deafness
E- Emotional state (reduced perceptual awareness)
F- Frequency of accidents (previous history of accidents)
G- Gait (impaired mobility) (Nugent et al. ,2011, p.43)
Patient priorities in scheduling activities to the extent their
condition will allow
HCP are legally required to involve patients in health care decisions
Informed consent as a priority prior to implementing care
Patient’s strengths and weaknesses taken into account
Moral and ethical decisions
Issues regarding time, resources and setting
Maslow’s Hierarchy of Needs
Approaching Practice Questions:
Step 1: Identify the problem in the question and if applicable identify what stage of the nursing process
is being identified in the question.
Step 2: Outline what you know and what you don’t know (questions you still have)
What do I know? What do I need to know? What do I have to do to know it? (Nugent et al., 2011, p.11)
Step 3: Identify possible solutions/ Determine Related outcomes
Step 4: Set priorities
Step 5: Re-read the question stem to determine what the question is asking.
When you get a question wrong:
What to do when you answer a practice question incorrectly.
1. Do not go straight to the rationales provided, first try to figure out where you went wrong with
the question
2. Revisit the question stem and re-highlight the key information in the question
3. Determine what the question is asking. Can you reword the stem to help you understand the
key focus? (might have to be careful with this)
4. List what you know about the information presented in the question
5. Revisit the potential answers- rewrite your rationales for either selecting or not selecting each
answer
6. Now revisit the rationale provided for the correct and incorrect answers
References
Aguilera, D.C. (1998). Crisis intervention: Theory and methodology (8th ed.). St. Louis, MO:
Mosby.
American Cancer Society (nd). Advance directives; Why do you need an advance directive?
Location: Author. Retrieved from www.cancer.org/advance-directives-pdf
American Nurses’ Association (2010). The art of engagement: Nurses, ANA work to address
conflict. Silver Springs: Author. Retrieved from
http://www.theamericannurse.org/index.php/2011/09/30/the-art-of-engagement/
American Nurses’ Association (2015). Revision of the Code of Ethics for Nurses with
Interpretive Statements Panel. Silver Springs: Author. Retrieved from
http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Revision-of-Code-ofEthics-Panel
Archer, P.M. & Harvey, G. (2014). Cardiopulmonary functioning and oxygenation. In J.C.
Ross-Kerr, M.J. Wood, B.J. Astle, & W. Duggleby Canadian Fundamentals of Nursing (5th
ed)(pp-877-935). Toronto: Elsevier.
Aronovitz, Leslie G.(1999, July 20). Testimony before the House Ways and Means
Subcommittee on Health, Hearing on Confidentiality of Health Information.
Astle, C.M., Hobbs, D. & West, K. (2010). Infection control. In J.C. Ross-Kerr & M.J. Wood
(Eds.), Potter & Perry’s Canadian Fundamentals of Nursing (Revised 4th ed.) (pp.635-674).
Toronto: Elsevier: Canada.
Baier, M. & Hegadoren, K. (2010). Stress and adaptation. In J.C. Ross-Kerr & M.J. Wood
Brokenshire, A. & Wunderlich, R. (2010). Activity and exercise. In J.C. Ross-Kerr & M.J. Wood
Bucher, L. & Goldsworthy, S. (2014). Nursing management: dysrhythmias. In M.A. Barry, S.
Goldsworthy & D. Goodridge Medical-Surgical Nursing in Canada: Assessment and
management of clinical problems (3rd Can ed). (pp.950-974). Toronto: Elsevier.
Bucher, L., Seckel, M. & Goldsworthy, S. (2014). Nursing management: Critical care
environment. In M.A. Barry, S. Goldsworthy & D. Goodridge Medical-Surgical Nursing in
Canada: Assessment and management of clinical problems (3rd Can ed). (pp.1922-1958).
Toronto: Elsevier.
Canadian Nurse (March, 2011). “I think my colleague has a problem…” Canadian Nurse.
