Exam (elaborations) NCLEX-PN Delmar's NCLEX-PN Review (NCLEX-PN REVIEW) 2ND EDITION, ISBN: 9781428310940

Exam (elaborations) NCLEX-PN Delmar's NCLEX-PN Review (NCLEX-PN REVIEW) 2ND EDITION, ISBN: 0940 CONTENTS Index of Tables xiii Preface xvii Contributors xix Questions You Might Have about the Examination 2 What Is the National Council of State Boards of Nursing? 2 What Is the Current Test Plan? 2 How Do I Apply to Take the Examination? 3 What Types of Questions Are on the Examination? 4 Do I Have to Know a Lot About Computers to Take the Examination? 4 How Is the Examination Scored? 4 Can I Take a Break? 4 When Will I Know If I Passed? 4 Tips for Test Taking 5 Look for Key Concepts 5 Look for Key Words 5 Utilize Test-Taking Strategies 5 Tips on How to Prepare for NCLEX-PN® 6 Review Content 6 Practice Multiple-Choice Questions 7 Practice Stress-Reduction Strategies 7 Examination Day 7 Management of Care 11 Client Rights 11 Delegation and Supervision 11 Incident/Unusual Occurrence Reports 11 Basic Hygienic Care 12 Bathing 12 Measurement of Vital Signs 12 Temperature 12 Pulse 13 Respiration 13 Blood Pressure 13 Managing Pain 14 Prevention of Infection 14 Chain of Events Leading to Infection 14 Asepsis 14 Immobility 16 Pressure Ulcer (Decubitus Ulcer, or Bedsore) 17 Positioning 18 Body Mechanics, Transfer, and Ambulation Techniques 20 Care of Client Needing Restraints 21 Care of the Client Needing Application of Heat or Cold 24 Application of Cold 24 Application of Heat 24 Care of the Client in Shock 25 Fluid and Electrolyte Balance 25 Body Fluids 25 Mechanisms of Fluid Balance 25 Electrolytes 26 Acid-Base Balance 29 General Concepts 29 Interpreting Blood Gases 29 Death 30 CHAPTER 2 ESSENTIAL CONCEPTS • 9 Clinical Problem Solving (Nursing Process) Overview 10 Steps of the Nursing Process 10 CHAPTER 1 HOW TO PREPARE FOR NCLEX-PN® • 1 Copyright 2010 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Legal Aspects: Informed Consent 46 Preoperative Period 46 Surgical Risk Factors 46 Preoperative Teaching 47 Physical Preparation for Surgery 47 Immediate Preoperative Care 48 Anesthesia 48 Conscious Sedation 48 General Anesthesia 48 Regional Anesthesia 49 Postoperative Period 49 Immediate Postoperative Care (Recovery Room, Postanesthesia Care Unit) 49 Nursing Care on Surgical Unit 49 VIII CONTENTS Laboratory Tests 68 Noninvasive Tests 69 Invasive Procedures 69 Cardiovascular Conditions 70 Hypertension 70 Angina 71 Myocardial Infarction 71 Percutaneous Transluminal Coronary Angioplasty (PTCA) 73 Coronary Artery Bypass Graft (CABG) 73 Cardiac Failure 74 Pacemaker 75 Defibrillation (Countershock) 76 Peripheral Vascular Disorders 76 Arteriosclerosis Obliterans (ASO) 77 Buerger’s Disease 77 Raynaud’s Disease 77 Aortic Aneurysm 78 Vein Disorders 78 Thrombophlebitis; Deep Vein Thrombosis (DVT) 78 Varicose Veins 79 CHAPTER 3 THE OLDER ADULT CLIENT • 37 CHAPTER 4 THE PERIOPERATIVE CLIENT • 45 CHAPTER 5 ONCOLOGY • 55 CHAPTER 6 THE CARDIOVASCULAR SYSTEM • 65 CHAPTER 7 THE HEMATOLOGIC SYSTEM • 87 CHAPTER 8 THE RESPIRATORY SYSTEM • 101 General Concepts 38 Theories of Aging 38 Biological 38 Psychosocial 38 