r

Bill Lamsback
Art Director
Brett MacNaughton
Editorial Product Manager
Annette Ferran
Production Manager
Beth Martz
Design Coordinator
Joan Wendt
Manufacturing Manager
Beth J. Welsh
The clinical treatments described and recommended in this publication are based on research and consultation with nursing, medical,
and legal authorities. To the best of our knowledge, these procedures reflect currently accepted practice. Nevertheless, they cannot be
considered absolute and universal recommendations. For individual applications, all recommendations must be considered in light
of the patient’s clinical condition and, before administration of new or infrequently used drugs, in light of the latest package-insert
information. The authors and publisher disclaim any responsibility for any adverse effects resulting from the suggested procedures,
from any undetected errors, or from the reader’s misunderstanding of the text.
© 2011 by Wolters Kluwer Health | Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No part
of it may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means—electronic, mechanical, photocopy,
recording, or otherwise—without prior written permission of the publisher, except for brief quotations embodied in critical articles and
reviews and testing and evaluation materials provided by publisher to instructors whose schools have adopted its accompanying textbook. For
information, write Lippincott Williams & Wilkins, 323 Norristown Road, Suite 200, Ambler, PA 19002-2756.
BILLINGSQ&A9E011007
Library of Congress Cataloging-in-Publication Data
Billings, Diane McGovern.
Lippincott’s Q & A review for NCLEX-RN / Diane M. Billings. — 10th ed.
p. ; cm.
Other title: Lippincott’s Q and A review for NCLEX-RN
Other title: Q & A review for NCLEX-RN
Includes bibliographical references and index.
ISBN 978-1-60831-125-5 (alk. paper)
1. Nursing—Examinations, questions, etc. 2. National Council Licensure Examination for Registered Nurses—Study guides.
I. Title. II. Title: Lippincott’s Q and A review for NCLEX-RN. III. Title: Q & A review for NCLEX-RN.
[DNLM: 1. Nursing Care—Examination Questions. WY 18.2]
RT55.M29 2011
610.73076—dc22
2010026389

Contributors
v
Desiree Hensel, PhD, RNC-NIC, CNE
Assistant Professor
Indiana University School of Nursing
Bloomington, Indiana
Margie A. Hull, MEd, APRN-BC, CNS, CDE
Diabetes CNS, CDE
Wishard Health Services
Indianapolis, Indiana
Lesley Milgrom, RN, MSN
Clinical Assistant Professor
Indiana University School of Nursing
Indianapolis, Indiana
Lee Schwecke, BSN, MSN, EdD
Associate Professor Emeritus
Indiana University School of Nursing
Staff Nurse, Psychiatric Pavilion
Community Hospital North
Indianapolis, Indiana
Sharon Vinten, MSN, RN, WHNP, CNE
Staff Nurse
Carolina’s Health Care System
Charlotte, North Carolina
Sandra Wood, MSN, APRN BC
Clinical Assistant Professor Emerita
Indiana University School of Nursing
Indianapolis, Indiana
Contributors to the Previous Edition
Karen Bawel-Brinkley, RN, MS, MSN, PhD
Carol Bostrom, RN, MSN, APRN, BC
Judith A. Halstead, RN, DNS
Margie Hull, MED, MSN, APRN-BC, CDE-RN
Colleen M. O’Leary-Kelley, PhD, RN
Virginia Richardson, RN, DNS, CPNP
Pat Twedt, RN, MS
Gayle Roux, PhD, RN, NP-C
Lee W. Schwecke, RN, MSN, EdD
Evelyn Stephenson, MSN, RNC
Sharon Vinton, MSN, RNC, WNP, CNE
Mary Ann Wehmer, RN, MSN, CNOR
Sandra Wood, MSN, APRN, BC
vi
Reviewers
OB AND PEDS REVIEWERS
Samantha H. Bishop, MN, RN, CPNP
Assistant Professor of Nursing
Division of Nursing and Health Sciences
Gordon College
Barnesville, Georgia
Sally Boyster, MSN, CNE
Coordinator/Professor Women’s & Children’s Nursing
Rose State College
Midwest City, Oklahoma
Stephanie C. Butkus, MSN, RN, CPNP
Assistant Professor
Kettering College of Medical Arts
Kettering, Ohio
Darlene Nebel Cantu, RNC-NIC, C-EFM,BSN, MSN
Assistant Professor
San Antonio College
San Antonio, Texas
Online faculty in Masters Nursing Program
University Of Phoenix
Online faculty in RN to BSN Nursing Program
Chamberlain College of Nursing
Cynthia Chatham, BSN, MSN, DSN
Associate Professor
University of Southern Mississippi Gulf Coast
Campus
Long Beach, Mississippi
Kim Cooper, MSN
Nursing Department Program Chair
Ivy Tech Community College
Terre Haute, Indiana
Elizabeth Di Fabio, MSN, BSN
Nursing Instructor
Anoka-Ramsey Community College
Coon Rapids, Minnesota
L. Sue Gabriel, EdD, MFS, MSN, RN, SANE-A, CFN
Associate Professor
Bryan LGH College of Health Sciences, School of
Nursing
Lincoln, Nebraska
Rochelle Kuhn, RN, MS, CRNP
Pediatric Nursing Instructor
Frankford Hospital School of Nursing
Philadelphia, Pennsylvania
Lucy Megginson, MSN, RN, PhD student
Assistant Professor of Nursing
Georgia Highlands College
Rome, Georgia
Linda Strong, MSN, RN, CPNP, CNE
Assistant Professor, Pediatric Nursing
Cuyahoga Community College
Cleveland, Ohio
PSYCH REVIEWERS
Lois Angelo, MSN, APRN
Assistant Professor of Nursing
Massachusetts College of Pharmacy and Health
Sciences
Boston, Massachusetts
Harlene Caroline, BSN, MS, PhD(c)
Professor
Curry College
Milton, Massachusetts
Edith Claros, RN, APRN-BC, PhD(c)
Assistant Professor of Nursing
Massachusetts College of Pharmacy School of
Nursing
Worcester, Massachusetts
Brandy Mechling, RN, MSN, CNS, PhD student
Lecturer
University of North Carolina at Wilmington
Wilmington, North Carolina
Mitzi Grace Mitchell, BScN, BA, MHSc, MN, DNS, PhD(c),
RN, GNC(c)
Lecturer
York University
Toronto, Ontario, Canada
Reviewers vii
Wendy J. Waldspurger Robb, PhD, RN, CNE
Director of the Graduate Nursing Program
Assistant Professor
Cedar Crest College
Allentown, Pennsylvania
Tami J. Rogers, DVM, MSN, BSN
Professor of Nursing
Valencia Community College
Orlando, Florida
JoAnn Evanko Thistlethwaite, RN, MNEd, ABD
Assistant Professor Medical Surgical Nursing
Indiana University of Pennsylvania
Indiana, Pennsylvania