Retrieved from http://www.canadian-nurse.com/en/articles/issues/2011/march-2011/ithink-my-colleague-has-a-problem
Canadian Nurses Association (2008). Fact sheet: Problematic Substance Abuse by Nurses.
Ottawa: Author. Retrieved from
www.nanb.nb.ca/PDF/CNAProblematic_Substance_Use_by_Nurses_E.pdf
Canadian Nurses Association (2008). Code of ethics for registered nurses. Ottawa: Author
Retrieved from http://cna-aiic.ca/en/on-the-issues/best-nursing/nursing-ethics
Canadian Nurses Association (July, 2008). Position statement: Ethical practice: Code of ethics
for registered nurses. Ottawa: Author. Retrieved from http://www.cnaaiic.ca/~/media/cna/page-content/pdf-en/ps95_code_of_ethics_2008_e.pdf
Canadian Nurses Association (November, 2007). Telehealth: The Role of the Nurse. CNA.
Retrieved from http://www2.cnaaiic.ca/CNA/documents/pdf/publications/PS89_Telehealth_e.pdf
Canadian Nurses Association (November, 2006). Position statement: Nursing Information
and knowledge management. Ottawa: Author. Retrieved from http://www2.cnaaiic.ca/CNA/documents/pdf/publications/PS87-Nursing-info-knowledge-e.pdf
Canadian Nurses Association (2006). Joint position statement: Practice environments:
Maximizing client, nurse and system outcomes. Author: Ottawa. Retrieved from
http://www2.cna-aiic.ca/CNA/documents/pdf/publications/PS88-Practice-Environmentse.pdf
Canadian Nurses Association (2005). Mental health and nursing: A summary of the issues.
Author: Ottawa. Retrieved from http://www2.cnaaiic.ca/CNA/documents/pdf/publications/BG6_Mental_Health_e.pdf
Canadian Nurses Association (November, 2005). Practice standard: Interprofessional
collaboration. Ottawa: Author. Retrieved from http://www2.cnaaiic.ca/CNA/documents/pdf/publications/PS117_Interprofessional_Collaboration_2011_e.p
df
Canadian Nurses Association (October, 2005). Children’s health and nursing: A summary of
the issues. Ottawa: Author. Retrieved from http://www2.cnaaiic.ca/CNA/documents/pdf/publications/BG2_Childrens_Health_and_Nursing_e.pdf
Canadian Nurses Association (September, 2001). What is Nursing Informatics and Why is it
so Important? Nursing now issues and trends in Canadian Nursing. Retrieved from
http://www2.cnaaiic.ca/CNA/documents/pdf/publications/NursingInformaticsSept_2001_e.pdf
Canadian Nurses Association (November, 1999). I see and am silent/ I see and speak out:
The ethical dilemma of whistle blowing. Ethics in Practice. Retrieved from
http://www.virtualcurriculum.com/N4210/Ethics_Pract_See_Silent_November_1999_e.pdf
Canadian Nurses Protective Society (1994). Consent for treatment: The role of the nurse.
Vol. 3 (2). CNPS. Retrieved from: http://www.cnps.ca/upload-files/pdf_english/consent.pdf
Canadian Nurses Protective Society (Apr. 2006). Consent for CPR. Vol. 15 (2). CNPS.
Retrieved from: http://www.cnps.ca/upload-files/pdf_english/cpr.pdf
Canadian Nurses Protective Society (Dec, 2009). Consent for the incapable adult. Vol. 13 (3).
CNPS. Retrieved from: http://www.cnps.ca/uploadfiles/pdf_english/consent_incapable.pdf
Centre for Addiction and Mental Health (nd). Mental Health and Addiction 101 Review
Series. Author: Toronto. Retrieved from
http://www.camh.net/education/online_courses_webinars/mha101/index.html
College of Nurses of Ontario (Feb, 2011). Preventing client abuse. Toronto: Author.