Developmental Tasks 38 Changes of Normal Aging 39 Characteristics and Pathophysiology 56 Assessment 56 Staging 56 Grading 56 Assessment 57 Interventions 57 Goals of Treatment 57 Surgery 57 Chemotherapy 58 Radiation Therapy 59 Emotional Support 60 Anatomy and Physiology of the Cardiovascular System 66 Vascular System 67 Diagnostic Procedures 68 Anatomy and Physiology of the Hematologic System 88 Spleen 88 Blood Transfusions and Blood Products 89 Disorders 90 Anemias 90 Clotting Disorders 92 White Cell Disorders 94 Other Malignant Disorders 94 Anatomy and Physiology 102 Nose 102 Pharynx 102 Larynx 102 Trachea (Windpipe) 102 Bronchial Tree 103 Lungs 103 Chest Wall 103 Pulmonary Circulation 103 Gas Exchange: Alveolar Ducts and Alveoli 103 Nursing Assessment 103 Health History 103 Physical Examination 104 Diagnostic Studies 104 Copyright 2010 Cengage Learning. 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CONTENTS IX Therapies and Procedures Related to the Respiratory System 105 Oxygen Therapy 105 Tracheostomy 105 Closed Chest Drainage 106 Respiratory Tract Conditions 107 Epistaxis (Nosebleed) 107 Cancer of the Larynx 107 Chronic Obstructive Pulmonary Disease (COPD) 107 Pneumonia 110 Pneumothorax 111 Thoracic Surgery 111 Tuberculosis 111 Histoplasmosis 112 CHAPTER 9 THE NEUROSENSORY SYSTEM • 117 Anatomy and Physiology 118 Structures 118 Eyes 121 Ears: Sensory Organs That Enable Hearing and Help to Maintain Balance 123 Diagnostic Procedures 124 Brain Scan 124 Lumbar Puncture 124 Cerebral Angiography 124 Computerized Axial Tomography (CAT or CT Scan) 124 Magnetic Resonance Imaging (MRI) 124 Electroencephalography (EEG) 124 Nervous System Disorders 125 Increased Intracranial Pressure 125 Head Injuries 126 Hyperthermia 126 Seizures 126 Cerebrovascular Accident(CVA) 127 Transient Ischemic Attack (TIA) 128 Spinal Cord Injury 128 Multiple Sclerosis 128 Myasthenia Gravis 130 Parkinson’s Disease 131 Guillain-Barré Syndrome (Infectious Polyneuritis) 131 Amyotrophic Lateral Sclerosis (ALS, Lou Gehrig’s Disease) 132 Trigeminal Neuralgia (Tic Douloureux) 133 Bell’s Palsy 133 Eye Conditions 133 Detached Retina 133 Cataract 133 Glaucoma 134 Eye Injury 135 Care of the Client Who Is Blind 135 Conditions of the Ear 135 Care of the Client with Diminished Hearing 135 Ménière’s Disease 136 Otosclerosis 136 CHAPTER 10 THE GASTROINTESTINAL SYSTEM • 143 CHAPTER 11 THE GENITOURINARY SYSTEM • 171 CHAPTER 12 THE MUSCULOSKELETAL SYSTEM • 189 Anatomy and Physiology 144 Mouth 144 Esophagus 144 Stomach 144 Small Intestine 145 Large Intestine 145 Hepatic, Biliary, and Pancreatic System 146 Diagnostic Procedures 147 Related Procedures 149 Enemas 149 Gastrointestinal Intubation 149 Gastrostomy Tube 150 Total Parenteral Nutrition (TPN) 150 Disorders of the Gastrointestinal System 151 Nausea and Vomiting 151 Diarrhea 152 Constipation 152 Hiatal Hernia 153 Gastroesophageal Reflux Disease (GERD) 153 Peptic Ulcer Disease 154 Cancer of the Stomach 156 Gastric Surgery 157 Hernias 157 Appendicitis 157 Chronic Inflammatory Bowel Disorders 158 Cancer of the Colon/Rectum 159 Bowel Surgery 159 Hemorrhoids 160 Disorders of the Liver 161 Disorders of the Gallbladder 163 Disorders of the Pancreas 164 Anatomy and Physiology of Urinary System 172 Male Reproductive System 172 Diagnostic Tests 175 Specific Urologic Disorders 176 Disorders of the Male Reproductive System 182 Anatomy and Physiology of Skeletal System 190 Muscular System 190 Cartilage 190 Ligaments and Tendons 190 Copyright 2010 Cengage Learning. 