Susan K. Tucker, RN, BSN, MSN, DNP
Division Director of Nursing
Gadsen State Community College
Gadsen, AL
Donna Williams, DNP, RN
Nurse Faculty
Itawamba Community College
Fulton, MS
Judith Young, CCRN, BSN, MSN
Clinical Assistant Professor
Indiana University School of Nursing
Indianapolis, Indiana
Veronica Garcia Walker, MSN, BSN, RN
UT Clinical Faculty
The University of Texas at Austin
Austin, Texas
MED-SURG REVIEWERS
Marlys Bohn, BSN, MS, PhD
Department Head, Nursing Student Services
South Dakota State University
Brookings, South Dakota
Deborah A. Green, MSN, RN, BC
Clinical Education Coordinator
Clarian North Medical Center
Carmel, Indiana
Susan A. Lisko, DNP, RN, MSN, BSN
Assistant Professor of Nursing
Youngstown State University
Youngtown, Ohio
Gina Maiocco, PhD, RN, CCNS
Assistant Professor/Coordinator Fast Track Program
West Virginia University
Morgantown, West Virginia
Lisa Peden, BSN, MSN
Associate Professor of Nursing
Dalton State College
Dalton, Georgia
viii
Preface
Introduction to the Q&A Review for
NCLEX-RN®
This exam review book, the accompanying
CD-ROM, and the online study resources have been
developed to help you prepare for the National
Council Licensing Examination for Registered
Nurses (NCLEX-RN®). You will also find this book
helpful for review when preparing for course exams,
final exams, NCLEX-RN assessment exams, or other
standardized or competency exams.
Study resources
This review book includes multiple resources that
you can use in any combination to meet your own
study and test preparation plans:
■ More than 5,800 test questions using 8 different formats of question types including the new
audio, video, and graphic option questions.
■A CD-ROM with more than 1,300 questions
with rationales for correct and incorrect
answers that provides you with ample opportunity to experience test-taking using computeradministered questions
and allows you to
customize tests for specific review and
practice
■ Questions written for all clinical areas of nursing (childbearing family and their neonate;
nursing care of infants, children, and adolescents; nursing care of adults with medical and
surgical health problems; and nursing care of
clients with psychiatric disorders and mental
health problems)
■ Questions organized by health problems to
facilitate review for course-specific exams
■ Questions coded by client needs to assure practice in all areas of the NCLEX-RN test plan
■ Questions coded by cognitive level to guide
study and test-taking at higher levels of the
cognitive domain
■ Questions emphasizing integrative processes
on the NCLEX-RN test plan
■ Questions with teaching feedback and rationales for both correct and incorrect answers
■ Questions using all types of question formats
used on the licensing exam (multiple choice,
multiple response, hot-spot, fill-in-the blank,
drag-and-drop/ordered response, chart/exhibit,
as well as graphic, audio, and video inclusion
questions)
■ Questions primarily written at higher levels
of the cognitive domain (analysis, synthesis,
evaluation, and creation)
■ Questions emphasizing clinical decision making,
clinical judgment, and management of care
■ Questions to provide practice for calculating
drug dosages, intravenous drip rates, intake and
output, and other questions requiring calculation and reporting of a numerical response to the
question
■ Questions emphasizing current nursing practice in the areas of client safety, managing care
quality, home care, health promotion, care of
the older adult, cancer nursing, end-of-life care,
perioperative care, community health nursing,
and emergency and disaster nursing
■ Questions about managing care quality and
safety at the end of each chapter
■ An entire chapter that explains the various test
question formats and strategies for answering
each type of test item and at each level of the
cognitive domain
■ Six comprehensive tests of 180 questions each
designed to resemble the testing format of the
NCLEX-RN
■ A description of the current NCLEX-RN test
plan
■ A study plan and checklist to guide systematic
preparation for the licensing examination
■ Information about developing study skills, taking
tests, and managing test anxiety
■ Tips for studying from students who have
successfully passed the NCLEX-RN exam
■ Addresses, telephone numbers, and websites
for the National Council of State Boards of
Nursing, Inc., and each state board of nursing
■ Online resources for students, including tips
for test-taking and downloadable NCLEX questions for your handheld media device
Preface ix
in answering questions that require you to calculate
drug doses and drip rates for intravenous infusions.
Using This Review Package for Preparing
for Nursing Exams
We suggest that you begin your review by using
the practice exams in the book to identify areas of
strength and areas in which you need further study.
Each exam contains specific questions written in the
style of the NCLEX-RN. Answers include rationales
for both correct and incorrect answer options to
reinforce learning. You may wish to score the results
of each practice test and identify areas in which you
need further review. To evaluate your results after
completing each exam, divide the number of your
correct responses by the total number of questions
in the test and multiply by 100. For example, if
you answered 72 of 90 items correctly, you would
divide 72 by 90 and multiply by 100, for a result of
80%. If you answered more than 75% of the items
in an area correctly, you are most likely prepared to
answer questions in that area on the NCLEX-RN. If
you answered fewer than 75% of the questions correctly, you need to determine why. Did you answer
incorrectly because of lack of content knowledge or
because you did not read carefully? Use this information to guide your study.