Retrieved from http://www.cno.org/Global/docs/ih/47008_fsPreventAbuse.pdf
College of Nurses of Ontario. (2010). CNO Learning Module: Documentation. Toronto:
Author. Retrieved from http://www.cno.org/en/learn-about-standardsguidelines/educational-tools/learning-modules/documentation-2010/
College of Nurses of Ontario (2009). Documentation, revised 2008. Toronto: Author.
Retrieved from http://www.cno.org/Global/docs/prac/41001_documentation.pdf
College of Nurses of Ontario (2009). Practice standard: Consent . Author: Toronto.
Retrieved from http://www.cno.org/Global/docs/policy/41020_consent.pdf
College of Nurses of Ontario (2009). Conflict prevention and management. Toronto: Author.
Retrieved from www.cno.org/Global/docs/prac/47004_conflict_prev.pdf
College of Nurses of Ontario (2009). Conflict prevention and management. Toronto: Author.
Retrieved from www.cno.org/Global/docs/prac/47004_conflict_prev.pdf
College of Nurses of Ontario (2009). Infection prevention and control. Toronto: Author.
Retrieved from http://www.cno.org/Global/docs/prac/41002_infection.pdf
College of Nurses of Ontario (2009). Restraints. Toronto: Author. Retrieved from
http://www.cno.org/Global/docs/prac/41043_Restraints.pdf
College of Nurses of Ontario (2009). Telepractice. CNO. Retrieved from
http://www.cno.org/Global/docs/prac/41041_telephone.pdf
College of Nurses of Ontario (nd). Learning Module: Consent. Author: Toronto. Retrieved
from http://www.cno.org/en/learn-about-standards-guidelines/educational-tools/learningmodules/consent/
College of Nurses of Ontario (nd). Abuse Prevention: One is Too Many. Toronto: Author.
Retrieved from http://www.cno.org/en/learn-about-standards-guidelines/educationaltools/abuse-prevention/
College of Nurses of Ontario (nd). CNO Learning Module: Restraints. Toronto: Author.
Retrieved from http://www.cno.org/en/learn-about-standards-guidelines/educationaltools/learning-modules/restraints/
College of Registered Nurses of British Columbia (February, 2009). Communicable diseases:
Preventing nurse-to-client transmission. Author: Vancouver. Retrieved from
https://www.crnbc.ca/Standards/Lists/StandardResources/442CommunicableDiseasesPracS
td.pdf
College of Registered Nurses of British Columbia (nd). Consent. CRNBC website. Retrieved
from https://www.crnbc.ca/Standards/Consent/Pages/Default.aspx
College of Registered Nurses of Nova Scotia (2007). Position statement: Quality nursing
practice environments. CRNNS. Retrieved from
http://www.crnns.ca/documents/Quality%20Nursing%20Practice%20Environments%20200
7.pdf
College of Registered Nurses of Nova Scotia (2008). Problematic Substance Abuse in the
Workplace CRNNS Document. Halifax: Author. Retrieved
fromhttp://www.crnns.ca/documents/Problematic%20Substance%20Use%20Resource%20
Guide.pdf
Costantinou, E. & Romaniuk, D. (2010). Client Safety. In J.C. Ross-Kerr & M.J. Wood (Eds.),
Potter & Perry’s Canadian Fundamentals of Nursing (Revised 4th ed.) (pp.796-828). Toronto:
Elsevier: Canada.
Curchoe, R.M., Astle, C., & Hobbs, D. (2014). Infection control. In J.C. Ross-Kerr, M.J. Wood,
B.J. Astle, & W. Duggleby Canadian Fundamentals of Nursing (5th ed)(pp.618-661). Toronto:
Elsevier.
Dearmon, V (2013). Risk management and legal issues. In L. Roussel Management and
Leadership for Nurse Administrators. Massachusetts: Jones and Bartlett Learning. Retrieved
from www.jblearning.com/samples/0763757144/57144_CH15_470_493.Pdf
DeMoss, M. & Romaniuk, D. (2014). Safety. In J.C. Ross-Kerr, M.J. Wood, B.J. Astle, & W.