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X CONTENTS Skin Cancer 232 Herpes Zoster (Shingles) 233 Herpes Simplex Virus, Type I 233 Burns 233 Anatomy of the Female Reproductive System 242 Physiology of the Female Reproductive System 243 Conditions of the Female Reproductive System 245 Breast Conditions 245 Conditions of the Uterus 246 Sexually Transmitted Diseases 248 Fertility Management 250 The Antepartal Client 257 Onset of Pregnancy/Fetal Development 257 Pregnancy 259 Antepartal Complications 263 The Intrapartal Client 272 Overview of Normal Labor 272 Nursing Care During Labor 274 Complications of Labor and Delivery 278 The Postpartal Client 287 Physiological Changes in the Postpartal Period 287 Complications 289 Normal Newborn 294 Transition to Extrauterine Life 294 Assessment of Newborn 295 High-Risk Newborn 297 Laboratory / Diagnostic Tests 190 Blood Tests 190 Other Tests 191 Related Procedures 191 Range-of-Motion (ROM) Exercises 191 Assistive Devices for Walking 191 Care of the Client with a Cast 193 Care of the Client in Traction 193 Disorders of the Musculoskeletal System 195 Fractures 195 Total Hip Replacement 196 Knee Replacement 197 Rheumatoid Arthritis 198 Osteoarthritis (Hypertrophic Arthritis) 199 Gout 199 Systemic Lupus Erythematosus (SLE) 200 Osteomyelitis 200 Herniated Nucleus Pulposus (HNP) 200 Amputation of a Limb 202 CHAPTER 13 THE ENDOCRINE SYSTEM • 209 CHAPTER 14 THE INTEGUMENTARY SYSTEM • 229 Anatomy and Physiology 210 Major Function Is to Regulate Body Functions 210 Pituitary Gland (Hypophysis) 210 Adrenal Gland 210 Thyroid Gland 210 Parathyroid Glands 210 Pancreas 212 Gonads 212 Endocrine Disorders 213 Pituitary Gland 213 Adrenal Gland 214 Thyroid Gland 215 Parathyroid Glands 218 Pancreas Disorders 218 Anatomy and Physiology 230 Skin 230 Hair 230 Nails 230 Glands 231 Laboratory and Diagnostic Studies 231 Disorders of the Integumentary System 231 Lesions of the Skin 231 Contact Dermatitis 232 Psoriasis 232 CHAPTER 15 THE FEMALE REPRODUCTIVE SYSTEM, MATERNITY, AND NEWBORNS • 241 CHAPTER 16 PEDIATRICS • 307 Growth and Development 308 First Year of Life 308 Toddler: One to Three Years 310 Preschooler: Three to Five Years 311 School-Aged Child 314 Adolescence 315 Reaction to Hospitalization/Separation 316 Toddler 316 Growth and Development Issues 316 Pediatric Conditions Related to the Cardiovascular System 325 Congenital Heart Defects 325 Rheumatic Fever 330 Kawasaki Disease (Mucocutaneous Lymph Node Syndrome) 331 Copyright 2010 Cengage Learning. 