(240)-343-2585

  

Summary of Red Letter Alerts (Pyramid Alerts) from each chapter of your Textbook “NCLEX RN Examination Comprehensive Review“ (Sounders, 7th Edition) Author: Linda Ann Silvestri *No other editions will be accepted, only the 7th Edition will be accepted.

Tip: See page xii (7) from your Textbook Preface. (Edition 7)

* Assignment Due 4 days 

* Only Accepted Format: Word.

– Start with Unit 2 (Unit II) and until Unit 20 (XX).

Type each RED letter Pyramid.

 Type each Critical Thinking question, answers, and Rationales chapter by chapter 

– The FIRST page of your assignment should contain the School name, Student full name, cohort, and date.

– The SECOND page should contain the Titles and numbers of Each Chapter and, the page number.

– From the THIRD page and on:

Type the chapter Title at the top of the page and continue with each Red Letters Pyramid Alert.

– Your Word document must page page-numbered.

 

Evolve Student Resources for Silvestri: Saunders Comprehensive
Review for the NCLEX-RN® Examination, Seventh Edition,
include the following:

How to Use the Online Practice Questions:
Customize your study session for your time and your own unique needs.
• Pre-test of 7 5 questions evaluates your current

knowledge. These results feed into a
personalized Study Calendar to help guide you
in your preparation for the NCLEX-RN examination.

• Study Mode: Receive immediate feedback after each
question. Select questions by Client Needs,
Integrated Process, Alternate Item Format Type, Priority
Concept, or specific Content Area. The answer, rationale,
test-taking strategy, question codes, priority concepts,
and reference sources for further remediation appear
immediately after you answer each question.

• Exam Mode: Take a practice exam, and receive your results
and feedback at the end. Select questions by Client Needs,
Integrated Process, Alternate Item Format Type, Priority
Concept, or specific Content Area. Then select the number of
questions you’d like to take in your exam—1 0 , 2 5 , 5 0 , or 1 0 0 .
When you’ve finished the exam, the percentage of questions you
answered correctly will be shown in a table, and you can go back to
review the correct answers—as well as rationales, test-taking strategies,
question codes, priority concepts, and reference(s)—for each question.

• Post-test of 7 5 questions simulating the NCLEX Client Needs percentages
helps you evaluate your progress.

Activate the complete learning experience that comes with each
NEW textbook purchase by registering with your scratch-off access code at

http://evolve.elsevier.com/Silvestri/comprehensiveRN/
If you purchased a used book and the scratch-off code at right has
already been revealed, the code may have been used and cannot
be re-used for registration. To purchase a new code to access these
valuable study resources, simply follow the link above.

*Evolve Student Resources are provided free with each NEW book purchase only.

Instructor of Nursing
Salve Regin a Un iversity, Newport, Rh ode Islan d

President
Nu rsin g Reviews, In c., Hen derso n , Nevad a
Nu rsin g Reviews, In c., Ch arlesto wn , Rh od e Islan d
an d
Profession al Nursin g Sem in ars, In c., Ch arlestown , Rh ode Islan d

Elsevier Consultant
HESI NCLEX-RN ® an d NCLEX-PN® Live Review Courses

Assistant Professor
To uro Un iversity Nevad a—Sch o ol of Nu rsin g
Hen d erson , Nevad a

3251 Riverport Lan e
St. Louis, Missouri 63043

SAUNDERS CO MPREHENSIVE REVIEW FO R THE
NCLEX-RN® EXAMINATIO N, SEVENTH EDITIO N

ISBN: 978-0-323-35851-4

Co p yrigh t © 2017 b y Elsevier, In c. All righ ts reserved .

No part of th is publicatio n m ay be reproduced or tran sm itted in an y form or by an y m ean s, electron ic
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broaden our un derstan din g, ch an ges in research m eth o ds, profession al practices, o r m ed ical treatm en t
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Practition ers an d research ers m u st always rely on th eir own experien ce an d kn owled ge in evaluatin g
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Previo us edition s copyrigh ted 2014, 2012, an d 2009.

NCLEX®, NCLEX-RN®, an d NCLEX-PN® are registered tradem arks of th e Nation al Coun cil of State Boards
of Nursin g, In c.

