Exam (elaborations) HESI COMPREHENSIVE REVIEW FOR THE NCLEX-PN EXAMINATION (2017, ELSEVIER) 5TH EDITION TINA CUELLAR

HESI COMPREHENSIVE REVIEW FOR THE NCLEX-PN EXAMINATION (2017, ELSEVIER) 5TH EDITION TINA CUELLAR HESI COMPREHENSIVE REVIEW FOR THE NCLEX-PN EXAMINATION (2017, ELSEVIER) 5TH EDITION By TINA CUELLAR ISBN: 978-0-323-42933-7 853 PAGES HESI Comprehensive Review for the NCLEX-PN® Examination FIFTH EDITION Hesi Editor Tina Cuellar, PhD, APRN, PMHCNS, BC 2 Table of Contents Cover image Title page Copyright Contributing Authors Reviewers Preface 1. Introduction to Testing and the NCLEX-PN® Examination The NCLEX-PN Licensing Examination Administration of the NCLEX-PN Tips for NCLEX-PN Success 2. Leadership and Management Legal Aspects of Nursing Review of Legal Aspects of Nursing Answers to Review Leadership and Management Review of Leadership and Management Answers to Review Disaster Nursing Review of Disaster Nursing Answers to Review 3 3. Advanced Clinical Concepts Respiratory Failure Review of Respiratory Failure Answers to Review Shock Disseminated Intravascular Coagulation Review of Shock and DIC Answers to Review Resuscitation Review of Resuscitation Answers to Review Fluid and Electrolyte Balance Review of Fluid and Electrolyte Balance Answers to Review Electrocardiogram Review of Electrocardiogram Answers to Review Perioperative Care Review of Perioperative Care Answers to Review HIV Infection Pediatric HIV Infection Review of HIV Infection Answers to Review Pain Review of Pain Answers to Review Death and Grief Review of Death and Grief Answers to Review 4. Medical-Surgical Nursing Caring and Nursing 4 Cultural Diversity Spiritual Assessment Respiratory System Review of Respiratory System Answers to Review Renal System Review of Renal System Answers to Review Cardiovascular System Review of Cardiovascular System Answers to Review Gastrointestinal System Review of Gastrointestinal System Answers to Review Endocrine System Review of Endocrine System Answers to Review Musculoskeletal System Review of Musculoskeletal System Answers to Review Neurosensory System Neurologic System Review of Neurosensory/Neurologic Systems Answers to Review Hematology/Oncology Review of Hematology/Oncology Answers to Review Reproductive System Review of Reproductive System Answers to Review Burns Review of Burns Answers to Review 5 5. Pediatric Nursing Growth and Development Pain Assessment and Management in the Pediatric Client Child Health Promotion Review of Child Health Promotion Answers to Review Respiratory Disorders Review of Respiratory Disorders Answers to Review Cardiovascular Disorders Review of Cardiovascular Disorders Answers to Review Neuromuscular Disorders Review of Neuromuscular Disorders Answers to Review Renal Disorders Review of Renal Disorders Answers to Review Gastrointestinal Disorders Review of Gastrointestinal Disorders Answers to Review Hematologic Disorders Hemophilia Review of Hematologic Disorders Answers to Review Metabolic and Endocrine Disorders Review of Metabolic and Endocrine Disorders Answers to Review Skeletal Disorders Review of Skeletal Disorder Answers to Review 6. Maternity Nursing 6 Anatomy and Physiology of Reproduction Antepartum Nursing Care Review of Anatomy and Physiology of Reproduction and Antepartum Nursing Care Answers to Review Fetal/Maternal Assessment Techniques Review of Fetal/Maternal Assessment Techniques Answers to Review Intrapartum Nursing Care Review of Intrapartum Nursing Care Answers to Review Normal Postpartum Period (Puerperium) Review of Normal Puerperium (Postpartum) Answers to Review The Normal Newborn Review of the Normal Newborn Answers to Review Complications of Pregnancy Review of Complications of Pregnancy Answers to Review Postpartum Complications Review of Postpartum Complications Answers to Review Complications of the Newborn Review of Complications of the Newborn Answers to Review 7. Psychiatric Nursing Therapeutic Communication Review of Therapeutic Communication and Treatment Modalities Answers to Review Anxiety Anxiety Disorders Review of Anxiety and Trauma- and Stressor-Related Disorders Answers to Review 7 Somatic Symptom Disorder and Related Disorders Review of Somatic Symptom Disorder and Related Disorders Answers to Review Dissociative Disorders Review of Dissociative Disorders Answers to Review Personality Disorders (DSM-5 Criteria) Review of Personality Disorders Answers to Review Eating Disorders Review of Eating Disorders Answers to Review Mood Disorders Review of Mood Disorders Answers to Review Schizophrenia Spectrum and Other Psychotic Disorders Review of Thought Disorders Answers to Review Substance Abuse Review of Substance Abuse Disorder Answers to Review Childhood and Adolescent Disorders Review of Childhood and Adolescent Disorders Answers to Review 8. Gerontologic Nursing Theories of Aging Physiologic Changes Psychosocial Changes Dementia Health Maintenance and Preventive Care End-of-Life Care Review of Gerontologic Nursing Answers to Review 8 A. NANDA-Approved Nursing Diagnoses and Definitions B. Normal Values Index 9 Copyright 3251 Riverport Lane St. Louis, Missouri 