After reviewing the specific content areas
in the practice exams, take the comprehensive
exams. These exams more realistically reflect the
NCLEX-RN because each test presents a variety of
situations commonly encountered in nursing practice and across all clinical disciplines. Underlying
knowledge, skills, and abilities related to the basic
sciences, fundamentals of nursing, pharmacology
and other therapeutic measures, communicable
diseases, legal and ethical considerations, and nutrition are included in items as needed to plan nursing
care for individual clients or groups of clients. The
comprehensive exams also include test items related
to client safety and care quality.
Next, use the CD-ROM to simulate taking computerized adaptive tests. Note how the questions
are presented on the computer screen, and practice
answering questions without using a pencil. Use the
diagnostic features of the CD-ROM to identify areas
for further study and develop your own customized
test for focused review.
And don’t forget to check the online resources
available at [Link] The
study tips will provide you with a foundation to begin
your exam preparation. The downloadable NCLEX
questions can be put on your iPhone, allowing you to
practice anytime and anywhere.
Organization of the book
The review book is organized in three sections. Each
section is designed to build on the previous section.
The first section of the book provides information about the licensing exam and how to prepare
for and take high-stakes examinations. A full chapter is devoted to explaining the various types of test
question formats and cognitive levels of questions
used on the licensing exam; the chapter also provides examples of all types and levels of questions
and strategies for answering them.
In the second section of the book, there are four
major units—nursing care of the childbearing family
and their neonate; nursing care of infants, children,
and adolescents; nursing care of adults with medical and surgical health problems; and nursing care
of clients with psychiatric disorders and mental
health problems. Within each unit, chapter tests are
grouped according to health problems and include
questions that are matched to the NCLEX-RN test
plan. At the end of each chapter there is a section of
questions about managing client safety and quality care. These questions are essential to test your
understanding of important concepts about patient
safety and quality. Because the test questions in this
section are organized around health problems, this
section is ideal for use when preparing for teachermade or commercially-prepared tests that focus on
specific content in your curriculum.
The third section of the book contains six
comprehensive exams written to simulate the
NCLEX-RN by placing test items in random order of
content area. Each test presents a variety of situations commonly encountered in nursing practice,
and includes test questions from all components of
the NCLEX-RN test plan and all types of questions
used on the licensing exam (except video and audio
questions, which are found only on the CD).
The CD-ROM
Additionally, this review package includes a CDROM with more than 1,300 questions. The CD-ROM
will allow you to practice with audio and video
questions, so be sure to use this feature of this Q&A
Review Book.
The CD-ROM can be used in several ways. For
example, you may take a test in the four content
areas, arrange a test to present questions in random
order, or select questions for particular review and
practice. The program also enables you to print out
test results to gauge your progress. The CD-ROM
simulates the actual NCLEX-RN exam by formatting
questions on a computer screen and requiring you to
use the keyboard and mouse to enter answers to the
questions. It also features a pop-up calculator for use
x
Acknowledgments
This book has been developed with the expertise
of a team of nationally recognized test item writers. Thanks to Desiree Hensel, Margie Hull, Leslie
Milgrom, Lee Schwecke, Sharon Vinten, and Sandy
Wood for developing questions to prepare students
for test-taking success. Thanks also to the editorial
staff at Lippincott Williams & Wilkins: Elizabeth
Nieginski for launching this book and Bill Lamsback
for guiding it to completion. Particular thanks goes
to developmental editor Annette Ferran for her
keen eye for design and detail, her ability to locate
resources for the new video, audio, and graphic
questions, and her support throughout the development of this book.
Diane M. Billings, EdD, RN, FAAN
Chancellor’s Professor Emeritus
Indiana University School of Nursing
xi
Abr
Bill Lamsback
Art Director
Brett MacNaughton
Editorial Product Manager
Annette Ferran
Production Manager
Beth Martz
Design Coordinator
Joan Wendt
Manufacturing Manager
Beth J. Welsh
The clinical treatments described and recommended in this publication are based on research and consultation with nursing, medical,
and legal authorities. To the best of our knowledge, these procedures reflect currently accepted practice. Nevertheless, they cannot be
considered absolute and universal recommendations. For individual applications, all recommendations must be considered in light
of the patient’s clinical condition and, before administration of new or infrequently used drugs, in light of the latest package-insert
information. The authors and publisher disclaim any responsibility for any adverse effects resulting from the suggested procedures,
from any undetected errors, or from the reader’s misunderstanding of the text.
© 2011 by Wolters Kluwer Health | Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No part
of it may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means—electronic, mechanical, photocopy,
recording, or otherwise—without prior written permission of the publisher, except for brief quotations embodied in critical articles and
reviews and testing and evaluation materials provided by publisher to instructors whose schools have adopted its accompanying textbook. For
information, write Lippincott Williams & Wilkins, 323 Norristown Road, Suite 200, Ambler, PA 19002-2756.
BILLINGSQ&A9E011007
Library of Congress Cataloging-in-Publication Data
Billings, Diane McGovern.
Lippincott’s Q & A review for NCLEX-RN / Diane M. Billings. — 10th ed.
p. ; cm.
Other title: Lippincott’s Q and A review for NCLEX-RN
Other title: Q & A review for NCLEX-RN
Includes bibliographical references and index.
ISBN 978-1-60831-125-5 (alk. paper)