Lib rary o f Co n gress Catalo gin g-in -Pu b licatio n Data
Nam es: Silvestri, Lin da An n e, auth or.
Title: Saun ders com preh en sive review for th e NCLEX-RN exam in ation / Lin da
An n e Silvestri.
O th er titles: Com preh en sive review for th e NCLEX-RN exam in ation
Description : Seven th ed ition . j St. Lo uis, Misso uri : Elsevier, [2017] j In cludes b ibliograph ical referen ces
an d in d ex.
Iden tifiers: LCCN 2016011692 j ISBN 9780323358514 (p bk. : alk. p aper)
Subjects: j MESH: Nu rsin g, Practical j Nursin g Care j Nu rsin g Process j Exam in ation Q u estion s
Classification : LCC RT62 j NLM WY 18.2 j DDC 610.73076–dc23
LC record available at h ttp:/ / lccn .loc.gov/ 2016011692

Content Strategist: Jam ie Blum
Content Development Manager: Laurie Gower
Content Development Specialist: Laura Go odrich
Publishing Services Manager: Jeff Patterson
Book Production Specialist: Bill Dro n e
Designer: Ren ee Duen ow

Prin ted in th e Un ited States of Am erica

Last digit is th e p rin t n u m ber: 9 8 7 6 5 4 3 2 1

Contents

UNIT I
NCLEX-RN® Exam Preparation, 1
1 Th e NCLEX-RN® Exam in atio n , 2
2 Path ways to Su ccess, 14
3 Th e NCLEX-RN® Exam in atio n fro m

a Grad u ate’s Persp ective, 18
4 Test-Takin g Strategies, 20

UNIT II
Professional Standards in Nursing, 30
5 Cu ltu ral Awaren ess an d Health Practices, 32
6 Eth ical an d Legal Issu es, 44
7 Prio ritizin g Clien t Care: Lead ersh ip ,

Delegatio n , an d Em ergen cy Resp o n se
Plan n in g, 59

UNIT III
Nursing Sciences, 76
8 Flu id s an d Electro lytes, 78
9 Acid -Base Balan ce, 97

10 Vital Sign s an d Lab o rato ry Referen ce
In tervals, 108

11 Nu tritio n , 124
12 Paren teral Nu tritio n , 134
13 In traven o u s Th erap y, 144
14 Ad m in istratio n o f Blo o d Pro d u cts, 158

UNIT IV
Fundamentals of Care, 169
15 Health an d Ph ysical Assessm en t o f th e Ad u lt

Clien t, 171
16 Pro visio n o f a Safe En viro n m en t, 192
17 Calcu latio n o f Med icatio n an d In traven o u s

Prescrip tio n s, 204
18 Perio p erative Nu rsin g Care, 215
19 Po sitio n in g Clien ts, 230
20 Care o f a Clien t with a Tu b e, 239

UNIT V
Growth and Development Across the
Life Span, 255
21 Th eo ries o f Gro wth an d Develo p m en t, 257
22 Develo p m en tal Stages, 265
23 Care o f th e O ld er Clien t, 281

UNIT VI
Maternity Nursing, 289
24 Rep ro d u ctive System , 291
25 Pren atal Perio d , 299
26 Risk Co n d itio n s Related to Pregn an cy, 314
27 Lab o r an d Birth , 332
28 Pro b lem s with Lab o r an d Birth , 346
29 Po stp artu m Perio d , 356
30 Po stp artu m Co m p licatio n s, 364
31 Care o f th e Newb o rn , 372
32 Matern ity an d Newb o rn Med icatio n s, 393

UNIT VII
Pediatric Nursing, 403
33 In tegu m en tary Diso rd ers, 404
34 Hem ato lo gical Diso rd ers, 411
35 O n co lo gical Diso rd ers, 419
36 Metab o lic an d En d o crin e Diso rd ers, 430
37 Gastro in testin al Diso rd ers, 439
38 Eye, Ear, an d Th ro at Diso rd ers, 457
39 Resp irato ry Diso rd ers, 463
40 Card io vascu lar Diso rd ers, 479
41 Ren al an d Urin ary Diso rd ers, 491
42 Neu ro lo gical an d Co gn itive