63043 HESI COMPREHENSIVE REVIEW FOR THE NCLEX-PN® EXAMINATION, FIFTH EDITION ISBN: 978-0-323-42933-7 Copyright © 2018 by Elsevier, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods, they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided 1) on procedures featured or 2) by the manufacturer of each product to be administered to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make 10 diagnoses, determine dosages and the best treatment for each individual patient, and take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Previous editions copyrighted 2015, 2012, and 2008. NANDA International Nursing Diagnoses: Definitions and Classifications 2012–2014; Herdman T.H. (Ed.); copyright © 2012, 1994–2012 NANDA International; Published by John Wiley & Sons, Limited. NCLEX®, NCLEX-RN®, and NCLEX-PN® are Registered Trademarks of the National Council of State Boards of Nursing, Inc. International Standard Book Number: 978-0-323-42933-7 Content Strategist: Jamie Blum Content Development Manager: Billie Sharp Associate Content Development Specialist: Samantha Dalton Publishing Services Manager: Jeff Patterson Book Production Specialist: Bill Drone Design Direction: Ryan Cook Printed in Canada Last digit is the print number: 9 8 7 6 5 4 3 2 1 11 Contributing Authors Safa'a Al-Arabi, PhD, RN, MSN, MPH, Associate Professor and Accelerated BSN Track Administrator, School of Nursing, University of Texas Medical Branch, Galveston, Texas Sharon L. Colley, PhD, MSN, BSN, RN, CNE, MSN Program Coordinator, Associate Professor, School of Nursing, Ferris State University, Big Rapids, Michigan Claudine Dufrene, PhD, RN-BC, GNP-BC, CNE, Assistant Professor, Carol and Odis Peavy School of Nursing, University of St. Thomas, Houston, Texas Tiffany Jakubowski, BSN, RN, ONC, CMSRN, Adjunct Nursing Faculty, Front Range Community College, Longmont, Colorado Sandra R. Jemison, RN, MSN, Assistant Professor, Cox College of Nursing and Health Sciences, Springfield, Missouri Necole Leland, MSN, RN, PNP, CPN, School of Nursing, University of Nevada, Las Vegas, Nevada Katherine Ralph, MSN, RN, CurriculumThe NCLEX-PN Licensing Examination A. The main purpose of a licensing examination such as the NCLEX-PN is to protect the public. B. The NCLEX-PN is: 1. Developed by the National Council of State Boards of Nursing. 2. Administered by the State Board of Nursing. 3. Designed to test the candidate’s capability for safe and effective nursing practice by measuring current, entry-level practical nursing behavior. Job Analysis Studies A. “Essential” knowledge on the NCLEX-PN test is determined by practice analysis studies. B. Practical nurses (PNs or vocational nurses [VNs]) submit statements about the frequency of nursing activities and the related impact on client safety. HESI Hint The 2015 LPN/VN Practice Analysis: Linking the NCLEX-PN Examination to Practice (Vol. 58) determines how frequently new practical nurses perform more than 150 types of nursing care activities. From the analysis, the 2017 NCLEX-PN Test Plan (effective April 1, 2017) identifies four major client needs categories, and two of those categories are further divided into a total of six subcategories and five fundamental nursing processes. They provide a basis for establishing a minimum level of knowledge and skills for PNs to use with a diverse patient population, in any setting, and within the laws and rules of each state (Table 1.1, Client Needs, and Table 1.2, Practical/Vocational Nursing Processes). HESI Hint For more information on the NCLEX-PN Test Plan and content related to each category, go to . The Nursing Process and Nursing Diagnoses A. PN role in the nursing process: Practical nurses use the nursing process to critically think and problem solve (see Table 1.2). B. Practical nurses assist the health care team to gather and organize data and recognize client needs and problems regardless of the client’s developmental stage or the health care setting. They also assist the RN in formulating nursing 19 diagnoses and developing plans of care. C. The National Conference of the North American Nursing Diagnosis Association (NANDA) guides nurses in the selection of nursing interventions for the purpose of achieving specific outcomes; outcomes and interventions are associated with specific diagnoses (Table 1.3, Components of a Nursing Diagnosis, and Appendix A, NANDA-Approved Nursing Diagnoses). HESI Hint A nursing diagnosis is not a medical diagnosis because a nursing diagnosis: Is subject to nursing management. May or may not come from a medical diagnosis. Is formulated and written by nurses. Is implemented from nursing orders (care plan and nursing interventions). Prioritizing Nursing Care on NCLEX-PN A. Many NCLEX-PN test items are designed to test your ability to set priorities. B. Some examples include: 1. Identify the MOST IMPORTANT client needs. 2. Identify the MOST IMPORTANT nursing intervention. 3. Which nursing action should be done FIRST? 