Ncsbn KEY Points - Lectures for NCLEX-RN Examination PDF

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Lectures for NCLEX-RN Examination...

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LESSON 1: MANAGEMENT OF CARE                      

According to QSEN, nurses must possess knowledge, skills and attitudes (KSAs) in six key areas to provide safe and quality client care Ethics guide the nurse toward client advocacy and the development of a therapeutic relationship In most situations, clients have the right to accept or refuse treatment If the client is unable to understand the information due to a language barrier, a trained medical interpreter must be present Legal documents that support clients' rights include advance directives, a living will, do not resuscitate (DNR) order and an informed consent The client and/or designated proxy can withdraw consent at any time Nurses are members of the interdisciplinary health care team The nursing team consists of registered nurses (RN), licensed practical or vocational nurses (LPN/VN) and unlicensed assistive personnel (UAP) A nurse's scope of practice is determined by the nurse practice act (NPA) of the state or jurisdiction in which the nurse is licensed Know the Five Rights of Delegation The nurse must monitor and evaluate the outcome of delegated and assigned tasks The nurse cannot delegate clinical decision-making The nurse must be able to effectively prioritize nursing interventions Good communication skills are essential when interacting with members of the health care team When the nurse's verbal and nonverbal communication messages do not agree, the client is more likely to believe the nonverbal message One well-known communication approach is the Situation-Background-AssessmentRecommendation (SBAR) method Nurses must follow best practices when documenting in the client's medical record (paper or electronic) It is every nurse's responsibility to protect the confidentiality, privacy and integrity of protected health information (PHI) Nurses shall actively participate in care coordination across the health care continuum Nurses play an important role in quality improvement (QI) activities within health care organizations Nurses function as teachers for their clients RNs cannot delegate client teaching to an LPN/VN and both RNs and LPN/VNs cannot delegate teaching to UAPs

Lesson 2: Safety & Infection Control  

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Patient identification should include the use of two, distinct patient identifiers. The client's room number should never be used as an identifier. Sentinel events are shocking events that occur in health care, such as surgery on the wrong body site, mismatched blood transfusion, a client's suicide while hospitalized or foreign objects left in the client's body after an operation. Nurses play a vital role in protecting clients from "failure to rescue." Use the mnemonic R.A.C.E. to remember what to do in case of smoke or a fire. Use the mnemonic P.A.S.S. to remember how to use a fire extinguisher. Nurses should remove malfunctioning equipment from client care areas immediately and notify the appropriate department.

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Nurses must ensure that all appropriate precautions are being followed for the client receiving brachytherapy to prevent radiation contamination. Nurses play a vital role in developing or assisting with developing an individualized plan of care for the client to prevent falls. There are three categories of restraints: chemical, physical and seclusion. The nurse must understand when restraint use is appropriate. A prescription for restraints must include specific details. A provider order for restraints can NEVER be written in advance for "what if" situations or "as needed" (i.e., PRN). Nurses play a key role in preventing HAIs such as CLABSI, CAUTI or VAP. Regular and correct hand hygiene is the single most effective way to prevent the spread of microorganisms. Nurses need to know how to correctly implement and evaluate transmission-based precautions. Nurses contribute to antimicrobial stewardship by working with the Interdisciplinary Team (IDT) to promote and reinforce the appropriate use of antibiotics. Nurses must provide or reinforce education for the client on the correct use of antibiotic therapy. Nurses must be able to recognize what an incident is and when to complete an incident report. Nurses' role in a disaster is to triage clients according to their injuries and chance for survival. Nurses are responsible for knowing their facility's emergency response and security plans. Due to migration, refugees and the globalization of travel, nurses must remain alert to the possibility of outbreaks of diseases that are otherwise not commonly seen in their communities or health care settings. By adhering to the health care agency's policies and using ergonomic principles, nurses can prevent or minimize the risk of injury to themselves.