1. Nursing—Examinations, questions, etc. 2. National Council Licensure Examination for Registered Nurses—Study guides.
I. Title. II. Title: Lippincott’s Q and A review for NCLEX-RN. III. Title: Q & A review for NCLEX-RN.
[DNLM: 1. Nursing Care—Examination Questions. WY 18.2]
RT55.M29 2011
610.73076—dc22
2010026389

Contributors
v
Desiree Hensel, PhD, RNC-NIC, CNE
Assistant Professor
Indiana University School of Nursing
Bloomington, Indiana
Margie A. Hull, MEd, APRN-BC, CNS, CDE
Diabetes CNS, CDE
Wishard Health Services
Indianapolis, Indiana
Lesley Milgrom, RN, MSN
Clinical Assistant Professor
Indiana University School of Nursing
Indianapolis, Indiana
Lee Schwecke, BSN, MSN, EdD
Associate Professor Emeritus
Indiana University School of Nursing
Staff Nurse, Psychiatric Pavilion
Community Hospital North
Indianapolis, Indiana
Sharon Vinten, MSN, RN, WHNP, CNE
Staff Nurse
Carolina’s Health Care System
Charlotte, North Carolina
Sandra Wood, MSN, APRN BC
Clinical Assistant Professor Emerita
Indiana University School of Nursing
Indianapolis, Indiana
Contributors to the Previous Edition
Karen Bawel-Brinkley, RN, MS, MSN, PhD
Carol Bostrom, RN, MSN, APRN, BC
Judith A. Halstead, RN, DNS
Margie Hull, MED, MSN, APRN-BC, CDE-RN
Colleen M. O’Leary-Kelley, PhD, RN
Virginia Richardson, RN, DNS, CPNP
Pat Twedt, RN, MS
Gayle Roux, PhD, RN, NP-C
Lee W. Schwecke, RN, MSN, EdD
Evelyn Stephenson, MSN, RNC
Sharon Vinton, MSN, RNC, WNP, CNE
Mary Ann Wehmer, RN, MSN, CNOR
Sandra Wood, MSN, APRN, BC
vi
Reviewers
OB AND PEDS REVIEWERS
Samantha H. Bishop, MN, RN, CPNP
Assistant Professor of Nursing
Division of Nursing and Health Sciences
Gordon College
Barnesville, Georgia
Sally Boyster, MSN, CNE
Coordinator/Professor Women’s & Children’s Nursing
Rose State College
Midwest City, Oklahoma
Stephanie C. Butkus, MSN, RN, CPNP
Assistant Professor
Kettering College of Medical Arts
Kettering, Ohio
Darlene Nebel Cantu, RNC-NIC, C-EFM,BSN, MSN
Assistant Professor
San Antonio College
San Antonio, Texas
Online faculty in Masters Nursing Program
University Of Phoenix
Online faculty in RN to BSN Nursing Program
Chamberlain College of Nursing
Cynthia Chatham, BSN, MSN, DSN
Associate Professor
University of Southern Mississippi Gulf Coast
Campus
Long Beach, Mississippi
Kim Cooper, MSN
Nursing Department Program Chair
Ivy Tech Community College
Terre Haute, Indiana
Elizabeth Di Fabio, MSN, BSN
Nursing Instructor
Anoka-Ramsey Community College
Coon Rapids, Minnesota
L. Sue Gabriel, EdD, MFS, MSN, RN, SANE-A, CFN
Associate Professor
Bryan LGH College of Health Sciences, School of
Nursing
Lincoln, Nebraska
Rochelle Kuhn, RN, MS, CRNP
Pediatric Nursing Instructor
Frankford Hospital School of Nursing
Philadelphia, Pennsylvania
Lucy Megginson, MSN, RN, PhD student
Assistant Professor of Nursing
Georgia Highlands College
Rome, Georgia
Linda Strong, MSN, RN, CPNP, CNE
Assistant Professor, Pediatric Nursing
Cuyahoga Community College
Cleveland, Ohio
PSYCH REVIEWERS
Lois Angelo, MSN, APRN
Assistant Professor of Nursing
Massachusetts College of Pharmacy and Health
Sciences
Boston, Massachusetts
Harlene Caroline, BSN, MS, PhD(c)
Professor
Curry College
Milton, Massachusetts
Edith Claros, RN, APRN-BC, PhD(c)
Assistant Professor of Nursing
Massachusetts College of Pharmacy School of
Nursing
Worcester, Massachusetts
Brandy Mechling, RN, MSN, CNS, PhD student
Lecturer
University of North Carolina at Wilmington
Wilmington, North Carolina
Mitzi Grace Mitchell, BScN, BA, MHSc, MN, DNS, PhD(c),
RN, GNC(c)
Lecturer
York University
Toronto, Ontario, Canada
Reviewers vii
Wendy J. Waldspurger Robb, PhD, RN, CNE
Director of the Graduate Nursing Program
Assistant Professor
Cedar Crest College
Allentown, Pennsylvania
Tami J. Rogers, DVM, MSN, BSN
Professor of Nursing
Valencia Community College
Orlando, Florida
JoAnn Evanko Thistlethwaite, RN, MNEd, ABD
Assistant Professor Medical Surgical Nursing
Indiana University of Pennsylvania
Indiana, Pennsylvania
Susan K. Tucker, RN, BSN, MSN, DNP
Division Director of Nursing
Gadsen State Community College
Gadsen, AL
Donna Williams, DNP, RN
Nurse Faculty
Itawamba Community College
Fulton, MS
Judith Young, CCRN, BSN, MSN
Clinical Assistant Professor
Indiana University School of Nursing
Indianapolis, Indiana
Veronica Garcia Walker, MSN, BSN, RN
UT Clinical Faculty
The University of Texas at Austin
Austin, Texas
MED-SURG REVIEWERS
Marlys Bohn, BSN, MS, PhD
Department Head, Nursing Student Services
South Dakota State University
Brookings, South Dakota
Deborah A. Green, MSN, RN, BC
Clinical Education Coordinator
Clarian North Medical Center
Carmel, Indiana
Susan A. Lisko, DNP, RN, MSN, BSN
Assistant Professor of Nursing
Youngstown State University
Youngtown, Ohio
Gina Maiocco, PhD, RN, CCNS
Assistant Professor/Coordinator Fast Track Program
West Virginia University
Morgantown, West Virginia
Lisa Peden, BSN, MSN
Associate Professor of Nursing
Dalton State College
Dalton, Georgia
viii
Preface
Introduction to the Q&A Review for
NCLEX-RN®
This exam review book, the accompanying
CD-ROM, and the online study resources have been
developed to help you prepare for the National
Council Licensing Examination for Registered
Nurses (NCLEX-RN®). You will also find this book
helpful for review when preparing for course exams,
final exams, NCLEX-RN assessment exams, or other
standardized or competency exams.
Study resources
This review book includes multiple resources that
you can use in any combination to meet your own
study and test preparation plans:
■ More than 5,800 test questions using 8 different formats of question types including the new
audio, video, and graphic option questions.