Duggleby Canadian Fundamentals of Nursing (5th ed)(pp-790-824). Toronto: Elsevier.
Duncan, S.M. (2014). Nursing leadership, management and collaborative practice. In J.C.
Ross-Kerr & M.J. Wood (Eds.), Potter & Perry’s Canadian Fundamentals of Nursing (5th ed.)
(pp.125-139). Toronto: Elsevier: Canada.
Duncan, S.M. (2010). Nursing leadership, management, and collaborative practice. In J.C.
Ross-Kerr and M.J. Wood (Eds) Potter & Perry’s Canadian Fundamentals of Nursing (revised
4th ed.) (pp.140-141). Toronto: Elsevier Canada.
Florida Department of Health (nd). Hospital medical surge planning for mass casualty
incidents. Florida: Author. Retrieved from www.floridahealth.gov/programs.../hosp-msplanning-for-mci.pdf
Foerstel, Karen (1999, March 13). Protecting Medical Records: Privacy vs. 'Progress'. CQ
Weekly. 593-595.
Gill, D.J. & Wunderlich, R. (2014). Activity and exercise. In J.C. Ross-Kerr, M.J. Wood, B.J.
Astle, & W. Duggleby Canadian Fundamentals of Nursing (5th ed)(pp-769-789). Toronto:
Elsevier.
Grant, L.G. & Yoder-Wise, P.S. (2015). Leading and managing in Canadian nursing (1st Can
ed). Toronto: Elsevier.
Grypma, S. & Psut, B. (2010). Spiritual health. In J.C. Ross-Kerr & M.J. Wood (Eds.), Potter &
Perry’s Canadian Fundamentals of Nursing (Revised 4th ed.) (pp.434-451). Toronto: Elsevier:
Canada.
Hannah, K.J. & Kennedy, M.A. (2014). Nursing informatics and Canadian nursing practice. In
J.C. Ross-Kerr & M.J. Wood (Eds.), Potter & Perry’s Canadian Fundamentals of Nursing (5th
ed.) (pp.228-241). Toronto: Elsevier: Canada.
Hannah, K.J. (2010). Nursing informatics and Canadian nursing practice. In J.C. Ross-Kerr &
M.J. Woods (Eds.) Potter & Perry’s Canadian Fundamentals of Nursing (Revised 4th ed.)(pp.
233-244). Toronto: Elsevier Canada.
Hargrove-Huttel, R.A. & Cadenhead-Colgrove, K. (2014). Prioritization, delegation &
management of care for the NCLEX-RN exam. Philadelphia: F.A. Davis
Health Professions Regulatory Network (nd). Position statement on interprofessional
collaborative practice. Nova Scotia: HPRN. Retrieved from
http://www.crnns.ca/documents/INTERPROFESSIONALCOLLABORATIVEPRACTICE2008.pdf
Lachman, V.D. (2012). Applying the ethics of care to your nursing practice. Medsurg
Nursing, 21(2), 112-116. Retrieved from
http://nursingworld.org/MainMenuCategories/EthicsStandards/Resources/Applying-theEthics-of-Care-to-Your-Nursing-Practice.pdf
Larsen, P.D., & Kramer-Kile, M.L. (2014). Models of care. In. (M.L. Kramer-Kile, J.C. Osuji,
P.D. Larsen, & I.M. Lubkin, Eds.), Chronic Illness in Canada: Impact and Intervention, 1st Ed
(pp.29-42). Burlington, MA: Jones and Bartlett Learning.
Lipe, S.K. & Beasley, S. (2004). Critical thinking in nursing: A cognitive skills workbook.
Philadelphia: Lippincott Williams & Wilkins.
Lyeria, F. & Barry, M.A. (2014). Documenting and reporting. In J.C Ross-Kerr & M.J. Woods
(Eds.), Potter & Perry’s Canadian Fundamentals of Nursing (5th ed.)(pp. 202-227). Toronto:
Elsevier Canada.