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CONTENTS XI Respiratory and Eyes, Ears, Nose, and Throat (EENT) Conditions 335 Tonsillitis (Not Usually Hospitalized) 335 Tonsillectomy/Adenoidectomy 335 Upper Respiratory Infections (URIs) 336 Epiglotittis 336 Laryngotracheobronchitis (Croup) 336 Otitis Media 337 Asthma (Reactive Airway Disease) 337 Cystic Fibrosis (Mucoviscidosis) 338 Respiratory Syncytial Virus (RSV) Infection 339 Pediatric Conditions Related to the Neurosensory System 343 Spina Bifida (Myelodysplasia) 343 Hydrocephalus 345 Brain Tumors 345 Reye’s Syndrome 346 Bacterial Meningitis 346 Cerebral Palsy 347 Tay-Sachs Disease 347 Conjunctivitis (Pink Eye) 348 Pediatric Conditions Related to the Gastrointestinal System 351 Cleft Lip 351 Cleft Palate 352 Esophageal Defects 352 Pyloric Stenosis 353 Gastroesophageal Reflux (GER) 354 Hirschsprung’s Disease (Congenital Aganglionic Megacolon) 354 Intussusception 354 Imperforate Anus 355 Celiac Disease 355 Hernias 355 Gastroenteritis 355 Parasitic Worms 356 Pediatric Conditions Related to the Genitourinary System 360 Urinary Tract Infection 360 Exstrophy of the Bladder 360 Cryptorchidism 361 Hypospadias 361 Nephrotic Syndrome 361 Acute Glomerulonephritis 361 Enuresis 361 Wilm’s Tumor (Nephroblastoma) 362 Pediatric Conditions Related to the Musculoskeletal System 364 Congenital Hip Dysplasia 364 Congenital Clubfoot: Talipes 365 Legg-Calvé Perthes Disease 366 Scoliosis 366 Muscular Dystrophy 367 Juvenile Rheumatoid Arthritis 367 Lyme Disease 367 Bone Tumors 368 Pediatric Conditions Related to the Endocrine System 370 Diabetes Mellitus 370 Congenital Hypothyroidism (Cretinism) 370 Hypopituitarism (Pituitary Dwarfism) 371 Hyperpituitarism (Gigantism) 371 Pediatric Conditions Related to the Integumentary System 373 Burns 373 Impetigo 373 Ringworm (Tinea) 373 Pediculosis (Lice) 374 Poison Ivy 374 Childhood Eczema 374 Basic Concepts 378 Therapeutic Communication 378 Phases in Nurse–Patient (Client) Relationship 378 Theoretical Models 379 Types of Interventions 380 Psychiatric Mental Health Problems 381 Anxiety 381 Anxiety Disorders 383 Eating Disorders 385 Loss and Grief 386 Mood Disorders 387 Schizophrenia 390 Suspicious and Paranoid Behaviors 391 Personality Disorders 392 Substance Abuse 393 Family Violence 395 Rape 396 Age-Related Disorders 397 Autistic Disorder 397 Chronic Organic Brain Syndromes 397 Legal Aspects of Psychiatric Nursing 398 Types of Admissions 398 Rights of Psychiatric Clients 398 CHAPTER 17 THE MENTAL HEALTH CLIENT • 377 CHAPTER 18 PHARMACOLOGY • 407 Basic Concepts 408 Preparing the Medication 408 Methods of Administration 408 Calculating Methods 411 Copyright 2010 Cengage Learning. 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XII CONTENTS Facts About Drug Action 413 Pharmacologic Agents 413 Antimicrobials and Antiparasitics 413 Central Nervous System Drugs 420 Drugs Affecting the Heart and Circulatory System 428 Peripheral Vasodilators 430 Hormonal Agents 435 Gastrointestinal Drugs 440 Arthritis and Gout Drugs 443 Drugs Affecting the Respiratory Tract 443 Eye Medications 445 Antineoplastic and Immunosuppressive Agents 446 Immunizations 449 Practice Test 1 486 Answer and Rationales for Practice Test 1 497 Practice Test 2 509 Answer and Rationales for Practice Test 2 519 Practice Test 3 531 Answer and Rationales for Practice Test 3 541 Practice Test 4 553 