Diso rd ers, 499
43 Mu scu lo skeletal Diso rd ers, 511
44 In fectio u s an d Co m m u n icab le

Diseases, 520
45 Ped iatric Med icatio n Ad m in istratio n an d

Calcu latio n s, 536

iii

UNIT VIII
Integumentary Disorders of the Adult
Client, 543
46 In tegu m en tary System , 544
47 In tegu m en tary Med icatio n s, 569

UNIT IX
Hematological and Oncological
Disorders of the Adult Client, 578
48 Hem ato lo gical an d O n co lo gical Diso rd ers, 580
49 Hem ato lo gical an d O n co lo gical

Med icatio n s, 614

UNIT X
Endocrine Disorders of the Adult
Client, 625
50 En d o crin e System , 626
51 En d o crin e Med icatio n s, 653

UNIT XI
Gastrointestinal Disorders of the
Adult Client, 669
52 Gastro in testin al System , 671
53 Gastro in testin al Med icatio n s, 698

UNIT XII
Respiratory Disorders of the Adult
Client, 706
54 Resp irato ry System , 708
55 Resp irato ry Med icatio n s, 737

UNIT XIII
Cardiovascular Disorders of the
Adult Client, 754
56 Card io vascu lar System , 755
57 Card io vascu lar Med icatio n s, 797

UNIT XIV
Renal and Urinary Disorders of the
Adult Client, 815
58 Ren al an d Urin ary System , 817
59 Ren al an d Urin ary Med icatio n s, 850

UNIT XV
Eye and Ear Disorders of the Adult
Client, 860
60 Th e Eye an d th e Ear, 861
61 Eye an d Ear Med icatio n s, 882

UNIT XVI
Neurological Disorders of the Adult
Client, 892
62 Neu ro lo gical System , 893
63 Neu ro lo gical Med icatio n s, 923

UNIT XVII
Musculoskeletal Disorders of the
Adult Client, 936
64 Mu scu lo skeletal System , 937
65 Mu scu lo skeletal Med icatio n s, 958

UNIT XVIII
Immune Disorders of the Adult
Client, 965
66 Im m u n e Diso rd ers, 966
67 Im m u n o lo gical Med icatio n s, 980

UNIT XIX
Mental Health Disorders of the Adult
Client, 987
68 Fo u n d atio n s o f Psych iatric Men tal Health

Nu rsin g, 988
69 Men tal Health Diso rd ers, 1000
70 Ad d ictio n s, 1019
71 Crisis Th eo ry an d In terven tio n , 1030
72 Psych iatric Med icatio n s, 1043

UNIT XX
Comprehensive Test, 1056

References, 1079

Glossary, 1081

Index, 1090

Priority Nursing Action List, Back of Inside Cover

iv Contents

To my parents—

To my mother, Frances Mary,

and in loving memory of my father, Arnold La wrence,

who taught me to always love, care,

and be the best that I could be.

To All Fu tu re Registered Nu rses,

Con gratulation s to you!

You sh ould be very proud an d pleased with yourself on your m ost recen t well-
deserved acco m plish m en t of com pletin g your n ursin g program to becom e a regis-
tered n urse. I kn ow th at you h ave worked very h ard to beco m e successful an d th at
yo u h ave proven to yourself th at in deed you can ach ieve your go als.

In m y opin io n , you are ab out to en ter th e m ost won derful an d rewardin g
profession th at exists. Your willin gn ess, desire, an d ability to assist th o se wh o n eed
n ursin g care will brin g great satisfaction to your life. In th e profession of n ursin g,
yo ur learn in g will be a lifelon g process. Th is aspect of th e profession m akes it stim –
ulatin g an d dyn am ic. Your learn in g process will con tin ue to exp an d an d grow as
th e profession con tin ues to evolve. Your n ext very im portan t en deavor will be
th e learn in g process in volved to ach ieve success in your exam in ation to beco m e
a registered n urse.