■ A CD-ROM with more than 1,300 questions
with rationales for correct and incorrect
answers that provides you with ample opportunity to experience test-taking using computeradministered questions
and allows you to
customize tests for specific review and
practice
■ Questions written for all clinical areas of nursing (childbearing family and their neonate;
nursing care of infants, children, and adolescents; nursing care of adults with medical and
surgical health problems; and nursing care of
clients with psychiatric disorders and mental
health problems)
■ Questions organized by health problems to
facilitate review for course-specific exams
■ Questions coded by client needs to assure practice in all areas of the NCLEX-RN test plan
■ Questions coded by cognitive level to guide
study and test-taking at higher levels of the
cognitive domain
■ Questions emphasizing integrative processes
on the NCLEX-RN test plan
■ Questions with teaching feedback and rationales for both correct and incorrect answers
■ Questions using all types of question formats
used on the licensing exam (multiple choice,
multiple response, hot-spot, fill-in-the blank,
drag-and-drop/ordered response, chart/exhibit,
as well as graphic, audio, and video inclusion
questions)
■ Questions primarily written at higher levels
of the cognitive domain (analysis, synthesis,
evaluation, and creation)
■ Questions emphasizing clinical decision making,
clinical judgment, and management of care
■ Questions to provide practice for calculating
drug dosages, intravenous drip rates, intake and
output, and other questions requiring calculation and reporting of a numerical response to the
question
■ Questions emphasizing current nursing practice in the areas of client safety, managing care
quality, home care, health promotion, care of
the older adult, cancer nursing, end-of-life care,
perioperative care, community health nursing,
and emergency and disaster nursing
■ Questions about managing care quality and
safety at the end of each chapter
■ An entire chapter that explains the various test
question formats and strategies for answering
each type of test item and at each level of the
cognitive domain
■ Six comprehensive tests of 180 questions each
designed to resemble the testing format of the
NCLEX-RN
■ A description of the current NCLEX-RN test
plan
■ A study plan and checklist to guide systematic
preparation for the licensing examination
■ Information about developing study skills, taking
tests, and managing test anxiety
■ Tips for studying from students who have
successfully passed the NCLEX-RN exam
■ Addresses, telephone numbers, and websites
for the National Council of State Boards of
Nursing, Inc., and each state board of nursing
■ Online resources for students, including tips
for test-taking and downloadable NCLEX questions for your handheld media device
Preface ix
in answering questions that require you to calculate
drug doses and drip rates for intravenous infusions.
Using This Review Package for Preparing
for Nursing Exams
We suggest that you begin your review by using
the practice exams in the book to identify areas of
strength and areas in which you need further study.
Each exam contains specific questions written in the
style of the NCLEX-RN. Answers include rationales
for both correct and incorrect answer options to
reinforce learning. You may wish to score the results
of each practice test and identify areas in which you
need further review. To evaluate your results after
completing each exam, divide the number of your
correct responses by the total number of questions
in the test and multiply by 100. For example, if
you answered 72 of 90 items correctly, you would
divide 72 by 90 and multiply by 100, for a result of
80%. If you answered more than 75% of the items
in an area correctly, you are most likely prepared to
answer questions in that area on the NCLEX-RN. If
you answered fewer than 75% of the questions correctly, you need to determine why. Did you answer
incorrectly because of lack of content knowledge or
because you did not read carefully? Use this information to guide your study.
After reviewing the specific content areas
in the practice exams, take the comprehensive
exams. These exams more realistically reflect the
NCLEX-RN because each test presents a variety of
situations commonly encountered in nursing practice and across all clinical disciplines. Underlying
knowledge, skills, and abilities related to the basic
sciences, fundamentals of nursing, pharmacology
and other therapeutic measures, communicable
diseases, legal and ethical considerations, and nutrition are included in items as needed to plan nursing
care for individual clients or groups of clients. The
comprehensive exams also include test items related
to client safety and care quality.
Next, use the CD-ROM to simulate taking computerized adaptive tests. Note how the questions
are presented on the computer screen, and practice
answering questions without using a pencil. Use the
diagnostic features of the CD-ROM to identify areas
for further study and develop your own customized
test for focused review.
And don’t forget to check the online resources
available at [Link] The
study tips will provide you with a foundation to begin
your exam preparation. The downloadable NCLEX
questions can be put on your iPhone, allowing you to
practice anytime and anywhere.
Organization of the book
The review book is organized in three sections. Each
section is designed to build on the previous section.
The first section of the book provides information about the licensing exam and how to prepare
for and take high-stakes examinations. A full chapter is devoted to explaining the various types of test
question formats and cognitive levels of questions
used on the licensing exam; the chapter also provides examples of all types and levels of questions
and strategies for answering them.
In the second section of the book, there are four
major units—nursing care of the childbearing family
and their neonate; nursing care of infants, children,
and adolescents; nursing care of adults with medical and surgical health problems; and nursing care
of clients with psychiatric disorders and mental
health problems. Within each unit, chapter tests are
grouped according to health problems and include
questions that are matched to the NCLEX-RN test
plan. At the end of each chapter there is a section of
questions about managing client safety and quality care. These questions are essential to test your
understanding of important concepts about patient
safety and quality. Because the test questions in this
section are organized around health problems, this
section is ideal for use when preparing for teachermade or commercially-prepared tests that focus on
specific content in your curriculum.
The third section of the book contains six
comprehensive exams written to simulate the
NCLEX-RN by placing test items in random order of
content area. Each test presents a variety of situations commonly encountered in nursing practice,
and includes test questions from all components of
the NCLEX-RN test plan and all types of questions
used on the licensing exam (except video and audio
questions, which are found only on the CD).
The CD-ROM
Additionally, this review package includes a CDROM with more than 1,300 questions. The CD-ROM
will allow you to practice with audio and video
questions, so be sure to use this feature of this Q&A
Review Book.