Answer and Rationales for Practice Test 4 563 Practice Test 5 577 Answer and Rationales for Practice Test 5 587 Practice Test 6 603 Answer and Rationales for Practice Test 6 613 Practice Test 7 627 Answer and Rationales for Practice Test 7 637 Practice Test 8 651 Answer and Rationales for Practice Test 8 662 INDEX 677 CHAPTER 19 NUTRITION AND SPECIAL DIETS • 459 Carbohydrates, Proteins, and Fats 460 Carbohydrates (CHO) 460 Proteins 460 Fats 461 Vitamins 461 Minerals 463 Nursing Care 463 Nutritional Guidelines 467 Food Pyramid 467 Special Diets 467 Consistency Modifications 467 Gluten-Free Diet 468 Phenylketonuria (PKU) Diet 468 Low-Purine Diet 469 Diets to Alter Acidity of Blood 469 Diets for Treatment of Diabetes 469 APPENDICES • 475 Appendix A: Symbols and Abbreviations 476 Appendix B: Metric System Equivalents 477 Appendix C: Temperature Conversions 478 Appendix D: Medical Prefixes and Suffixes 479 Appendix E: NANDA International Nursing Diagnoses 2009–2011 482 PRACTICE TESTS • 485 Copyright 2010 Cengage Learning. 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XIII INDEX OF TABLE S 1.1 NCLEX-PN® Test Plan 2 2.1 Normal Vital Signs 13 2.2 Handwashing 15 2.3 Standard Precautions 15 2.4 Guidelines for a Sterile Field 15 2.5 Transmission-Based Precautions 15 2.6 Immobility 16 2.7 Types of Exercises 17 2.8 Types of Movement 18 2.9 Nursing Diagnoses Related to Shock 25 2.10 Fluid Imbalances 26 2.11 Types of Solutions 26 2.12 Electrolyte Imbalances 27 2.13 Composition of IV Fluids 27 2.14 Acid Base Facts 29 2.15 Blood Gas Values 29 2.16 Helpful Hints for Interpreting Blood Gases 29 2.17 Major Acid-Base Alterations 30 2.18 Stages of Dying and Death According to Kubler-Ross 30 2.19 Nursing Diagnoses Related to Dying and Death 30 3.1 Nursing Diagnoses Related to Aging 39 3.2 Nursing Diagnoses Related to Abuse of an Older Adult Client 42 4.1 Stages of General Anesthesia 48 5.1 Cancer Chemotherapeutic Agents 58 5.2 Bleeding Precautions 59 5.3 Neutropenic Precautions 59 5.4 Nursing Diagnoses Related to Chemotherapy and Radiation 60 6.1 Nursing Diagnoses Related to Hypertension 70 6.2 Dietary Sources of Potassium 70 6.3 Nursing Diagnoses Related to Angina 71 6.4 Serum Enzyme Changes After a Myocardial Infarction 72 6.5 Nursing Diagnoses Related to Myocardial Infarction 72 6.6 Anticoagulants Therapy 73 6.7 High Sodium Foods 74 6.8 Nursing Diagnoses Related to Heart Failure 74 6.9 Signs of Digitalis Toxicity 75 6.10 Nursing Diagnoses Related to Peripheral Vascular Disease 76 6.11 Antilipemic Therapy 77 6.12 Nursing Diagnoses Related to Thrombophlebitis 78 7.1 Nursing Diagnoses Related to Anemia 90 7.2 Nursing Diagnoses Related to Sickle Cell Anemia 91 7.3 Nursing Diagnoses Related to Hemophilia 93 7.4 Nursing Diagnoses Related to Leukemia 94 7.5 Nursing Diagnoses Related to AIDS 96 8.1 Tracheobronchial Suctioning 105 8.2 Nursing Diagnoses Related to Tracheostomy Care 106 8.3 Nursing Diagnoses Related to Cancer of the Larynx 107 8.4 Nursing Diagnoses Related to COPD 109 8.5 Nursing Diagnoses Related to Pneumonia 110 8.6 Nursing Diagnoses Related to Pneumothorax 111 8.7 Nursing Diagnoses Related to