Maslow, A. H.; Source: Psychological Review, Vol 50(4), Jul 1943, 370-396.
Mininni, N.C. (March, 2012). The beat goes on. A pacemaker primer: Whether temporary or
permanent, single-or dual chamber, pacemakers optimize cardiac output & improve quality
of life. American Nurse Today, 7(3),26-31.
National Council of State Boards of Nursing (1995). Delegation: Concepts and decisionmaking process. Chicago: IL: Author
National Council of State Boards of Nursing (1997). The five rights of delegation. Chicago, IL:
Author.
National Council of State Boards of Nursing (nd). A nurse manager’s guide to substance use
disorder in nursing. Author. Retrieved from https://www.ncsbn.org/substance-use-innursing.htm
National Council of State Boards of Nursing (Spring, 2013b). Understanding the NCLEX
examination through the core values of NCSBN. NCLEX Communique, 1-8.
National Council of State Boards of Nursing (2013a). Detailed test plan for national council
licensure examination: Item writer/item reviewer/nurse educator version. Chicago: Author.
Retrieved from https://www.ncsbn.org/1287.htm
Nugent, P.M. & Vitale, B.A. (2012). Test success: Test-taking techniques for beginning
nursing students (6th ed). Philadelphia: F.A. Davies.
Parsons, J. & Hawranik, P.G. (2014). Sensory alterations. In J.C. Ross-Kerr & M.J. Wood
(Eds.), Potter & Perry’s Canadian Fundamentals of Nursing (5th ed.) (pp.1301-1324).
Pesut, B. & Vinek, J. (2014). Spiritual health. In J.C. Ross-Kerr & M.J. Wood (Eds.), Potter &
Perry’s Canadian Fundamentals of Nursing (5th ed.) (pp.433-446). Toronto: Elsevier: Canada.
Raffin Bouchal, S. & Ecker, M. (2014). Nursing values and ethics. In J.C. Ross-Kerr & M.J.
Wood (Eds.), Potter & Perry’s Canadian Fundamentals of Nursing (5th ed.) (pp.80-93).
Registered Nurses Association of Ontario (2010). Enhancing healthy adolescent
development: A summary of recommendations. Author: Toronto. Retrieved from
http://rnao.ca/bpg/guidelines/enhancing-healthy-adolescent-development
Registered Nurses’ Association of Ontario (2006). Supporting and strengthening families
through unexpected life events. Toronto: Author. Retrieved from
http://rnao.ca/bpg/guidelines/supporting-and-strengthening-families-through-expectedand-unexpected-life-events, 8-12, 18-28.
Registered Nurses’ Association of Ontario (2006). Collaborative practice among nursing
teams guideline. Toronto: Author. Retrieved from
http://rnao.ca/bpg/guidelines/collaborative-practice-among-nursing-teams-guideline
Registered Nurses’ Association of Ontario (2006). Healthy work environments best practice
guidelines: Collaborative practice among nursing teams. Toronto: Author. Retrieved from
http://rnao.ca/bpg/guidelines/collaborative-practice-among-nursing-teams-guideline
Registered Nurses’ Association of Ontario (2012). Promoting safety: Alternative approaches
to the use of restraints. Toronto: Author. Retrieved from
http://rnao.ca/bpg/guidelines/promoting-safety-alternative-approaches-use-restraints
Registered Nurses’ Association of Ontario (September, 2010). Strategies to support selfmanagement in Chronic Conditions: Collaboration with clients. Author: Toronto. Retrieved
from http://rnao.ca/sites/rnao-ca/files/Strategies_to_Support_SelfManagement_in_Chronic_Conditions_-_Collaboration_with_Clients.pdf
Registered Nurses’ Association of Ontario (January, 2009). Assessment and care of adults at
risk for suicide ideation and behaviour. Toronto: Author. Retrieved from
http://rnao.ca/bpg/guidelines/assessment-and-care-adults-risk-suicidal-ideation-andbehaviour
Registered Nurses’ Association of Ontario (March, 2005). Summary of recommendations:
Women abuse: Screening, identification and initial response best practice guideline.
