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Illustrated Study Guide for the NCLEXRN® Exam NINTH EDITION

JoAnn Zerwekh, EdD, MSN, RN President/CEO, Nursing Education Consultants, Inc., Chandler, Arizona

Disclaimer This title includes additional digital media when purchased in print format. For this digital book edition, media content may not be included.

Table of Contents Cover image Title page Disclaimer Copyright Contributors Reviewers Preface Acknowledgments 1. Testing strategies for the NCLEX-RN ® examination Specific strategies and examples of multiple-choice questions

2. Health implications across the life span 3. Concepts of nursing practice 4. Nursing management and ethical/legal concepts 5. Emergency and disaster preparedness and bioterrorism

6. Pharmacology and medication administration 7. Homeostasis concepts 8. Immune: Care of adult, maternity, and pediatric clients 9. Cancer concepts 10. Psychosocial nursing care 11. Integumentary: Care of adult and pediatric clients Critical care nursing

12. Sensory: Care of adult and pediatric clients The eye The ear

13. Endocrine: Care of adult, maternity, and pediatric clients 14. Hematology: Care of adult and pediatric clients 15. Respiratory: Care of adult and pediatric clients 16. Vascular: Care of adult clients 17. Cardiac: Care of adult, maternity, and pediatric clients 18. Gastrointestinal: Care of adult and pediatric clients 19. Hepatic and biliary: Care of adult and pediatric clients 20. Neurology: Care of adult and pediatric clients

21. Musculoskeletal: Care of adult and pediatric clients 22. Reproductive: Care of adult and pediatric clients 23. Urinary-renal: Care of adult and pediatric clients 24. Maternity nursing care Antepartum Intrapartum and postpartum

25. Newborn nursing care Normal laboratory data References and Resources Index

Copyright

3251 Riverport Lane St. Louis, Missouri 63043 ILLUSTRATED STUDY GUIDE FOR THE NCLEX-RN® EXAM, NINTH EDITION ISBN: 978-0-323-28010-5 Copyright © 2016 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: www.elsevier.com/permissions. 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 (i) on procedures featured or (ii) 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 diagnoses, to determine dosages and the best treatment for each individual patient, and to 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. NCLEX®, NCLEX-RN® and NCLEX-PN® are registered trademarks of the National Council of State Boards of Nursing, Inc. Previous editions copyrighted 2013, 2010, and 2006. Library of Congress Cataloging-in-Publication Data Illustrated study guide for the NCLEX-RN exam / [edited by] JoAnn Zerwekh.—Ninth edition.   p. ; cm.  Study guide for the NCLEX-RN exam  Includes bibliographical references and index.  ISBN 978-0-323-28010-5 (pbk. : alk. paper)  I. Zerwekh, JoAnn Graham, editor. II. Title: Study guide for the NCLEX-RN exam.  [DNLM: 1. Nursing Care—Examination Questions. 2. Nursing Care—Outlines. 3. Licensure, Nursing—Examination Questions. 4. Licensure, Nursing—Outlines. 5. Nursing Process—Examination Questions. 6. Nursing Process—Outlines. WY 18.2] RT55 610.73076—dc23 2015027109

Executive Content Strategist: Yvonne Alexopoulos Content Development Manager: Jean Fornango Content Development Specialist: Melissa Rawe Publishing Services Manager: Jeff Patterson Book Production Specialist: Bill Drone Book Designer: Xiaopei Chen Marketing Manager: Julie Mark Printed in Canada.