4. Which client should be cared for FIRST? Examination Item Formats A. Several different item types (alternate item formats) are presented on the NCLEX-PN examination. TABLE 1.1 Client Needs with Threaded Integrated Processes: Caring, Clinical Problem Solving, Culture & Spirituality, Communication & Documentation, and Teaching & Learning 20 21 Based on the results of the 2014 LPN/VN Practice Analysis: Linking the NCLEX-PN Examination to Practice (Vol. 58). The percentages indicate the amount of questions written for each client need category in the 2015 NCLEX-PN Test Plan. Adapted from National Council of State Boards of Nursing, Inc. NCLEX-PN Examination: Test Plan for the National Council Licensure Examination for Licensure Practical/Vocational Nurses, 2015, Chicago, IL. . 1. The majority of the questions are multiple-choice items with four choices (answers) from which to choose one correct answer. 2. Multiple-response items require the candidate to select one or more responses from five to seven choices. The item instructs the candidate to choose all that apply. 3. Fill-in-the-blank questions require the candidate to calculate the answer and type in the numbers. 4. Hot-spot items require the candidate to identify an area on a picture or graph and click on the area. 5. Chart/exhibit format presents a chart or exhibit that the candidate needs to read to be able to answer the problem. 22 TABLE 1.2 Practical/Vocational Integrated Nursing Processes TABLE 1.3 Components of a Nursing Diagnosis 6. Ordered response items require a candidate to rank order or move options to provide the correct order of actions or events. 7. Graphic format items require the candidate to choose the correct graphic in response to the question. 8. Audio format items require the candidate to listen to an audio clip using headphones and then select the correct option that applies to the audio clip. B. There is no set percentage of alternate items on the NCLEX-PN examination. All examination items are scored either right or wrong. There is no partial credit in scoring any examination questions. 23 Administration of the NCLEX-PN A. The NCLEX-PN Computer Adaptive Testing (CAT) is administered at Pearson Professional Centers in the United States, selected by the National Council of State Boards of Nursing (NCSBN). B. Pearson VUE is responsible for adapting the NCLEX-PN examination to the CAT format, processing candidate applications, and transmitting test results to its data center for scoring. C. The NCSBN generates the NCLEX-PN test items. Understanding CAT A. NCLEX-PN consists of 85 to 205 multiple-choice or alternative format items. B. The candidate is presented with a test item. 1. If the question is answered correctly, a slightly more difficult item follows, and the level of difficulty increases with each item until an item is missed. 2. If the question is answered incorrectly, a slightly less difficult item follows, and the level of difficulty decreases with each item until the candidate answers an item correctly. C. The process continues until the candidate has achieved a definite “pass” or “fail” score. A message indicating that the candidate has completed the examination appears on the screen. D. The item number the candidate is currently answering appears in the upper right side of the screen. E. The greatest number of items appearing on your examination is 205. Taking the Test A. A test administrator provides each candidate with an erasable note board that may be replaced as needed while testing. A candidate may not bring his or her own note boards, scratch paper, or writing instruments to the examination. B. You must answer each question before proceeding to the next one. Returning to a question or skipping a question is not allowed during testing. You will not be able to change an answer once you proceed to the next question; this works in your favor. C. When taking the examination, read carefully and maintain a reasonable pace. Time Frame and Breaks A. The candidate receives up to 5 hours to complete the examination. The 5 hours include a tutorial, sample questions, breaks, and completion of the examination. B. Two programmed optional breaks are given, one after 2 hours of testing and another after 3½ hours of testing. A candidate may take an unscheduled break at any time. All breaks count against testing time. 24 C. When candidates take a break, they must leave the testing room and will be required to provide a fingerprint before and after the break. Results and Scoring A. When the candidate answers the minimum number of items (85) and has performed with 95% certainty above or below the passing standard, the computer test stops and calculates whether the candidate has passed or failed. B. If a candidate has answered the maximum number of items (205) and is not at the end of the 5-hour limit, the candidate’s ability estimate is precise. So if the ability estimate is at or above the passing standard, the candidate passes, and if the ability estimate is at or below the passing standard, the candidate fails. C. If a candidate has run out of time (5-hour limit) and has not answered the maximum number of items (205) but shows a consistent pattern above the passing standard, then the candidate will pass even if he or she has run out of