Thoracic Surgery 111 8.8 Nursing Diagnoses Related to Tuberculosis 112 9.1 Cranial Nerves 121 9.2 Autonomic Nervous System 121 9.3 Glasgow Coma Scale 125 9.4 Nursing Diagnoses Related to Increased Intracranial Pressure 125 9.5 Nursing Diagnoses Related to Seizures 126 9.6 Anticonvulsant Medications 127 9.7 Nursing Diagnoses Related to Cerebrovascular Accident 127 9.8 Nursing Diagnoses Related to Spinal Cord Injury 130 9.9 Nursing Diagnoses Related to Multiple Sclerosis 130 9.10 Nursing Diagnoses Related to Myasthenia Gravis 130 9.11 Nursing Diagnoses Related to Parkinson’s Disease 131 9.12 Drugs Used to Treat Parkinson’s Disease 132 9.13 Nursing Diagnoses Related to Guillain-Barré Syndrome 132 Copyright 2010 Cengage Learning. 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Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. 9.14 Nursing Diagnoses Related to Amyotrophic Lateral Sclerosis 133 9.15 Nursing Diagnoses Related to Bell’s Palsy 133 9.16 Nursing Diagnoses Related to Eye Conditions 134 9.17 Nursing Diagnoses Related to Ménière’s Disease 136 10.1 Procedure for a Cleansing Enema 149 10.2 Nursing Diagnoses Related to Total Parenteral Nutrition 150 10.3 Nursing Diagnoses Related to Nausea and Vomiting 151 10.4 Antiemetics 151 10.5 Antidiarrheals 152 10.6 Laxatives 153 10.7 Nursing Diagnoses Related to Hiatal Hernia 153 10.8 Nursing Diagnoses Related to Peptic Ulcers 154 10.9 Medications Used in the Treatment of Peptic Ulcer 155 10.10 Nursing Diagnoses Related to Stomach Cancer 156 10.11 Nursing Diagnoses Related to Appendectomy 158 10.12 Nursing Diagnoses Related to Chronic Inflammatory Bowel Disorders 158 10.13 Nursing Diagnoses Related to Diverticulosis and Diverticulitis 159 10.14 Types of Bowel Surgeries 160 10.15 Nursing Diagnoses Related to Bowel Surgery 160 10.16 Colostomy Irrigationy 160 10.17 Nursing Diagnoses Related to Hemorrhoids 161 10.18 Nursing Diagnoses Related to Liver Disorders 161 10.19 Nursing Diagnoses Related to Esophageal Varices 162 10.20 Nursing Diagnoses Related to Cholecystectomy 164 10.21 Nursing Diagnoses Related to Pancreas Disorders 164 11.1 Urinary Catheterization 176 11.2 Nursing Diagnoses Related to Cystitis 176 11.3 Nursing Diagnoses Related to Nephrolithiasis 177 11.4 Nursing Diagnoses Related to Renal Transplantation 178 11.5 Nursing Diagnoses Related to Acute Renal Failure 179 11.6 Nursing Diagnoses Related to Chronic Renal Failure 179 11.7 Nursing Diagnoses Related to Hemodialysis 181 11.8 Nursing Diagnoses Related to Peritoneal Dialysis 181 11.9 Nursing Diagnoses Related to Prostate Surgery 182 12.1 Nursing Diagnoses Related to the Client with a Cast 193 12.2 Nursing Diagnoses Related to the Client who Is in Traction 195 12.3 Nursing Diagnoses Related to the Client with a Bone Fracture 196 12.4 Nursing Diagnoses Related to Fractured Hip 197 12.5 Nursing Diagnoses Related to Knee Replacement 198 12.6 Nursing Diagnoses Related to Arthritis 199 12.7 Nursing Diagnoses Related to Gout 199 12.8 Nursing Diagnoses Related to Systemic Lupus Erythematosus 200 12.9 Nursing Diagnoses Related to Osteomyelitis 200 12.10 Nursing Diagnoses Related to Herniated