Lesson 3: Health Promotion & Maintenance  

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Health can be defined as a state of complete physical, mental and social well-being. Health disparities are differences in health status, health care services and health outcomes of clients who belong to a minority group based on race or ethnicity, sex, sexual identity, age, disability, religion, socioeconomic status or geographic location. Nurses play an essential role in improving health and health care for all by working toward elimination of health disparities. The desired outcome of the nurse's health promotion activities is for clients to experience improved health, enhanced functional ability and a better quality of life. Nurses must apply their knowledge of health promotion and maintenance in a compassionate, nonjudgmental and culturally sensitive manner that incorporates the beliefs, values and preferences of the client (and their family). Complementary and alternative therapies or medicine must be accepted as an addition to a client's self-care and incorporated, if appropriate, into the client's nursing plan of care. Nurses should help clients identify risk factors that may impact their health and provide information how to prevent and treat modifiable health risk behaviors. Nurses must demonstrate proficiency in collecting data about the client's current health status and their health history, including their family medical history. Nurses must have a basic understanding of family planning, preconception health and the nursing care priorities for the pregnant client from conception through birth. Abstinence is the only 100% effective way to protect against pregnancy.

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The nurse should advise a client who might be or is pregnant to seek advice from a health care provider early in the pregnancy. Nurses must be able to safely care for the client, or assist with nursing care, during labor, delivery and the postpartum period. Nurses must be able to teach (RN) or reinforce teaching (LPN/VN) for pregnant and postpartum clients about the physiological and emotional changes they might experience. Nurses must know how to safely care for a newborn, in order to assist with nursing care from immediately after delivery to discharge. Nurses must be able to teach (RN) or reinforce teaching (LPN/VN) for new parent(s) on how to safely and appropriately care for their infant. Through a foundational understanding of human growth and development, nurses create, or assist in creating, a plan of care that addresses the specific needs of the client's stage of growth and development. While providing end-of-life care, the nurse assists the client to die with dignity, without avoidable pain and in a manner that integrates the client's wishes and supports their highest quality of life. Brain death refers to the permanent loss of all brain function, including those of the brainstem. Brain death is a clinical diagnosis that is made by the health care provider.

Lesson 4: Psychosocial Integrity        

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Therapeutic communication includes both verbal and nonverbal techniques. The nurse must be proficient in cross-cultural communication such as communicating with clients whose primary language is not English. When communicating with clients and their families, it is a good idea to ask for feedback from the client at regular intervals and provide an opportunity to ask questions or clarify information. When communicating with clients with hearing loss, speak slowly while facing the client. There is no need to shout. Using visual information can enhance the spoken word. When communicating with clients who have had a stroke, approach the client from the unaffected visual-sensory side and be aware of the type of aphasia the client might be experiencing. When communicating with clients with dementia, reality orientation is not recommended. Ask simple yes and no questions that require simple answers. Use the K.I.S.S. technique when communicating with clients with cognitive and/or neuro-sensory deficits. The nurse must be careful to avoid nontherapeutic communication techniques, such as asking "why" questions, giving false reassurance or giving opinions based on one's own values rather than on an objective, client-focused response. Using therapeutic communication helps the nurse to establish a therapeutic client-nurse relationship and a therapeutic environment or milieu. The S.O.L.E.R. techniques support active listening and therapeutic communication. There are three phases in the client-nurse relationship: orientation, working and termination. When the nurse encounters a client who is nonadherent/noncompliant with their treatment plan, the nurse should remain nonjudgmental and first explore the reasons for noncompliance with the client. The nurse must be sensitive to a client's cultural background and can use the steps In E.T.H.N.I.C. when caring for diverse clients. The nurse must have a basic understanding of the emotional responses that clients can experience and exhibit after a loss.