I am excited an d pleased to be able to provid e yo u with th e Sau n ders Pyramid to
Success produ cts, wh ich will h elp you prepare for yo ur n ext im portan t profession al
go al, beco m in g a registered n urse. I wan t to th an k all of m y form er n ursin g studen ts
wh om I h ave assisted in th eir studies for th e NCLEX-RN® exam in ation for th eir
willin gn ess to offer ideas regardin g th eir n eeds in preparin g for licen su re. Studen t
id eas h ave certain ly added a special un iquen ess to all of th e products available in
th e Sau n ders Pyramid to Success.

Saun ders Pyramid to Success products provide yo u with everyth in g th at you n eed to
ready yourself for th e NCLEX-RN exam in ation . Th ese produ cts in clude m aterial
th at is required for th e NCLEX-RN exam in ation for all n ursin g studen ts regardless
of edu cation al backgroun d, specific stren gth s, areas in n eed of im provem en t, or
clin ical experien ce durin g th e n ursin g program .

So let’s get started an d begin our journ ey th rough th e Saun ders Pyramid to Success,
an d welcom e to th e won derful profession of n ursin g!

Sin cerely,

vi

About the Author

Linda Anne Silvestri, PhD, RN
( Photo by Laurent W. Valliere.)

As a ch ild, I always dream edof beco m in g eith er a n urse
or a teach er. In itially I ch ose to
beco m e a n urse because I really
wan ted to h elp oth ers, esp e-

cially th ose wh o were ill. Th en I realized th at both of
m y dream s could com e true; I could be both a n urse
an d a teach er. So I pursued m y dream s.

I received m y diplom a in n ursin g at Cooley Dickin –
son Hospital Sch o ol of Nursin g in North am pton , Mas-
sach usetts. Afterward, I worked at Baystate Med ical
Cen ter in Sprin gfield, Massach usetts, wh ere I cared for
clien ts in acute m edical-surgical un its, th e in ten sive care
un it, th e em ergen cy dep artm en t, pediatric un its, an d
oth er acu te care un its. Later I received an associate degree
from Holyo ke Com m un ity College in Ho lyoke, Massa-
ch usetts; m y BSN from Am erican In tern ation al College
in Sprin gfield, Massach usetts; an d m y MSN from An n a
Maria College in Paxton , Massach usetts, with a dual
m ajo r in Nursin g Man agem en t an d Patien t Education .
I received m y Ph D in Nu rsin g from th e Un iversity of
Nevad a, Las Vegas, an d con d ucted research on self-
efficacy an d th e predictors of NCLEX® success. I am also
a m em ber of th e Hon o r Society of Nu rsin g, Sigm a Th eta
Tau In tern ation al, Ph i Kappa Ph i, th e Am erican Nu rses
Asso ciation , th e Nation al League for Nursin g, th e West-
ern In stitute of Nursin g, th e Eastern Nu rsin g Research
Society, an d th e Golden Key In tern ation al Ho n our Soci-
ety. In ad dition , I received th e 2012 Alum n a of th e Year/
Nurse of th e Year Award from th e Un iversity of Nevada,
Las Vegas, Sch ool of Nursin g.

As a n ative of Sprin gfield, Massach usetts, I began m y
teach in g career as an in structo r of m edical-surgical n urs-
in g an d leadersh ip-m an agem en t n ursin g in 1981 at
Baystate Med ical Cen ter Sch ool of Nu rsin g. In 1989,

I relocated to Rh od e Islan d an d began teach in g ad-
van ced m edical-surgical n ursin g an d psych iatric n ursin g
to RN an d LPN studen ts at th e Com m un ity College of
Rh ode Islan d. Wh ile teach in g th ere, a group of studen ts
approach ed m e for assistan ce in preparin g for th e
NCLEX exam in ation . I h ave always h ad a very special
in terest in test success for n ursin g studen ts because of
m y own person al experien ces with testin g. Takin g tests
was n ever easy for m e, an d as a studen t I n eeded to fin d
m eth od s an d strategies th at would brin g success. My
own difficult experien ces, desire, an d dedication to assist
n ursin g studen ts to overcom e th e obstacles associated
with testin g in spired m e to develop an d write th e m an y
produ cts th at would foster success with testin g. My exp e-
rien ces as a studen t, n ursin g edu cator, an d item writer
for th e NCLEX exam in ation s aided m e as I developed
a com preh en sive review course to prepare n ursin g
graduates for th e NCLEX exam in ation .