The CD-ROM can be used in several ways. For
example, you may take a test in the four content
areas, arrange a test to present questions in random
order, or select questions for particular review and
practice. The program also enables you to print out
test results to gauge your progress. The CD-ROM
simulates the actual NCLEX-RN exam by formatting
questions on a computer screen and requiring you to
use the keyboard and mouse to enter answers to the
questions. It also features a pop-up calculator for use
x
Acknowledgments
This book has been developed with the expertise
of a team of nationally recognized test item writers. Thanks to Desiree Hensel, Margie Hull, Leslie
Milgrom, Lee Schwecke, Sharon Vinten, and Sandy
Wood for developing questions to prepare students
for test-taking success. Thanks also to the editorialr

Bill Lamsback
Art Director
Brett MacNaughton
Editorial Product Manager
Annette Ferran
Production Manager
Beth Martz
Design Coordinator
Joan Wendt
Manufacturing Manager
Beth J. Welsh
The clinical treatments described and recommended in this publication are based on research and consultation with nursing, medical,
and legal authorities. To the best of our knowledge, these procedures reflect currently accepted practice. Nevertheless, they cannot be
considered absolute and universal recommendations. For individual applications, all recommendations must be considered in light
of the patient’s clinical condition and, before administration of new or infrequently used drugs, in light of the latest package-insert
information. The authors and publisher disclaim any responsibility for any adverse effects resulting from the suggested procedures,
from any undetected errors, or from the reader’s misunderstanding of the text.
© 2011 by Wolters Kluwer Health | Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No part
of it may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means—electronic, mechanical, photocopy,
recording, or otherwise—without prior written permission of the publisher, except for brief quotations embodied in critical articles and
reviews and testing and evaluation materials provided by publisher to instructors whose schools have adopted its accompanying textbook. For
information, write Lippincott Williams & Wilkins, 323 Norristown Road, Suite 200, Ambler, PA 19002-2756.
BILLINGSQ&A9E011007
Library of Congress Cataloging-in-Publication Data
Billings, Diane McGovern.
Lippincott’s Q & A review for NCLEX-RN / Diane M. Billings. — 10th ed.
p. ; cm.
Other title: Lippincott’s Q and A review for NCLEX-RN
Other title: Q & A review for NCLEX-RN
Includes bibliographical references and index.
ISBN 978-1-60831-125-5 (alk. paper)
1. Nursing—Examinations, questions, etc. 2. National Council Licensure Examination for Registered Nurses—Study guides.
I. Title. II. Title: Lippincott’s Q and A review for NCLEX-RN. III. Title: Q & A review for NCLEX-RN.
[DNLM: 1. Nursing Care—Examination Questions. WY 18.2]
RT55.M29 2011
610.73076—dc22
2010026389

Contributors
v
Desiree Hensel, PhD, RNC-NIC, CNE
Assistant Professor
Indiana University School of Nursing
Bloomington, Indiana
Margie A. Hull, MEd, APRN-BC, CNS, CDE
Diabetes CNS, CDE
Wishard Health Services
Indianapolis, Indiana
Lesley Milgrom, RN, MSN
Clinical Assistant Professor
Indiana University School of Nursing
Indianapolis, Indiana
Lee Schwecke, BSN, MSN, EdD
Associate Professor Emeritus
Indiana University School of Nursing
Staff Nurse, Psychiatric Pavilion
Community Hospital North
Indianapolis, Indiana
Sharon Vinten, MSN, RN, WHNP, CNE
Staff Nurse
Carolina’s Health Care System
Charlotte, North Carolina
Sandra Wood, MSN, APRN BC
Clinical Assistant Professor Emerita
Indiana University School of Nursing
Indianapolis, Indiana
Contributors to the Previous Edition
Karen Bawel-Brinkley, RN, MS, MSN, PhD
Carol Bostrom, RN, MSN, APRN, BC
Judith A. Halstead, RN, DNS
Margie Hull, MED, MSN, APRN-BC, CDE-RN
Colleen M. O’Leary-Kelley, PhD, RN
Virginia Richardson, RN, DNS, CPNP
Pat Twedt, RN, MS
Gayle Roux, PhD, RN, NP-C
Lee W. Schwecke, RN, MSN, EdD
Evelyn Stephenson, MSN, RNC
Sharon Vinton, MSN, RNC, WNP, CNE
Mary Ann Wehmer, RN, MSN, CNOR
Sandra Wood, MSN, APRN, BC
vi
Reviewers
OB AND PEDS REVIEWERS
Samantha H. Bishop, MN, RN, CPNP
Assistant Professor of Nursing
Division of Nursing and Health Sciences
Gordon College
Barnesville, Georgia
Sally Boyster, MSN, CNE
Coordinator/Professor Women’s & Children’s Nursing
Rose State College
Midwest City, Oklahoma
Stephanie C. Butkus, MSN, RN, CPNP
Assistant Professor
Kettering College of Medical Arts
Kettering, Ohio
Darlene Nebel Cantu, RNC-NIC, C-EFM,BSN, MSN
Assistant Professor
San Antonio College
San Antonio, Texas
Online faculty in Masters Nursing Program
University Of Phoenix
Online faculty in RN to BSN Nursing Program
Chamberlain College of Nursing
Cynthia Chatham, BSN, MSN, DSN
Associate Professor
University of Southern Mississippi Gulf Coast
Campus
Long Beach, Mississippi
Kim Cooper, MSN
Nursing Department Program Chair
Ivy Tech Community College
Terre Haute, Indiana
Elizabeth Di Fabio, MSN, BSN
Nursing Instructor
Anoka-Ramsey Community College
Coon Rapids, Minnesota
L. Sue Gabriel, EdD, MFS, MSN, RN, SANE-A, CFN
Associate Professor
Bryan LGH College of Health Sciences, School of
Nursing
Lincoln, Nebraska
Rochelle Kuhn, RN, MS, CRNP
Pediatric Nursing Instructor
Frankford Hospital School of Nursing
Philadelphia, Pennsylvania
Lucy Megginson, MSN, RN, PhD student
Assistant Professor of Nursing
Georgia Highlands College
Rome, Georgia
Linda Strong, MSN, RN, CPNP, CNE
Assistant Professor, Pediatric Nursing
Cuyahoga Community College
Cleveland, Ohio
PSYCH REVIEWERS
Lois Angelo, MSN, APRN
Assistant Professor of Nursing
Massachusetts College of Pharmacy and Health
Sciences
Boston, Massachusetts
Harlene Caroline, BSN, MS, PhD(c)
Professor
Curry College
Milton, Massachusetts
Edith Claros, RN, APRN-BC, PhD(c)
Assistant Professor of Nursing
Massachusetts College of Pharmacy School of
Nursing
Worcester, Massachusetts
Brandy Mechling, RN, MSN, CNS, PhD student
Lecturer
University of North Carolina at Wilmington
Wilmington, North Carolina
Mitzi Grace Mitchell, BScN, BA, MHSc, MN, DNS, PhD(c),
RN, GNC(c)
Lecturer
York University