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The response of clients to loss depends on their values, beliefs, culture, previous experience with loss and support system. The nurse must be able to differentiate between a client's adaptive and maladaptive grief response. The nurse should always remember that grieving is not a linear process. Everyone grieves in their own way and there is no time limit for how long a client should grieve. Stress is a universal phenomenon, meaning it is experienced by everyone, including nurses. Stress causes psychological and physical responses in the body. The nurse should assist clients with how to recognize stressful situations and how to manage stress effectively. The nurse must possess a basic understanding of techniques that can help clients relieve stress, including cognitive restructuring. When a situation or stress overwhelms a client's coping mechanisms, the client can experience a crisis. The nurse plays an important role in crisis intervention, including suicide prevention. The nurse must understand the warning signs and risk factors for suicide and must intervene immediately for the client at risk for suicide. Nurses are considered "mandated reporters" for clients who they suspect are victims of abuse, maltreatment or neglect. The nurse must have a basic understanding of concepts of mental health and how mental illnesses are diagnosed and treated, including illness-specific pharmacotherapy.

Lesson 5: Basic Care & Comfort               

It is important for the nurse to know the essential nutrients and concepts of nutrition. The average adult client should consume 25 to 30 calories per kilogram of body weight to maintain their current weight. Carbohydrates are the quickest source of energy and the primary source of fuel for all cells. Lipids are the most concentrated source of energy and the major form of stored energy. Proteins are essential for cell growth and wound healing and serve as a secondary source of energy for cell metabolism. Vitamins (water or fat soluble) are organic substances essential for body growth and metabolism. Minerals are inorganic substances that act as essential catalysts in many biochemical reactions in the body. Water accounts for 60 to 70% of total body weight in adults and has many essential functions. Body fluids and electrolytes play a vital role in helping the body maintain a stable internal environment called homeostasis. Major electrolytes include chloride, bicarbonate, phosphate, sodium, potassium, calcium and magnesium. The kidneys, with help from a number of other systems, are responsible for regulating the body’s fluid balance. The nurse collaborates with the Interdisciplinary Team (IDT) to determine the client’s nutritional status and needs. The nurse must be proficient in identifying factors can affect a client’s nutritional status. The nurse must be familiar with recommendations for daily nutrient intake. Some clients are prescribed a therapeutic diet and the nurse must understand what food modifications that diet entails.

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When a client cannot maintain or achieve adequate nutritional intake, nutritional support is required. Nutritional support can consist of enteral nutrition, nutritional supplements or total parenteral nutrition (TPN). The nurse must be proficient in the nursing interventions required to ensure client safety when administering nutritional support. The nurse must be able to recognize fluid and/or electrolyte imbalances and strategies to prevent and treat them. The nurse must have a basic understanding of mobility and complications that can occur in clients with impaired mobility. The nurse collaborates with physical, occupational and speech therapists to meet the needs of clients who require assistive/adaptive devices and equipment. The nurse must understand the concepts of urine and bowel elimination in order to develop or assist in the development of a plan of care for clients experiencing impaired elimination. The nurse must be able to recognize and intervene for complications related to impaired elimination. The nurse must be proficient in caring for clients with alternative or therapeutic elimination systems, such as an ostomy or indwelling urinary catheter. It is important for the nurse to know about and be able to explain or help implement interventions that promote rest and sleep for clients experiencing sleep problems. The nurse must understand the concepts of pain and pain management in order to develop or assist in the development of a plan of care for clients experiencing acute and/or chronic pain.