Later, in 1994, I began teach in g m edical-su rgical
n ursin g at Salve Regin a Un iversity in Newport, Rh ode
Islan d, an d I rem ain th ere as an ad jun ct faculty m em ber.
I also prepare n ursin g studen ts at Salve Regin a Un iversity
for th e NCLEX-RN exam in ation .

I establish ed Profession al Nursin g Sem in ars, In c. in
1991 and Nursin g Reviews, In c. in 2000. Th ese com pan ies
are located in Ch arlestown , Rh ode Islan d. In 2012, I estab-
lish ed an addition al com pan y, Nursin g Reviews, In c. in
Hen derson , Nevada. Both com panies are dedicated to
h elpin g n ursin g graduates ach ieve th eir goals of becom in g
registered n urses, licen sed practical/ vocation al n urses,
or both .

Today, I am th e successful auth o r of n um erou s
review produ cts. Also, I serve as an Elsevier con sultan t
for HESI Live Reviews, th e review courses for th e NCLEX
exam in ation s con ducted th rough ou t th e coun try. I am
so pleased th at you h ave decided to join m e on your
journ ey to success in testin g for n ursin g exam in ation s
an d for th e NCLEX-RN exam in ation !

vii

Contributors

Consultants
Dia nne E. Fiorent ino
Research Co o rd in ato r
Nu rsin g Reviews, In c.
Hen d erson , Nevad a

Ja mes Guiba ult, Jr., BS, Pha rmD
Clin ical Ph arm acist
Wilbrah am , Massach usetts

Nichola s L. Silvest ri, BA
Ed itorial an d Co m m u n icatio n s An alyst
Nu rsin g Reviews, In c.
Ch arlesto wn , Rh o de Islan d

Ja ne Tyerma n, RN, MScN, PhD
Facu lty
Tren t/ Flem in g Sch oo l o f Nu rsin g
Peterb oro ugh , O n tario, Can ada

Contributors
Ma rilee Aufdenkamp, BSN, MS
Assistan t Pro fesso r
Sch oo l o f Nu rsin g
Creigh to n Un iversity
O m ah a, Nebraska

Ja skaranjeet Bhulla r, RN
Graduate
Sch oo l o f Nu rsin g
To uro Un iversity Nevad a
Hen d erson , Nevad a

Jea n Burt , BS, BSN, MSN
In structor, Nu rsin g
City Co lleges o f Ch icago
Ch icago , Illin o is

Reit ha Ca ba niss, EdD, MSN
Nu rsin g Directo r
Bevill State Co m m u n ity College
Jasp er, Alab am a

Ba rbara Ca llaha n, MEd, RN, NCC, CHSE
Retired
Len oir Com m un ity College
Kin ston , No rth Carolin a

Na ncy Curry, BSN, MSN
Assistan t Pro fessor, Nu rsin g
No rth western State Un iversity Co llege o f Nu rsin g an d Sch o ol

o f Allied Health
Sh revepo rt, Lou isian a

Ma tt ie Da vis, DNP, MSN, RN
Nu rsin g In stru cto r, Health Scien ces
J.F. Drake State Tech n ical Co llege
Hun tsville, Alabam a

Ma rgie Fra ncisco, EdD, MSN, RN
Nu rsin g Professo r
Health Division
Illin ois Valley Com m un ity College
O glesby, Illin o is

Ma rilyn Greer, MS, RN
Asso ciate Professo r o f Nu rsin g
Ro ckfo rd Co llege
Ro ckfo rd , Illin o is

Joyce Ha mmer, RN, MSN
Ad ju n ct Facu lty, Nursin g
Mon ro e Co un ty Com m un ity College
Mon ro e, Mich igan

Donna Russo, MSN, CCRN, CNE
Nu rsin g In stru cto r
ARIA Health Sch oo l o f Nu rsin g
Ph ilad elp h ia, Pen n sylvan ia