Nucleus Pulposus 201 12.11 Nursing Diagnoses Related to Amputation of a Limb 202 13.1 Nursing Diagnoses Related to Cushing’s Syndrome 215 13.2 Nursing Diagnoses Related to Addisons’s Disease 215 13.3 Nursing Diagnoses Related to Hypothyroidism 216 13.4 Nursing Diagnoses Related to Hyperthyroidism 217 13.5 Oral Glucose Tolerance Test 219 13.6 Nursing Diagnoses Related to Diabetes Mellitus 219 13.7 Insulins 220 13.8 Antidiabetic Agents 221 13.9 Glycemic Index 222 14.1 Nursing Diagnoses Related to Skin Disorders 232 14.2 Nursing Diagnoses Related to Skin Cancer 233 14.3 Nursing Diagnoses Related to Burns 235 15.1 Procedure for Self-Examination of Breasts 246 15.2 Nursing Diagnoses Related to Breast Cancer 246 15.3 Nursing Diagnoses Related to Mastectomy 246 15.4 Nursing Diagnoses Related to Hysterectomy 248 15.5 Nursing Diagnoses for Sexually Transmitted Diseases 248 15.6 Fertility Awareness Methods of Contraception 250 15.7 Hormonal Methods of Contraception 251 15.8 Mechanical Contraceptives/Chemical Barrier 252 15.9 Intrauterine Device 252 15.10 Sterilization: Permanent Termination of Fertility 253 15.11 Nursing Diagnoses Related to Infertility 253 15.12 Nutrient Needs During Pregnancy 260 15.13 Nursing Diagnoses Related to Pregnancy 261 15.14 Discomforts of Pregnancy 262 15.15 Nursing Diagnoses Related to Cardiac Conditions During Pregnancy 263 15.16 Nursing Diagnoses Related to Diabetes in Pregnancy 264 15.17 Nursing Diagnoses Related to Hyperemesis Gravidarum 264 15.18 Nursing Diagnoses Related to Abortion 266 15.19 Nursing Diagnoses Related to Ectopic Pregnancy 265 15.20 Nursing Diagnoses Related to Pregnancy-Induced Hypertension 266 15.21 Nursing Diagnoses Related to Placenta Previa 267 15.22 Nursing Diagnoses Related to Abruptio Placenta 267 15.23 Nursing Diagnoses Related to Adolescent Pregnancy 267 15.24 Prodromal (False) versus True Labor 274 15.25 Phases of First Stage of Labor 275 15.26 Nursing Diagnoses Related to Normal Labor 275 15.27 Analgesia Used in Labor 276 15.28 Anesthesia Used for Labor and Delivery 276 15.29 Apgar Scoring 277 15.30 Nursing Diagnoses Related to the Postpartal Period 278 15.31 Nursing Diagnoses Related to the Normal Newborn 297 15.32 Nursing Diagnoses Related to the Premature Infant 297 XIV INDEX OF TABLES Copyright 2010 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. INDEX OF TABLES XV 15.33 Nursing Diagnoses Related to Respiratory Distress Syndrome 299 15.34 Nursing Diagnoses Related to Rh and ABO Incompatibility 299 15.35 Nursing Diagnoses for Infant Born to Addicted Mother 300 15.36 Nursing Diagnoses Related to Necrotizing Enterocolitis 301 16.1 Summary of Growth and Development Milestones in First Year of Life 310 16.2 Toddler Nutritional Needs (12–30 Month Summary) 311 16.3 Preschooler Nutritional Needs (3–5 Year Summary) 312 16.4 School Age Nutritional Needs (6–12 Years Summary) 314 16.5 Adolescent Nutritional Needs 316 16.6 Recommended Childhood Immunization Schedule 317 16.7 Nursing Diagnoses Related to Failure to Thrive 318 16.8 Nursing Diagnoses Related to Accidental Poisonings 319 16.9 Nursing Diagnoses Related to Lead Poisoning 320 