Last digit is the print number: 9 8 7 6 5 4 3 2 1

Contributors Joanna Barnes, RN, BSN, MSN, ADN Program Director, Health Science Program Chair, Grayson College, Denison, Texas Deanne A. Blach, MSN, RN, Nurse Educator, President, DB Productions of Northwest Arkansas, Inc., Green Forest, Arkansas Michele Deck, RN, MEd, BSN, LCCE, FACCE, Trainers, Baton Rouge, Louisiana

CEO, GAMES/Tool Thyme for

Sharon Decker, PhD, RN, ANEF, FAAN Professor and Covenant Health System Endowed Chair in Simulation and Nursing Education Director of the F. Marie Hall SimLife Center Director of TTUHSC Quality Enhancement Plan, Lubbock, Texas Debra L. Fontenot, DNP, RN, CPNP, CNE, Community College, Alvin, Texas Ashley Zerwekh Garneau, PhD, RN, College, Phoenix, Arizona Shirley A. Greenway, MSN, RN, College, Denison, Texas Michael W. Hutton, MSN, RN, Bryan, Texas

Director, Nursing Programs, Alvin

Nursing Faculty, GateWay Community

Associate Degree Nursing Professor, Grayson

Director, Associate Nursing Program, Blinn College,

Sharon Johns, MSN, RN, CNE, Nurse Educator, Nursing Education Consultants, Inc., Chandler, Arizona, Sherman, Texas Ashley White, MSN, RN, OCN, Alvin, Texas Mary Ann Yantis, BS, MS, Arizona, Dallas, Texas

Nursing Instructor, Alvin Community College,

Faculty, Nursing Education Consultants, Inc., Chandler,

Tyler Zerwekh, BA, MPH, DrPH, REHS, Administrator, Environmental Health Services Bureau, Shelby County Health Department, Memphis, Tennessee

Item writers Mary Boyce, MSN, RN, CCRN, CNE, Mesa, Arizona

Nursing Faculty, Mesa Community College,

Sharon Decker, PhD, RN, ANEF, FAAN, Professor, School of Nursing, Texas Tech University Health Sciences Center, Lubbock, Texas Sharon L. Johns, MSN, RN, CNE, Nurse Educator, Nursing Education Consultants, Inc., Chandler, Arizona, Sherman, Texas

Reviewers Carol C. Annesser, RN, MSN, BC, CNE, of Northwest Ohio, Toledo, Ohio

Assistant Professor, Nursing, Mercy College

Shelley Cobbett, RN, BN, GNT, MN, EdD, Assistant Professor, School of Nursing, Dalhousie University, Yarmouth, Nova Scotia, Canada Julie Darby, MSN, RN, CNE, Assistant Professor of Nursing, Baptist College of Health Sciences, Memphis, Tennessee Maggie Davis-Kendrick, MSN, College, Los Angeles, California

Associate Professor, Los Angeles Trade Technical

Fernande E. Deno, RN, MSN, CNE, College, Coon Rapids, Michigan

Nursing Faculty, Anoka Ramsey Community

Margie L. Francisco, EdD, MSN, RN, Nursing Professor, Second-Year Program Coordinator, Illinois Valley Community College, Oglesby, Illinois Sheila Grossman, PhD, APRN, FNP-BC, FAAN, Professor & FNP Track Coordinator Director, Faculty Scholarship, School of Nursing, Fairfield University, Fairfield, Connecticut Donna Walker Hubbard, MSN, RN, CNNe, of Mary Hardin-Baylor, Belton, Texas

Retired Assistant Professor, University

Cheryl A. Lehman, PhD, RN, CNS-BC, RN-BC, CRRN, Clinical Professor—retired; Nursing Consultant, The University of Texas Health Science Center at San Antonio, San Antonio, Texas Sue A. McCann, MSN, DNC, RN, University of Pittsburgh Medical Center, Department of Dermatology, Pittsburgh, Pennsylvania, Beaumont, Texas Jane V. McCloskey, RN, MSN, Charlotte, North Carolina

Faculty, Carolinas College of Health Sciences,

Deema Tackett, MSN, RN, CNL, College, Hillsboro, Ohio

Assistant Professor, Southern State Community

Daryle Wane, PhD, ARNP, FNP-BC, RN to BSN Coordinator, Professor of Nursing BSN Faculty, Pasco-Hernando State College, New Port Richey, Florida Nancy Wozney, PhD, RN, College, Winona, Minnesota