Ma ry Scheid, RN, MSN
NCMC Breast Cen ter
No rth Colo rad o Medical Cen ter
Greeley, Colorado

Laurent W. Va lliere, BS, DD
Vice Presiden t o f Nu rsin g Reviews, In c.
Pro fessio n al Nu rsin g Sem in ars, In c.
Ch arlesto wn , Rh o de Islan d

Donna Wilsker, MSN, BSN
Assistan t Pro fessor
Dish m an Dep artm en t of Nursin g
Lam ar Un iversity
Beau m on t, Texas

viii

Item Writer and Section Editor
Donna Russo, MSN, CCRN, CNE
Nursin g In structor
ARIA Health Sch o ol of Nursin g
Ph iladelph ia, Pen n sylvan ia

Item Writers
Amber Ba llard, MSN, RN
Registered Nurse
Em ergen cy Dep artm en t
Sp arrow Health System
Lan sin g, Mich igan

Bett y Cheng, MSN
Assistan t Professor
Sch o ol o f Nursin g
MCPHS Un iversity
Bosto n , Massach u setts

Christ ina Keller, MSN, RN
In stru cto r
Sch o ol o f Nursin g
Radfo rd Un iversity
Radfo rd , Virgin ia

Heidi Monroe, MSN, RN-BC, CAPA
Assistan t Professor o f Nu rsin g
NCLEX-RN® Co ordin ator
Bellin Co llege
Green Bay, Wiscon sin

Betha ny Hawes Sykes, EdD, RN, CEN, CCRN
Em ergen cy Dep artm en t RN
St Lu ke’s Hosp ital
New Bed ford, Massach usetts
Adju n ct Faculty
Departm en t o f Nu rsin g
Salve Regin a Un iversity
Newp ort, Rh o de Islan d

Linda Turchin, RN, MSN, CNE
Assistan t Professo r, Nu rsin g
Fairm o n t State Un iversity
Fairm o n t, West Virgin ia

Donna Wilsker, MSN, BSN
Assistan t Professo r
Dish m an Departm en t o f Nu rsin g
Lam ar Un iversity
Beaum o n t, Texas

Olga Va n Dyke, PhD (c), CAGS, MSN
Assistan t Professo r
Sch o ol o f Nu rsin g
MCPHS Un iversity
Bosto n , Massach u setts

The author and publisher would also like to acknowledge the following individuals for contributions to the previous edition of this book:

Marilee Au fd en kam p , RN, MS
Hastin gs, Neb raska

Margaret Barn es, MSN, RN
Marion , In dian a

Reith a Cab an iss, MSN, RN, CNE
Jasp er, Alabam a

Jo an n a E. Cain , BSN, BA, RN
Austin , Texas

Barb ara Callah an , MEd , RN, NCC,
CHSE

Kin sto n , North Caro lin a

Mary C. Carrico , MS, RN
Pad ucah , Ken tu cky

Mary L. Do well, Ph D, RN, BC
San An to n io, Texas

Beth B. Gau l, Ph D, RN
Des Moin es, Io wa

Su san Go ld en , MSN, RN
Ro swell, New Mexico

Marilyn L. Jo h n essee Greer, MS, RN
Ro ckfo rd , Illin ois

Jam ie Lyn n Jo n es, MSN, RN, CNE
Little Rock, Arkan sas

Lyn n Ko rvick, Ph D, RN, CNE
Jop lin , Misso u ri

Tara McMillan -Q u een , RN, MSN,
ANP, GNP

Ch arlo tte, North Carolin a

Heid i Mo n ro e, MSN, RN-BC, CPAN,
CAPA

Green Bay, Wisco n sin

David Mo rro w, BSN, RN
Las Vegas, Nevad a

Deb ra L. Price, RN, MSN, CPNP
Fort Worth , Texas

Do n n a Ru sso , RN, MSN, CCRN
Ph ilad elp h ia, Pen n sylvan ia

An gela Silvestri, Ph D, RN, CNE
Hen d erson , Nevad a

Ch ristin e Su m p , MSN, RN
No rfo lk, Virgin ia

Beth an y Hawes Sykes, Ed D, RN,
CEN, CCRN

Newpo rt, Rh od e Islan d

Lin d a Tu rch in , RN, MSN, CNE
Fairm o n t, West Virgin ia

Lau ren t W. Valliere, BS, DD
Ch arlesto wn , Rh o de Islan d

ixContributors

Reviewers

Da nese M. Boob, RN-BC, BSN, MSN/ ED
Certification in Perin atal Nu rsin g an d Med ical-Surgical