Lesson 6-A: Parenteral Therapies              

The nurse plays an essential role in preparing, administering and evaluating the effects of medications for their clients. The nurse is expected to understand the pharmacotherapeutic principles for all medications given to or taken by their clients. Two major goals of medication administration are to prevent or limit adverse drug events (ADEs) and to recognize dangerous side effects. The nurse must be familiar with the teratogenic risk classification of drugs. The nurse must monitor for and recognize extreme adverse drug interactions as indicated by a black box warning. The nurse must be diligent in the prevention of medication errors. The nurse must know high-alert medications that have a high potential to cause harm if administered incorrectly to the client. The nurse must follow the 10 Rights of Medication Administration. The nurse must be able to accurately perform basic mathematical calculations in order to confirm dosages of prescribed medications. The nurse must be proficient in converting units of measurement from one system to another. The nurse is responsible for monitoring the client for local and systemic complications related to IV therapy, whether the IV is peripherally or centrally administered. Although a temporary vascular access device used for hemodialysis can be considered a CVAD, it is used exclusively for dialysis and should only be accessed by specially-trained dialysis nurses. Before starting a TPN infusion, the nurse must verify that the ingredients in the solution match what the HCP ordered. Requiring blood component therapy can cause an ethical or legal dilemma for clients or their family. Some religions, e.g., Jehovah's Witnesses, forbid receiving blood transfusions. The nurse must be

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cognizant of these potential issues and collaborate with the HCP, while at the same time advocating for the client. Never use dextrose- or lactated Ringer's-containing solutions to prime blood tubing and administer blood products! Avoid giving any medications through the same IV line or tubing used for the blood transfusion.

Lesson 7: Reduction of Risk Potential Pulmonary Hygiene 

The nurse is responsible for implementing interventions that promote airway clearance and reduce the risk of respiratory complications.

Oxygen Therapy 

A nonrebreather mask with flowmeter set at 15 liters will provide the highest fraction of inspired oxygen (FiO2) available from a supplemental oxygen device.

Tracheostomy    

Clients with a new tracheostomy may have bloody secretions for a few days after the procedure or after a complete tube change. A tracheostomy obturator should be available at the bedside at all times. Fungal Infections can develop under moist tracheostomy dressings. Ask another member of the Interdisciplinary Team (IDT) such as another nurse or respiratory therapist, to assist with care of a new tracheostomy to prevent accidental dislodgement.

Mechanical Ventilation  

If an alarm sounds while caring for a client on a ventilator, assess the client first. If the alarm continues to sound and the client develops distress:  Disconnect the client from the ventilator.  Use a manual resuscitation (ambu) bag to ventilate the client.  Call for help immediately.

Suctioning and Chest Physiotherapy  

Do not apply suction for longer than 10 seconds. Hyperoxygenate prior to and immediately after suctioning. Administer prescribed bronchodilator medication before chest physiotherapy.

Chest Tubes  

While using a wet chest drainage system, gentle bubbling in suction control chamber is expected and indicates that there is suction. While using a dry chest drainage system:  Bubbling in the water seal chamber indicates an air leak and should be reported to the health care provider (HCP).  Notify the HCP if drainage is more than 100 mL/hour, if it becomes bright red or the amount suddenly increases.

Wounds    

Never change a dressing or touch a wound without wearing gloves. The first post-operative dressing change is usually performed by the HCP, not the nurse. Pre-medicate the client with an analgesic before a complex dressing change. If a drain is present, carefully remove wound dressings one layer at a time to avoid dislodging the drain.

Casts   

A cast may be heavy or impair mobility due to its location and the type of casting material. A cast may smell sour but should never smell foul. Report signs of neurovascular impairment immediately.

Traction 

Weights for traction should be freely hanging at all times.

Specimen Collection  

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Obtain all specimens wearing the appropriate personal protective equipment (PPE) and following standard precautions. Seal all specimen containers tightly and place in a sealable, leak-proof biohazard pouch during transport to the lab. Specimens should be delivered to the laboratory as quickly as possible. Do not allow specimens to sit at room temperature.

X-rays and Other Diagnostic Tests  

Not all fractures show on X-ray, so the diagnosis should include clinical data. Following a laparoscopy, carbon dioxide trapped in the abdomen may cause discomfort and even shoulder pain.

Lesson 8-A: Cardiovascular-Hematologic     

Cardiovascular disease (CVD) is the leading cause of death in the U.S. and in many other countries. Current research has shown t...