Dean of Nursing and Allied Health, Minnesota State

Preface JoAnn Zerwekh

This ninth edition of Illustrated Study Guide for the NCLEX-RN® Exam continues to provide an up-to-date review book illustrated with graphics, pictures, and cartoon images to enhance your review and retention of critical nursing information. The book contains information specifically designed to assist you in preparing for the National Council Licensure Examination for Registered Nurses (NCLEX-RN®). This text emphasizes the integrated approach to nursing practice that the NCLEX-RN is designed to test. The book’s primary purpose is to assist you to thoroughly review facts, principles, and applications of the nursing process. It should alleviate many of the concerns you may have about what, how, and when to study. I have spent a great deal of time studying the NCLEX-RN test format and have incorporated that information into this book. Discussion and examples of the alternate format questions are included. In my review courses, which I have taught across the country, I have identified specific student needs and correlated this information with the test plan to develop this study guide. Study questions are at the end of each chapter to help you check your level of comprehension. In addition, there is a companion Evolve website (http://evolve.elsevier.com/Zerwekh/studyguide/) that contains questions for practicing your testing skills. Graphics highlighting important information make the book more visually appealing. They include: ALERT Alert identifies important concepts that are reflected on the RN Practice Analysis from the National Council of State Boards of Nursing, Inc. Nursing Priority assists to distinguish priorities of nursing care. Adult disease conditions are easily located by this design element. Pediatric disease conditions are easily located by this design element. Self-Care and Home Care can be found under the Nursing Interventions section. Medication information is easily found in chapter appendixes. High-Alert Medications identified by The Joint Commission and the Institute for Safe Medication Practices are noted by this symbol. The comments from our review course participants and extensive content reviews have helped shape the development of this ninth edition. I hope this text will prove to be even more beneficial to nursing faculty, students, and graduate nurses. Thank you for allowing me to be part of your success in nursing.

Acknowledgments I truly appreciate the continuing support of my children and stepchildren—Tyler Zerwekh, Ashley Zerwekh Garneau, Carrie Parks, and Matt Masog, who have given me my wonderful grandchildren who lighten my day and make me smile—Maddie and Harper Zerwekh, Ben Garneau, Alexis and Brooklyn Parks, and Owen Masog. To John Masog, my husband, thank you for your tolerance, love, and willingness to continue to share and support me in the midst of our busy lives. Thanks also for the awesome lemon drops (you are the consummate mixologist) and the excellent meals you prepare for us. A special note of thanks to C. J. Miller, RN, BSN, cartoonist, who has worked with me from the beginning of the Memory Notebooks of Nursing and the many editions of Nursing Today: Transition and Trends, and more recently with the Mosby’s Memory Notecard series. She continues to brighten the day and brings to all of my books images and cartoons that are so unique. This edition offers the opportunity to be responsive to nursing faculty and students who have utilized the book. Their comments and suggestions for the production of this ninth edition have been incorporated into the revision. It is my pleasure to acknowledge the individuals who assisted me in the technical preparation and production of this edition. My sincere appreciation to the following: Elaine Nokes, my chief of operations, who keeps everything with Nursing Education Consultants, Inc., my review business and my publishing company organized and running smoothly. Yvonne Alexopoulos, Senior Content Strategist, with whom I have worked on many editions of the Nursing Today: Transition & Trends book—it has been a so easy to work with you on the Illustrated Study Guide for the NCLEX-RN® Exam review book. Melissa Rawe, Content Development Specialist, who provided helpful assistance to me and the contributors from the beginning part of the revision process throughout the entire production cycle of the book. Bill Drone, Book Production Specialist, who monitored the production of this book and kept me on schedule. It is always a pleasure to work with you! Thank you to all!