Nu rsin g
Dep artm en t of Nursin g
Pen n sylvan ia State Un iversity
Hersh ey, Pen n sylvan ia

Jea n Eliza bet h Burt , MS, RN
Nu rsin g In stru cto r
Wilbu r Wrigh t Co llege
Ch icago , Illin o is

Bet ty Cheng, MSN, RN, FNP
In structor of Nursin g
Sch oo l o f Nu rsin g
Q uin cy College
Q uin cy, Massach usetts

Ma rguerite C. DeBello, RN, MSN, ACNS-BC,
CNE, NP

Assistan t Pro fesso r
Sch oo l o f Nu rsin g
Eastern Mich igan Un iversity
Ypsilan ti, Mich igan

Ma rgie L. Fra ncisco, EdD, MSN, RN
Nu rsin g Professo r
Nu rsin g/ Health Pro fessio n s Dep artm en t Illin o is
Valley Co m m u n ity Co llege
O glesb y, Illin o is

Shari Gould, MSN, RN
Asso ciate Professor o f Nu rsin g
Career, Health an d Tech n ical Profession s Departm en t
Victoria Co llege
Victoria, Texas

Sheila Grossman, PhD, APRN, FNP-BC, FAAN
Pro fessor & Coo rdin ato r, Fam ily Nu rse Practitio n er Track
Nu rsin g Departm en t
Fairfield Un iversity Sch oo l o f Nu rsin g
Fairfield, Co n n ecticut

Joyce Ha mmer, RN, MSN
Ad ju n ct Clin ical Facu lty
Nu rsin g Departm en t
Mon ro e Co u n ty Com m un ity College
Mon ro e, Mich igan

Lila h M. Ha rper, RN, CA
Presid en t, Harper Con sultin g Services
Valley Cen ter, Califo rn ia
Lead Nu rse Plan n er, An derso n Con tin u in g Edu catio n
Sacram en to, Califo rn ia

Laura Hope, MSN, RN
Nu rsin g Faculty
Nu rsin g Program
Floren ce-Darlin gto n Tech n ical Co llege
Floren ce, Sou th Caro lin a

Donna Wa lker Hubba rd, RN, MSN, CNNe
Assistan t Pro fessor, Retired
Nu rsin g Departm en t
Un iversity of Mary Hardin -Baylo r
Belton , Texas

Pa ula Celest e Hughes, MSN, RN
Nu rsin g Faculty
Nu rsin g an d Allied Health Dep artm en t
Georgia North western Tech n ical College
Ro m e, Geo rgia

Georgina Julious, RN, BSN, MSN
BLS In stru cto r; Facility Ad m in istrato r
Nu rsin g Departm en t
O ut-Patien t Dialysis
Hartsville, So uth Caro lin a

Eliza bet h B. McGrat h, MS, APRN, AGACNP-BC,
AOCNP, ACHPN

Nu rse Practitio n er
Dartm o uth Hitch cock Medical Cen ter—Geisel Sch oo l o f
Medicin e at Dartm ou th
Leb an o n , New Ham psh ire

Pa t A. Perryma n, MSN, RN, PhD
Presid en t
Ad m in istration
Dallas Nursin g In stitu te
Dallas, Texas

Ka ren Robert son, RN, MSN, MBA, PhD(c)
Asso ciate Professo r
Nu rsin g Departm en t
Ro ck Valley Co llege
Ro ckfo rd , Illin o isx

Charlot t e D. St ra hm, DNSc, RN, CNS
Assistan t Professor
Departm en t o f Nu rsin g
Pu rd ue Un iversity No rth Cen tral
Westville, In d ian a