Toronto, Ontario, Canada
Reviewers vii
Wendy J. Waldspurger Robb, PhD, RN, CNE
Director of the Graduate Nursing Program
Assistant Professor
Cedar Crest College
Allentown, Pennsylvania
Tami J. Rogers, DVM, MSN, BSN
Professor of Nursing
Valencia Community College
Orlando, Florida
JoAnn Evanko Thistlethwaite, RN, MNEd, ABD
Assistant Professor Medical Surgical Nursing
Indiana University of Pennsylvania
Indiana, Pennsylvania
Susan K. Tucker, RN, BSN, MSN, DNP
Division Director of Nursing
Gadsen State Community College
Gadsen, AL
Donna Williams, DNP, RN
Nurse Faculty
Itawamba Community College
Fulton, MS
Judith Young, CCRN, BSN, MSN
Clinical Assistant Professor
Indiana University School of Nursing
Indianapolis, Indiana
Veronica Garcia Walker, MSN, BSN, RN
UT Clinical Faculty
The University of Texas at Austin
Austin, Texas
MED-SURG REVIEWERS
Marlys Bohn, BSN, MS, PhD
Department Head, Nursing Student Services
South Dakota State University
Brookings, South Dakota
Deborah A. Green, MSN, RN, BC
Clinical Education Coordinator
Clarian North Medical Center
Carmel, Indiana
Susan A. Lisko, DNP, RN, MSN, BSN
Assistant Professor of Nursing
Youngstown State University
Youngtown, Ohio
Gina Maiocco, PhD, RN, CCNS
Assistant Professor/Coordinator Fast Track Program
West Virginia University
Morgantown, West Virginia
Lisa Peden, BSN, MSN
Associate Professor of Nursing
Dalton State College
Dalton, Georgia
viii
Preface
Introduction to the Q&A Review for
NCLEX-RN®
This exam review book, the accompanying
CD-ROM, and the online study resources have been
developed to help you prepare for the National
Council Licensing Examination for Registered
Nurses (NCLEX-RN®). You will also find this book
helpful for review when preparing for course exams,
final exams, NCLEX-RN assessment exams, or other
standardized or competency exams.
Study resources
This review book includes multiple resources that
you can use in any combination to meet your own
study and test preparation plans:
■ More than 5,800 test questions using 8 different formats of question types including the new
audio, video, and graphic option questions.
■ A CD-ROM with more than 1,300 questions
with rationales for correct and incorrect
answers that provides you with ample opportunity to experience test-taking using computeradministered questions
and allows you to
customize tests for specific review and
practice
■ Questions written for all clinical areas of nursing (childbearing family and their neonate;
nursing care of infants, children, and adolescents; nursing care of adults with medical and
surgical health problems; and nursing care of
clients with psychiatric disorders and mental
health problems)
■ Questions organized by health problems to
facilitate review for course-specific exams
■ Questions coded by client needs to assure practice in all areas of the NCLEX-RN test plan
■ Questions coded by cognitive level to guide
study and test-taking at higher levels of the
cognitive domain
■ Questions emphasizing integrative processes
on the NCLEX-RN test plan
■ Questions with teaching feedback and rationales for both correct and incorrect answers
■ Questions using all types of question formats
used on the licensing exam (multiple choice,
multiple response, hot-spot, fill-in-the blank,
drag-and-drop/ordered response, chart/exhibit,
as well as graphic, audio, and video inclusion
questions)
■ Questions primarily written at higher levels
of the cognitive domain (analysis, synthesis,
evaluation, and creation)
■ Questions emphasizing clinical decision making,
clinical judgment, and management of care
■ Questions to provide practice for calculating
drug dosages, intravenous drip rates, intake and
output, and other questions requiring calculation and reporting of a numerical response to the
question
■ Questions emphasizing current nursing practice in the areas of client safety, managing care
quality, home care, health promotion, care of
the older adult, cancer nursing, end-of-life care,
perioperative care, community health nursing,
and emergency and disaster nursing
■ Questions about managing care quality and
safety at the end of each chapter
■ An entire chapter that explains the various test
question formats and strategies for answering
each type of test item and at each level of the
cognitive domain
■ Six comprehensive tests of 180 questions each
designed to resemble the testing format of the
NCLEX-RN
■A description of the current NCLEX-RN test
plan
■ A study plan and checklist to guide systematic
preparation for the licensing examination
■ Information about developing study skills, taking
tests, and managing test anxiety
■ Tips for studying from students who have
successfully passed the NCLEX-RN exam
■ Addresses, telephone numbers, and websites
for the National Council of State Boards of
Nursing, Inc., and each state board of nursing
■ Online resources for students, including tips
for test-taking and downloadable NCLEX questions for your handheld media device
Preface ix
in answering questions that require you to calculate
drug doses and drip rates for intravenous infusions.
Using This Review Package for Preparing
for Nursing Exams
We suggest that you begin your review by using
the practice exams in the book to identify areas of
strength and areas in which you need further study.
Each exam contains specific questions written in the
style of the NCLEX-RN. Answers include rationales
for both correct and incorrect answer options to
reinforce learning. You may wish to score the results
of each practice test and identify areas in which you
need further review. To evaluate your results after
completing each exam, divide the number of your
correct responses by the total number of questions
in the test and multiply by 100. For example, if
you answered 72 of 90 items correctly, you would
divide 72 by 90 and multiply by 100, for a result of
80%. If you answered more than 75% of the items
in an area correctly, you are most likely prepared to
answer questions in that area on the NCLEX-RN. If
you answered fewer than 75% of the questions correctly, you need to determine why. Did you answer
incorrectly because of lack of content knowledge or
because you did not read carefully? Use this information to guide your study.
