TEST PREP NCLEX-RN(2005) AMERICAN BOOKWORKS CORPORATION - CLIFFSTESTPREP NCLEX-RN (2005)

TEST PREP NCLEX-RN(2005) AMERICAN BOOKWORKS CORPORATION - CLIFFSTESTPREP NCLEX-RN (2005) CliffsTestPrep® NCLEX-RN® An American BookWorks Corporation Project Contributing Authors/Consultants Amy Anderson, RN, MSN Texas Tech University Health Sciences Center, School of Nursing, TX Wanda Bradshaw, RNC, MSN Duke University, NC Valerie Eschiti, RN, MSN, CHTP, HNC Midwestern State University, TX Sara Freuchting University of Arkansas, AR Sharon Krumm, RN, MN, CCRN Arkansas State University, AR Mary Alice Momeyer, MSN, CNP Ohio State University, OH Cynthia O’Neal, Ph.D., RN Texas Tech University Health Sciences Center School of Nursing, TX Deborah Persell, MSW, RN, CPNP Arkansas State University, AR Vicki A. Schnetter, MSN, RN Texas Tech University Health Sciences Center School of Nursing, TX Brenda Leigh Yolles Smith, Ed.D. RN, MN, CNM, ICCE Arkansas State University, AR Carolyn Mathis White, RN, MSN, FNP, PNP, JD University of South Alabama, AL Joan Rowe Williams, MS, RN, CS, CNP Ohio State University, OH CliffsTestPrep® NCLEX-RN® An American BookWorks Corporation Project Contributing Authors/Consultants Amy Anderson, RN, MSN Texas Tech University Health Sciences Center, School of Nursing, TX Wanda Bradshaw, RNC, MSN Duke University, NC Valerie Eschiti, RN, MSN, CHTP, HNC Midwestern State University, TX Sara Freuchting University of Arkansas, AR Sharon Krumm, RN, MN, CCRN Arkansas State University, AR Mary Alice Momeyer, MSN, CNP Ohio State University, OH Cynthia O’Neal, Ph.D., RN Texas Tech University Health Sciences Center School of Nursing, TX Deborah Persell, MSW, RN, CPNP Arkansas State University, AR Vicki A. Schnetter, MSN, RN Texas Tech University Health Sciences Center School of Nursing, TX Brenda Leigh Yolles Smith, Ed.D. RN, MN, CNM, ICCE Arkansas State University, AR Carolyn Mathis White, RN, MSN, FNP, PNP, JD University of South Alabama, AL Joan Rowe Williams, MS, RN, CS, CNP Ohio State University, OH CliffsTestPrep® NCLEX-RN Published by: Wiley Publishing, Inc. 111 River Street Hoboken, NJ Copyright © 2005 Wiley, Hoboken, NJ Published by Wiley, Hoboken, NJ Published simultaneously in Canada ISBN-13: 978-0-7645-7288-3 ISBN-10: 0-7645-7288-1 Library of Congress Control Number is available from the publisher. 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Table of Contents Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 PART I: SUBJECT AREA REVIEW CHAPTERS Coordinated Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Advance Directives • Advocacy • Client Care Assignments • Client Rights • Collaboration with Multidisciplinary Team • Concepts of Management and Supervision • Confidentiality • Consultation • Continuity of Care • Delegation • Establishing Priorities • Ethical Practice • Informed Consent • Legal Rights Responsibilities • Performance Improvement (Quality Assurance) • Referral Process • Resource Management • Staff Education • Supervision Safety and Infection Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Accident/Error Prevention • Disaster Planning • Emergency Response Plan • Error Prevention • Handling Hazardous and Infectious Materials • Home Safety • Injury Prevention • Medical and Surgical Asepsis • Reporting of Incident/Event/Irregular Occurrence/Variance • Safe Use of Equipment • Security Plans • Standard/ Transmission-Based/Other Precautions • Use of Restraints/Safety Devices Health Promotion and Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Aging Process • Ante/Intra/Postpartum and Newborn Care • Data Collection Techniques • Developmental Stages and Transitions • Disease Prevention • Expected Body Image Changes • Family Planning • Growth and Development • Health and Wellness • Health Promotion • Health Screening • High Risk Behaviors • Human Sexuality • Immunizations • Lifestyle Choices • Principles of Teaching/Learning • Self-Care • Techniques of Physical Assessment Psychosocial Integrity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 Abuse or Neglect • Behavioral Interventions • Chemical Dependency • Coping Mechanisms • Crisis Intervention • Cultural Diversity • End-of-Life Concepts • Family Dynamics • Grief and Loss • Mental Health Concepts • Psychopathology • Religious or Spiritual Influences on Health • Sensory/Perceptual Alterations • Situational Role Changes • Stress Management • Support Systems • Therapeutic Communication • Therapeutic Environment • Unexpected Body Image Changes Basic Care and Comfort . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295 Alternative and Complementary Therapies • Assistive Devices • Elimination • Mobility/ Immobility • Non-Pharmacological Comfort Interventions • Nutrition and Oral Hydration • Palliative/Comfort Care • Personal Hygiene • Rest and Sleep Pharmacological Therapies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337 Adverse Effects/Contraindications and Side Effects • Blood and Blood Products • Central Venous Access Devices • Dosage Calculations • Expected Effects • Intravenous Therapy • Medication Administration • Pharmacological Agents/Actions • Pharmacological Pain Management • Total Parenteral Nutrition Reduction of Risk Potential . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385 Diagnostic Tests • Laboratory Values • Monitoring Conscious Sedation • Potential for Alterations in Body Systems • Potential for Complications of Diagnostic Tests/Treatments/ Procedures • Potential for Complications of Surgical and Health Alterations • Therapeutic Procedures • Vital Signs Physiological Adaptation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419 Alterations in Body Systems • Fluid and Electrolyte Imbalances • Hemodynamics • Illness Management • Infectious Diseases • Medical Emergencies • Pathophysiology • Radiation Therapy • Unexpected Response to Therapies PART II: NCLEX-RN PRACTICE TESTS NCLEX-RN Practice Test 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 467 Answers and Explanations for Practice Test 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 495 NCLEX-RN Practice Test 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 517 Answers and Explanations for Practice Test 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 546 NCLEX-RN Practice Test 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 567 Answers and Explanations for Practice Test 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 596 iv CliffsTestPrep NCLEX-RN 1 Introduction The NCLEX-RN examination has recently been updated and revised. This book has been written to help you prepare for—and pass—that exam. The NCLEX (National Council Licensure Examination) is required in order for you to obtain a license to practice as a registered nurse. The exam is administered by the National Council of State Boards of Nursing and ensures that your license is acceptable throughout the entire United State and its territories. By passing this test, you will be able to practice as a registered nurse. The test itself is based on the specialized knowledge that you should have at this point, and it tests your skills and ability to meet the various requirements that will be required within the nursing process. Because this is a test of basic competency, you will be able to demonstrate your abilities as an entry-level nurse on this exam. It is not a test for the more experienced nurse, because you will not encounter questions about more sophisticated elements of the nursing profession, nor is it an indicator of how you will fare in the profession. During the examination, which is computerized, you will answer anywhere from 75 to 265 questions, so there is a limit to the amount of material that will be covered on the test. In this book, we’ve tried to give you as much material as possible, based on previous tests, and, of course, these questions are written by nurse-educators, who are familiar with this version of NCLEX-RN and who teach their students with the goal of passing this exam. The CAT Exam You probably are aware that the NCLEX-RN is computerized. Sometimes the exam is called a CAT (Computerized Adaptive Testing) test, because the computer adapts to your responses. You begin with a moderately difficult question, and if you answer it correctly, the next question will be slightly more difficult. If you answer incorrectly, the next question will be slightly easier. Essentially, the computer is selecting questions based on your abilities. The more questions you answer, the more the computer understands your responses and can tailor the questions for you. Thus, if you answer most of the questions correctly, you may have to answer only 75 questions, because they have increased in difficulty from the first question onward. If you have trouble with a large number of questions, the computer keeps trying easier questions until you answer correctly. At the most, you will be asked to answer 265 questions. You cannot skip questions as you work through the test, since each question is predicated on the previous response. So you will have to spend time working on each question. However, if you can’t deduce the answer in any logical way, select any answer to move on to the next one. The next one will be easier and perhaps will restore your confidence. The entire testing period is five hours. This includes a brief tutorial, sample questions, and scheduled breaks during the testing period. How to Use This Book This book contains a series of eight chapters, each chapter containing questions based on the latest format of the exam. We cover the following topics, based on what are known as Client Needs categories. There are four basic Client Needs categories, and as you can see, two of these categories are broken down into six subcategories. All of the topics and subtopics are covered in this book, although many of them may be combined into similar topic areas. ■ Safe and Effective Care Environment ■ Coordinated Care ■ Safety and Infection Control ■ Health Promotion and Maintenance ■ Psychosocial Integrity ■ Physiological Integrity 2 CliffsTestPrep NCLEX-RN ■ Basic Care and Comfort ■ Pharmacological Therapies ■ Reduction of Risk Potential ■ Physiological Adaptation In addition, we’ve also included answers and explanations that will help you understand the material in greater depth. We’ve explained not only the correct answers, but in most cases, we’ve tried to help you understand why the other choices were incorrect. Because the answers are presented right after the questions in the review chapters, you will have immediate feedback to the questions. You should, of course, know much of this material already, but there are certainly a lot of topics that you might not be as familiar with as some of the others that are presented in this book. The process is to read the question, try to understand what they’re asking of you, try to determine the answer, and then check the answer that accompanies that question. Furthermore, certain important concepts are integrated throughout the Client Needs categories and subcategories: 1. Nursing Process. This is the scientific approach to client care that includes data collection, planning, and implementation and evaluation. 2. Caring. This is the interaction between you, as the registered nurse, and the clients, their families, or their significant others. Client care requires mutual respect and trust. 3. Communication and Documentation. It is of utmost importance that you are able to be clear and concise in your interactions with those of the families as well as those of others on your healthcare team. This requires the ability to communicate both verbally and nonverbally and to be accountable in keeping and maintaining records and patients’ charts. 4. Teaching and Learning.You must demonstrate the appropriate skills and attitudes that promote changes in yourself and others, by learning and teaching. Being an effective RN requires the ability to share information with clients and their families. About the Content As mentioned, there are eight Client Needs chapters, and within those chapters are individual subcategories, for which you’ll be responsible. Following is a list of all of the Client Needs chapters and the percentage of questions that will appear on the test, as well as the subcategories. Keep in mind that other material might be covered on the test. Safe and Effective Care Environment Coordinated Care (13–19%) Advance Directives Advocacy Client Care Assignments Client Rights Collaboration with Multidisciplinary Team Concepts of Management and Supervision Confidentiality Consultation Continuity of Care Delegation Establishing Priorities Ethical Practice Informed Consent Legal Rights Responsibilities Performance Improvement (Quality Assurance) Referral Process Resource Management Staff Education Supervision Safety and Infection Control (8–14%) Accident/Error Prevention Disaster Planning Emergency Response Plan Error Prevention Handling Hazardous and Infection Materials Home Safety Injury Prevention Medical and Surgical Asepsis Reporting of Incident/Event/Irregular Occurrence/Variance Safe Use of Equipment Security Plans Standard/Transmission-Based/Other Precautions Use of Restraints/Safety Devices Health Promotion and Maintenance (6–12%) Aging Process Ante/Intra/Postpartum and Newborn Care Data Collection Techniques Developmental stages and Transitions Disease Prevention Expected Body Image Changes Family Planning Growth and Development Health and Wellness Health Promotion Health Screening High Risk Behaviors Human Sexuality Immunizations Lifestyle Choices Principles of Teaching/Learning Self-Care Techniques of Physical Assessment Psychosocial Integrity (6–12%) Abuse or Neglect Behavioral Interventions Chemical Dependency Coping Mechanisms Crisis Intervention Cultural Diversity 3 Introduction End-of-Life Concepts Family Dynamics Grief and Loss Mental Health Concepts Psychopathology Religious or Spiritual Influences on Health Sensory/Perceptual Alterations Situational Role Changes Stress Management Support Systems Therapeutic Communication Therapeutic Environment Unexpected Body Image Changes Physiological Integrity Basic Care and Comfort (6–12%) Alternative and Complementary Therapies Assistive Devices Elimination Mobility/Immobility Non-Pharmacological Comfort Interventions Nutrition and Oral Hydration Palliative/Comfort Care Personal Hygiene Rest and Sleep Pharmacological Therapies (13–19%) Adverse Effects/Contraindications and Side Effects Blood and Blood Products Central Venous Access Devices Dosage Calculations Expected Effects Intravenous Therapy Medication Administration Pharmacological Agents/Actions Pharmacological Pain Management Total Parenteral Nutrition Reduction of Risk Potential (13–19%) Diagnostic Tests Laboratory Values Monitoring Conscious Sedation Potential for Alterations in Body Systems Potential for Complications of Diagnostic Tests/Treatments/Procedures