Vital Signs, Pain Assessment, and Lab Value Interpretation | Chapter 10 from Saunders Comprehensive Review for the NCLEX-PN Examination (7th Edition)

Welcome to Chapter 10 of the Saunders Comprehensive Review for the NCLEX-PN Examination (7th Edition) by Linda Anne Silvestri and Angela E. Silvestri. This chapter is the foundation of clinical nursing assessment, focusing on accurate measurement of vital signs, evidence-based pain assessment, and the critical interpretation of laboratory values. With NCLEX-style examples and practical scenarios, it prepares students for safe, competent, and culturally sensitive nursing care.

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Vital Signs: Accurate Measurement and Interpretation

• Temperature: Techniques—oral, rectal, axillary, tympanic, temporal; know age-appropriate and situational selection. Normal: 36.5–37.5°C (97.7–99.5°F).
• Pulse: Radial, apical (with stethoscope), and pulse deficit detection. Normal adult: 60–100 bpm.
• Respiratory Rate: Observe rate, rhythm, and depth. Normal adult: 12–20/min.
• Blood Pressure: Proper cuff size, positioning, and orthostatic vital sign technique. Normal adult: <120/<80 mmHg.
• Oxygen Saturation (SpO2): Pulse oximetry; normal range: 95–100% (consider baseline in chronic illness).

Assess for abnormal trends and correlate findings to clinical context (e.g., post-op hypotension or tachycardia).

Pain Assessment: Culturally Competent and Age-Appropriate Care

• Differentiate acute, chronic, and phantom pain types.
• Use pain scales (numeric, visual, Wong-Baker Faces) for reliable self-report.
• Integrate verbal and nonverbal cues—be alert to stoicism, culture-specific behaviors, or altered mental status.
• Reassess and document pain relief effectiveness after intervention.

Nonpharmacologic strategies: heat/cold, massage, binders, distraction, TENS unit.
Pharmacologic strategies: acetaminophen, NSAIDs, opioids (morphine, hydromorphone)—including safety with antidotes and side effect monitoring.

Laboratory Reference Intervals: Normal Ranges and Clinical Implications

• Electrolytes:
  • Sodium: 135–145 mEq/L
  • Potassium: 3.5–5.0 mEq/L
  • Calcium: 8.6–10.2 mg/dL
  • Magnesium: 1.6–2.6 mg/dL
  • Glucose (fasting): 70–100 mg/dL
• Hematologic: Hemoglobin, hematocrit, platelets, WBCs, neutropenic precautions for low WBC.
• Renal: BUN: 7–20 mg/dL; Creatinine: 0.6–1.2 mg/dL.
• Coagulation:
  • PT: 11–14 seconds
  • INR: <1.1 (therapeutic 2–3 for anticoagulated patients)
  • aPTT: 25–35 seconds (therapeutic 1.5–2.5x normal on heparin)
• Lipids: Total cholesterol: <200 mg/dL; LDL: <100 mg/dL; HDL: >40 mg/dL (men), >50 mg/dL (women).
• Glycosylated Hemoglobin (A1C): <5.7% (normal), diabetes: ≥6.5%.

Know which abnormal values to report and understand dietary/medication precautions (e.g., warfarin and leafy greens, hypokalemia risk with furosemide).

Safety Precautions and Practical Skills

• Venipuncture: correct site selection, sample labeling, and infection control.
• Timing: some labs require fasting or specific timing (e.g., morning cortisol).
• Monitor for bleeding risk with low platelets or anticoagulation therapy.
• Apply orthostatic BP technique to identify hypotension or volume loss.

Clinical Scenarios and NCLEX Practice

Chapter 10 features real-world examples—interpreting lab abnormalities, recognizing urgent findings, and tailoring pain interventions. Practice with NCLEX-style questions and case scenarios to build clinical judgment.

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Conclusion: Confident Nursing Assessment and Lab Interpretation

Chapter 10 of Saunders Comprehensive Review for the NCLEX-PN Examination (7th Edition) gives you the skills to assess, interpret, and act on vital signs, pain scores, and lab results. By mastering these foundations, you’ll ensure safe and evidence-based care—both on the NCLEX-PN and in your nursing practice.

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