Christ ine Sump, MSN, RN
Nursin g Lectu rer
Nursin g Dep artm en t
O ld Do m in io n Un iversity
Norfolk, Virgin ia

Daryle Wane, PhD, ARNP, FNP-BC
RN to BSN Coo rd in ato r
Departm en t o f Health O ccu patio n s
Pasco-Hern an d o State College
New Po rt Rich ey, Florid a

Donna Wilsker, MSN, RN
Assistan t Professo r
Dish m an Departm en t o f Nu rsin g
Lam ar Un iversity
Beaum o n t, Texas

Ka ren Winsor, MSN, RN, ACNS-BC
APRN for O rth op edic Trau m a
Austin , Texas

xiReviewers

Preface

“To laugh often and much, to appreciate beauty,
to find the best in others, to leave the world a bit better,

to know that even one life has breathed easier
because you have lived, this is to have succeeded.”

—Ralph Waldo Emerson

Welcome to Saunders Pyra mid
t o Success!
An Essential Resource for Test Success
Saunders Comprehensive Review for the NCLEX-RN ® Exam-
ination is on e in a series of produ cts design ed to assist
you in ach ievin g your go al of beco m in g a registered
n urse. Th is text will provide you with a com preh en sive
review of all n ursin g con ten t areas specifically related
to th e n ew 2016 test plan for th e NCLEX-RN exam in a-
tion , wh ich is im plem en ted by th e Nation al Coun cil
of State Boards of Nu rsin g. Th is resource will h elp
you ach ieve success on your n ursin g exam in ation s dur-
in g n ursin g sch o ol an d on th e NCLEX-RN exam in ation .

Organization

Th is book con tain s 20 un its an d 72 ch apters. Th e ch ap-
ters are design ed to iden tify specific com pon en ts of n urs-
in g con ten t. Th ey con tain practice question s, in cludin g a
critical th in kin g question , an d both m ultiple-ch oice an d
altern ate item form ats th at reflect th e ch apter con ten t
an d th e 2016 test plan for th e NCLEX-RN exam in ation .
Th e fin al un it con tain s a 75-question Com p reh en sive
Test. All question s in th e book an d on th e Evo lve site
are presen ted in NCLEX-style form at.

Th e n ew test plan iden tifies a fram ework based on
Client Needs. Th ese Clien t Needs categories in clude Safe
an d Effective Care En viron m en t, Health Prom otion and
Main ten ance, Psych osocial In tegrity, an d Physiological
In tegrity. Integrated Processes are also iden tified as a com –
pon en t of th e test plan . Th ese in clude Carin g, Com m un i-
cation an d Docum en tation , Culture an d Spirituality,
Nursin g Process, an d Teach in g an d Learn in g. All ch apters
address th e com pon en ts of th e test plan fram ework.

Special Features of the Book
Pyramid Terms
Pyramid Terms are im portan t to th e discussion of th e con –
ten t in th e ch apters in each un it. Th erefore, th ey are in

bold green type th rou gh out th e con ten t section of each
ch apter. Th e defin ition s can be foun d in th e Glossary at
th e en d of th e book.

Pyramid to Success
Th e Pyramid to Success, a featured part of each un it in –
troduction , provides you with an overview, guidan ce,
an d direction regardin g th e focus of review in the particular
con ten t area, as well as th e con ten t area’s relative im por-
tan ce to the 2016 test plan for th e NCLEX-RN exam in a-
tion . Th e Pyramid to Success reviews th e Clien t Needs an d
provides learn in g objectives as th ey pertain to the con ten t
in th at un it. Th ese learn in g objectives iden tify the specific
com pon en ts to keep in m in d as you review each ch apter.

Priority Concepts
Each ch apter iden tifies two Priority Concepts reflective of
its con ten t. Th ese Priority Concepts will assist you to focus
on th e im portan t aspects of th e con ten t an d associated
n ursin g in terven tion s.

Pyramid Points
Pyramid Points ( ) are placed next to specific content
through out th e ch apters. Th e Pyramid Points h ighlight con-
tent th at is im portan t for preparin g for the NCLEX-RN
exam ination and iden tify con ten t that is likely to …