Potential for Complications of Surgical and Health Alterations Therapeutic Procedures Vital Signs 4 CliffsTestPrep NCLEX-RN Physiological Adaptation (11–17%) Alterations in Body Systems Fluid and Electrolyte Imbalances Hemodynamics Illness Management Infectious Diseases Medical Emergencies Pathophysiology Radiation Therapy Unexpected Response to Therapies All of the topics and subtopics are covered in this book, although many of them may be combined into similar topic areas. Types of Questions Most of the questions are multiple choice with four options. There are, however, other types of questions, such as fill-inthe- blanks, and even identifying items with “hot spots.” What this means is that you’ll be given an illustration, table, or perhaps a chart, and you have to click on it with the on-screen cursor to identify the correct answer. Because it’s computerized, the machine can identify the spot where you’ve clicked. We’ll cover more of these later in this introduction. The Multiple-Choice Format Most of the standardized tests that you’ve probably taken throughout your educational career have contained multiplechoice questions. For some reason, these types of questions give a large percentage of test takers a difficult time. If you approach these questions carefully, they should be easier than you think. Let’s analyze the concept of the multiple-choice question. Keep in mind that these questions are created to test your ability to recognize the correct answer from four choices. From the start, you should be happy that there are only four choices, not five, as there are on many exams. This reduces the number of incorrect options. Questions are comprised of several parts: ■ The question stem ■ The correct choice ■ Distracters As test-item writers create questions, they normally approach it as follows: ■ One choice is absolutely correct. ■ One or two choices are absolutely incorrect. ■ One or two choices may be similar to the correct answer but might contain some information that is not quite accurate or on target, or even might not answer the specific question (often called distracters). How do you approach the questions? First, read the question and see whether you know the answer. If you know it automatically, you can look at the choices and select the correct one. Let’s look at a very simple example here. 1. Mammography is used to detect which of the following conditions? 1. pain 2. tumor 3. edema 4. epilepsy 5 Introduction This should be a very simple and clear question and answer. It’s a question that most lay people would know, without the benefit of a nursing school education. You should know that mammography is used to detect tumors or cysts in the breasts. It is not used to detect any of the other conditions. Of course, you should know that a mammogram is the image produced by a low-dose x-ray of the breast. If you don’t know the answer, you have certain options, using the time-honored approach of process of elimination. Are there any choices that you can immediately eliminate? For example, choice 1 is not likely to be identified by mammography. It’s possible that a patient experiencing pain comes for a mammogram to identify the source of the pain, but it cannot “see” pain. Thus, you can eliminate that answer. Now you’ve improved your odds of answering the question correctly. Instead of having only a 25 percent chance (one out of four choices) to identify the correct answer, you now have a 33 percent chance (one out of three choices). After you’ve eliminated this one, move to the next choice. It’s possible that mammography is used to locate tumors. (Yes, we know this is the correct answer, but the exercise here is to demonstrate how to eliminate the choices if you didn’t know that answer.) The next choice is edema. If you know that edema is a swelling caused by an abnormal accumulation of fluid in body tissues, you might think it possible that a mammogram can spot the fluid and that might be a possible answer. Hold on to that choice for a moment and move to choice 4, epilepsy. Epilepsy is a disorder of the central nervous system, and you should know this. Is it possible for a mammogram to spot a nervous disorder? This can’t be a correct choice if you know that a mammogram is an x-ray. So you can eliminate that choice also. This leaves only two choices—tumor or edema. At this point, if you really don’t know the answer, you have to guess. But at this stage, having eliminated two very clear incorrect choices, you have a 50 percent chance (one out of two choices) to guess the correct answer. It is important to read the questions carefully. Look at the following example: 2. All of the following should be done when fetal heart monitoring indicates fetal distress except: 1. increasing maternal fluids. 2. administering oxygen. 3. decreasing maternal fluids. 