After reviewing the specific content areas
in the practice exams, take the comprehensive
exams. These exams more realistically reflect the
NCLEX-RN because each test presents a variety of
situations commonly encountered in nursing practice and across all clinical disciplines. Underlying
knowledge, skills, and abilities related to the basic
sciences, fundamentals of nursing, pharmacology
and other therapeutic measures, communicable
diseases, legal and ethical considerations, and nutrition are included in items as needed to plan nursing
care for individual clients or groups of clients. The
comprehensive exams also include test items related
to client safety and care quality.
Next, use the CD-ROM to simulate taking computerized adaptive tests. Note how the questions
are presented on the computer screen, and practice
answering questions without using a pencil. Use the
diagnostic features of the CD-ROM to identify areas
for further study and develop your own customized
test for focused review.
And don’t forget to check the online resources
available at [Link] The
study tips will provide you with a foundation to begin
your exam preparation. The downloadable NCLEX
questions can be put on your iPhone, allowing you to
practice anytime and anywhere.
Organization of the book
The review book is organized in three sections. Each
section is designed to build on the previous section.
The first section of the book provides information about the licensing exam and how to prepare
for and take high-stakes examinations. A full chapter is devoted to explaining the various types of test
question formats and cognitive levels of questions
used on the licensing exam; the chapter also provides examples of all types and levels of questions
and strategies for answering them.
In the second section of the book, there are four
major units—nursing care of the childbearing family
and their neonate; nursing care of infants, children,
and adolescents; nursing care of adults with medical and surgical health problems; and nursing care
of clients with psychiatric disorders and mental
health problems. Within each unit, chapter tests are
grouped according to health problems and include
questions that are matched to the NCLEX-RN test
plan. At the end of each chapter there is a section of
questions about managing client safety and quality care. These questions are essential to test your
understanding of important concepts about patient
safety and quality. Because the test questions in this
section are organized around health problems, this
section is ideal for use when preparing for teachermade or commercially-prepared tests that focus on
specific content in your curriculum.
The third section of the book contains six
comprehensive exams written to simulate the
NCLEX-RN by placing test items in random order of
content area. Each test presents a variety of situations commonly encountered in nursing practice,
and includes test questions from all components of
the NCLEX-RN test plan and all types of questions
used on the licensing exam (except video and audio
questions, which are found only on the CD).
The CD-ROM
Additionally, this review package includes a CDROM with more than 1,300 questions. The CD-ROM
will allow you to practice with audio and video
questions, so be sure to use this feature of this Q&A
Review Book.
The CD-ROM can be used in several ways. For
example, you may take a test in the four content
areas, arrange a test to present questions in random
order, or select questions for particular review and
practice. The program also enables you to print out
test results to gauge your progress. The CD-ROM
simulates the actual NCLEX-RN exam by formatting
questions on a computer screen and requiring you to
use the keyboard and mouse to enter answers to the
questions. It also features a pop-up calculator for use
x
Acknowledgments
This book has been developed with the expertise
of a team of nationally recognized test item writers. Thanks to Desiree Hensel, Margie Hull, Leslie
Milgrom, Lee Schwecke, Sharon Vinten, and Sandy
Wood for developing questions to prepare students
for test-taking success. Thanks also to the editorial
staff at Lippincott Williams & Wilkins: Elizabeth
Nieginski for launching this book and Bill Lamsback
for guiding it to completion. Particular thanks goes
to developmental editor Annette Ferran for her
keen eye for design and detail, her ability to locate
resources for the new video, audio, and graphic
questions, and her support throughout the development of this book.
Diane M. Billings, EdD, RN, FAAN
Chancellor’s Professor Emeritus
Indiana University School of Nursing
xi
About the Author
Diane Billings, EdD, RN, FAAN, award-winning
author and nursing educator, offers more than 35
years’ experience teaching nursing from the associate through the graduate levels, with a special focus
on the NCLEX-RN examination.
Dr. Billings’ NCLEX experience includes developing and teaching NCLEX review courses, integrating computer-
based licensing exam review programs
into nursing curricula, and designing NCLEX test
questions. A nationally recognized test-item writer,
her NCLEX preparation books have helped thousands of students pass the NCLEX-RN exam.
The Chancellor’s Professor of Nursing at Indiana
University since 2002, Dr. Billings is the recipient
of the National League for Nursing’s Award for
Outstanding Leaders
staff at Lippincott Williams & Wilkins: Elizabeth
Nieginski for launching this book and Bill Lamsback
for guiding it to completion. Particular thanks goes
to developmental editor Annette Ferran for her
keen eye for design and detail, her ability to locate
resources for the new video, audio, and graphic
questions, and her support throughout the development of this book.
Diane M. Billings, EdD, RN, FAAN
Chancellor’s Professor Emeritus
Indiana University School of Nursing
xi
About the Author
Diane Billings, EdD, RN, FAAN, award-winning
author and nursing educator, offers more than 35
years’ experience teaching nursing from the associate through the graduate levels, with a special focus
on the NCLEX-RN examination.
Dr. Billings’ NCLEX experience includes developing and teaching NCLEX review courses, integrating computer-
based licensing exam review programs
into nursing curricula, and designing NCLEX test
questions. A nationally recognized test-item writer,
her NCLEX preparation books have helped thousands of students pass the NCLEX-RN exam.
The Chancellor’s Professor of Nursing at Indiana
University since 2002, Dr. Billings is the recipient
of the National League for Nursing’s Award for
Outstanding Leaders out the Author
Diane Billings, EdD, RN, FAAN, award-winning
author and nursing educator, offers more than 35
years’ experience teaching nursing from the associate through the graduate levels, with a special focus
on the NCLEX-RN examination.
Dr. Billings’ NCLEX experience includes developing and teaching NCLEX review courses, integrating computer-
based licensing exam review programs
into nursing curricula, and designing NCLEX test
questions. A nationally recognized test-item writer,
her NCLEX preparation books have helped thousands of students pass the NCLEX-RN exam.
The Chancellor’s Professor of Nursing at Indiana
University since 2002, Dr. Billings is the recipient
of the National League for Nursing’s Award for
Outstanding Leadersffgdf