CHAPTER 1

Testing strategies for the NCLEX-RN® examination One of the first steps in being successful on the NCLEX® (National Council Licensure Examination) is to understand how the test is developed. An important step in preparing for the examination is to find out as much as possible about the test. This will help reduce stress and anxiety. During each of your nursing classes, you were given a syllabus with course objectives and provided with presentations to guide you through the information that would be included on course examinations. In most academic settings, the faculty member who teaches the course is also responsible for the development and construction of examinations; thus, you are being taught by the same person who prepares the tests, which can be a great advantage. As you begin to prepare for the NCLEX, it is important to consider who determines the content of the test plan and constructs the questions based on the test plan. The National Council of State Boards of Nursing (NCSBN) is responsible for the development of the content and the construction of questions or items for the NCLEX examination. A practice analysis is conducted by the NCSBN every 3 years to validate the test plan and to determine currency of nursing practice. Content experts are consulted to assist in the creation of the practice analysis. The activity performances and knowledge identified by the content experts are analyzed with consideration given to frequency, as well as importance of the nursing activity. The percentage of test items on the test plan does not specifically address specialty areas. However, on review of the nursing activities, many of the test plan areas address specialty areas of nursing practice. This analysis provides the basis for development of the content to be included in the NCLEX Test Plan. The content experts are practicing nurses who work with or supervise new graduates in the practice setting. These content experts represent all geographic areas and are selected according to their area of practice; therefore, all areas of nursing practice are addressed in the development of the test plan. Item writers are selected to create questions based on the content identified in the test plan. All new test items or questions are reviewed by item reviewers who are also nurses in current practice and who have been directly involved with supervision of new graduate nurses. Content experts and item reviewers not only create new items, they are also involved in the continual review of items in the NCLEX test pool to ensure all items reflect current practice. So what does all this mean? It means that nurses in current practice and nursing faculty work together to identify the content and to develop questions for the NCLEXRN. All geographic areas, as well as all areas of nursing practice, are included. The purpose of the examination is to assure the public that each candidate who passes the examination can practice safely and effectively as a newly licensed, entry-level

registered nurse. Every U.S. state uses the NCLEX-RN to determine entry into nursing practice as a registered nurse (RN). Each state is responsible for the testing requirements, retesting procedures, and entry into practice within that state. Each state requires the same competency level or passing standard on the NCLEX. There is no variation in the passing standard from state to state.

Test plan The test plan is based on research conducted by the NCSBN every 3 years. The purpose of this research is to determine the most important and frequent activities of nurses who were successful on the NCLEX and who have been working after successful completion of the NCLEX. The research indicates that the majority of graduate nurses is working in an acute care environment and is responsible for caring for adult and older adult clients. Each question reflects a level of the nursing process or an area of client needs, and each question is categorized according to a validated level of difficulty. The examination consists of questions that are designed to test the candidate’s ability to apply the nursing process, prioritize client care, and determine appropriate nursing responses and interventions to provide safe nursing care.

Integrated processes Integrated throughout the test plan are principles that are fundamental to the practice of nursing.

Nursing process The nursing process is a scientific approach to problem solving; it has been a common thread in your nursing curriculum since the beginning of school. There is nothing new about the nursing process on the NCLEX. Assessment data are obtained, the data are analyzed, a plan is formulated, nursing actions are implemented, and the results of that intervention are evaluated. It is important to keep the steps of the nursing process in mind when you are critically evaluating an NCLEX question. See Box 1-1 Key Words for Identifying the Nursing Process.

Box 1-1

KEY WORDS FOR IDENTIFYING THE NURSING PROCESS The following words and phrases have the same meaning and are often interchangeable. The words are associated with activities in the practice analysis. • Assessment: gather objective and subjective, determine, observe, identify findings, recognize changes, notice, detect, find data, verify data, gather information, describe

status, assess client • Analysis: interpret data, identify a nursing diagnosis, collect additional data, examine client data, consider nursing data, examine client data for priority • Planning: establish goals, plan interventions, create plan, generate goals, prioritize outcomes of client care, arrange priorities and interventions, formulate short-term goal or long-term goals, prepare list of client outcomes, develop and modify nursing plan of care • Implementation: implement nursing interventions, delegate nursing care, offer alternatives, teach, give, administer, chart, document, explain, inform, encourage, advise, provide, prepare, counsel, teach, perform or assist with client care and needs • Evaluation: evaluate nursing care, question results, monitor findings, repeat assessment, compare outcomes with expected nursing care outcomes, reestablish, consider alternatives, determine changes and response, appraise findings, modify plan of care, evaluate plan of care based on client compliance

Caring The interaction of the client and the nurse...