4. turning the mother. How did you answer this question? Did you take note of the word “except?” All of the choices are correct except for choice 3. This is the only intervention that should not be done when fetal distress is indicated. Finally, pay attention to words like always, never, or not. Most things in the world are not always or never, and you should be careful if a question asks you to choose which of the choices is not. . .! Or, like the question above, “All are correct except. . .! Some of the questions might ask you about measurements. For example, there is a big difference between 0.401, 4.01, 40.1, and 401. Keep things like decimal points in mind as you read these types of questions. Make sure, also, that you know your measurements like liters and milliliters, fluid ounces, and so on. As you go through this book, take your time with the questions and answers. Try to analyze what you answered incorrectly and learn from the answers. Identify those questions where you were able to use the process of elimination. Check how well you did on those. How many did you just know and were able to answer? Don’t just worry about how well or poorly you did. Take the time to do an analysis of your results. These are the secrets to being a successful test taker. Obviously, you must be armed with an education and have the knowledge and skills to be able to take the test. You will, however, have a better chance if you practice the techniques of answering multiple-choice questions. 6 CliffsTestPrep NCLEX-RN Alternate Forms of Questions As we mentioned briefly, most of the questions in the test will be multiple-choice questions with four choices. However, because of the power of the computer, you will also encounter some alternate forms of questions: 1. Multiple-choice questions that may have more than one correct choice. However, unlike the regular four-choice questions, you will likely see a prompt that will tell you to choose or select all that apply. There may be more than four choices in these questions. 2. Fill-in-the-blank questions where you’ll be asked to type a specific number or word. 3. Calculation or ordered response question that will require you to either do some computing or itemize the items presented in the correct order. 4. “Hot spot” items that will ask you to identify with the cursor the appropriate area on a picture or other graphic on the screen. Why do they give you these types of questions? It is believed that you will be able to develop your competence in certain areas, beyond which multiple-choice questions cannot test. If, for example, you are asked to do a problem that requires calculations, by actually doing them yourself, you will prove yourself more capable than merely selecting the correct answer from four choices (especially since you’ve learned the secrets of answering these types of questions earlier in this section). Alternative Response Items Multiple Choice Problems 1. The nurse is caring for a client with tuberculosis. Which of the following infection control precautions should the nurse implement? Select all that apply. 1. Wear a particulate respirator mask when entering the client’s room. 2. Wear a gown when assessing the client’s peripheral pulses. 3. Wear gloves when checking the client’s blood pressure. 4. Wear sterile gloves when taking the client’s oral temperature. 5. Place the client in a reverse air flow room. 2. A diabetic client receives his morning insulin, but then eats only half of his breakfast. A few hours later, the client complains of a headache and weakness. Which of the following interventions should the nurse implement? Check all that apply. 1. Give the client another dose of insulin. 2. Check the client’s blood glucose. 3. Have the client exercise. 4. Offer the client some orange juice. 5. Encourage the client to eat a snack. Fill-in-the-Blank (Calculation) 3. The physician orders a client to receive cefazolin sodium (Kefzol) 500 mg IM now. The nurse has 250 mg/ml available. How many milliliters will the nurse give? 7 Introduction 4. The nurse is completing the intake and output record for a client who had a thoracotomy with chest tube placement. The client had the following intake and output during the eight-hour shift. Intake: 6 oz. of tea 1 cup of diced chicken salad 8 oz. of water 1⁄2 cup of green beans 4 oz. of sherbet 1000 ml of D5 1⁄2 NS IV fluid Output: 1200 ml of urine from the urinary drainage bag 50 ml of drainage from the chest tube How many milliliters should the nurse document as the client’s intake? Fill-in-the-Blank (Ordered Response) 5. A nurse enters a client’s hospital room and discovers the client is cyanotic and is not breathing. Place the interventions the nurse should perform in the order of priority. 1. Place the client on a cardiac monitor. 2. Call for help. 3. Check for a pulse. 4. Open the airway. 5. Begin cardiac compressions. Insert your answer here: __________ 6. A client walks into the emergency room stating he has just been stabbed in the neck. The nurse notes that he is bleeding heavily from the right side of the neck. Put the nursing