Toronto: Author. Retrieved from http://rnao.ca/bpg/guidelines/woman-abuse-screeningidentification-and-initial-response
Registered Nurses’ of Ontario (2005). Interventions for postpartum depression. Author:
Toronto. Retrieved from http://rnao.ca/bpg/guidelines/interventions-postpartumdepression
Registered Nurses’ Association of Ontario (March, 2004). Breastfeeding—The best start:
Health education fact sheet. Author: Toronto. Retrieved from http://rnao.ca/bpg/factsheets/breastfeeding-best-start
Registered Nurses’ Association of Ontario (2003). Breastfeeding best practice guideline for
nurses. Author: Toronto. Retrieved from Registered Nurses’ Association of Ontario (August,
2002). Crisis intervention. Toronto: Author. Retrieved from
http://rnao.ca/bpg/guidelines/crisis-intervention
Roberts, A.R. & Ottens, A.J. (2005). The seven-stage crisis intervention model: A road map
to goal attainment, problem solving & crisis resolution. Retrieved from
http://btci.edina.clockss.org/cgi/reprint/5/4/329
Romaniuk, D. (2010). Client safety. In J.C Ross-Kerr & M.J. Woods (Eds.) Potter & Perry’s
Canadian Fundamentals of Nursing (Revised 4th ed.) (pp. 816-827). Toronto: Elsevier
Canada.
Ross-Kerr, J.C. (2010). The development of nursing in Canada. In J.C Ross-Kerr & M.J. Woods
(Eds.) Potter & Perry’s Canadian Fundamentals of Nursing (Revised 4th ed.) (pp. 37) Toronto:
Elsevier Canada.
Rubenfeld, M.G. & Scheffer, B.K. (1999). Critical thinking in nursing: An interactive
approach. Philadelphia: Lippincott Williams & Wilkins.
Sams, C. & Griffin Perry, A. (2014). Caring in nursing practice.
Schutte, D. & Obel, I.W.P. (2002). Dangerous & life-threatening drugs- practical lessons from
the long QT syndrome. Cardiovascular Journal of South Africia, 13(2), p.54-61.
Silvestri, L.A. & Silvestri, A. (2012). Rntertainment: The NCLEX examination review game (2nd
ed). Missouri: Mosby Elsevier.
Silvestri, L.A. (2014). Saunders comprehensive review for the NCLEX-RN® examination. St.
Louis: Elsevier.
Stang, D. (2012). Traction. Healthline. Retrieved from
http://www.healthline.com/health/traction#Overview1
Stockert, P.A. & Duncan, S.M. (2010). Nursing leadership, management and collaborative
practice. In J.C. Ross-Kerr & M.J. Wood (Eds) Canadian Fundamentals of Nursing (Revised 4th
edition). Toronto, ON: Mosby, Elsevier
Stockert, P.A. & Weaver, K. (2014). Nutrition. In J.C. Ross-Kerr & M.J. Wood (Eds.), Potter &
Perry’s Canadian Fundamentals of Nursing (5th ed.) (pp.1050-1111). Toronto: Elsevier:
Canada.
Weston, M. & Roberts, D. (2013). The influence of quality improvement efforts on patient
outcomes and nursing work: A perspective from chief nursing officers at three large health
systems. The Online Journal of Issues in Nursing, Vol 18(3),
doi:10.3912/OJIN.Vol18No)3Man02
White, P. & Hall, M. (2006). Mapping the literature of case management nursing. Journal of
Med Libr Assoc, 94(2), E99-E106. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1463029/
Yancey, V. & Hunter, J. (2014). The experience of loss, death and grief. In J.C Ross-Kerr &
M.J. Woods (Eds.), Potter & Perry’s Canadian Fundamentals of Nursing (5th ed.)(pp. 447471). Toronto: Elsevier Canada.

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