16.10 Nursing Diagnoses Related to Heart Defects 328 16.11 Nursing Diagnoses Related to Congestive Heart Failure 330 16.12 Nursing Diagnoses Related to Kawasaki’s Disease 332 16.13 Nursing Diagnoses Related to Tonsillitis 335 16.14 Nursing Diagnoses Related to Tonsillectomy/ Adenoidectomy 335 16.15 Nursing Diagnoses Related to Upper Respiratory Infection 336 16.16 Nursing Diagnoses Related to Epiglottis/Croup 336 16.17 Nursing Diagnoses Related to Otitis Media and Myringotomy with Pressure Equalizing (PE) Tube Insertion 337 16.18 Nursing Diagnoses Related to Asthma 338 16.19 Nursing Diagnoses Related to Cystic Fibrosis 339 16.20 Nursing Diagnoses Related to Respiratory Syncytial Virus 339 16.21 Nursing Diagnoses Related to Myelomeningocele 344 16.22 Nursing Diagnoses Related to Hydrocephalus 345 16.23 Nursing Diagnoses Related to Brain Tumors 346 16.24 Nursing Diagnoses Related to Royes’s Syndrome 346 16.25 Nursing Diagnoses Related to Meningitis 347 16.26 Nursing Diagnoses Related to Cerebral Palsy 347 16.27 Nursing Diagnoses Related to Tay-Sachs Disease 348 16.28 Nursing Diagnoses Related to Conjunctivitis 348 16.29 Nursing Diagnoses Related to Cleft Lip and Palate 352 16.30 Nursing Diagnoses Related to Esophageal Disorders 353 16.31 Nursing Diagnoses Related to Pyloric Stenosis 354 16.32 Nursing Diagnoses Related to Hirschsprung’s Disease 354 16.33 Nursing Diagnoses Related to Intussusception 354 16.34 Nursing Diagnoses Related to Imperforate Anus 355 16.35 Nursing Diagnoses Related to Celiac Disease 355 16.36 Nursing Diagnoses Related to Gastroenteritis 356 16.37 Nursing Diagnoses Related to Parasites 356 16.38 Nursing Diagnoses Related to Exstrophy of the Bladder 361 16.39 Nursing Diagnoses Related to Cryptorchidism 361 16.40 Nursing Diagnoses for Hypospadias (Postoperative) 361 16.41 Nursing Diagnoses Related to Enuresis 362 16.42 Nursing Diagnoses Related to Wilm’s Tumor 362 16.43 Nursing Diagnoses Related to Congenital Hip Dysplasia 365 16.44 Nursing Diagnoses Related to Club Foot 366 16.45 Nursing Diagnoses Related to Legg-Calvé Perthes Disease 366 16.46 Nursing Diagnoses Related to Structural Scoliosis 367 16.47 Nursing Diagnoses Related to Muscular Dystrophy 367 16.48 Nursing Diagnoses Related to Lyme Disease 368 16.49 Nursing Diagnoses Related to Bone Cancer 368 16.50 Nursing Diagnoses Related to Congenital Hypothyroidism (Cretinism) 371 16.51 Nursing Diagnoses Related to Impetigo 373 16.52 Nursing Diagnoses Related to Ringworm (Tinea) 373 16.53 Nursing Diagnoses Related to Pediculosis (Lice) 374 16.54 Nursing Diagnoses Related to Poison Ivy 374 16.55 Nursing Diagnoses Related to Eczema 374 17.1 Therapeutic Communication Techniques 378 17.2 Barriers to Communication 378 17.3 Erikson’s Developmental Stages 379 17.4 Levels of Anxiety 382 17.5 Defense Mechanisms 382 17.6 Nursing Diagnoses Related to Anxiety Disorders 383 17.7 Antianxiety Medications 383 17.8 Antianxiety Medications: Side Effects and Nursing Care 383 17.9 Comparison of Anorexia and Bulimia 385 17.10 Nursing Diagnoses Related to Eating Disorders 386 17.11 Nursing Diagnoses Related to Grief 387 17.12 Nursing Diagnoses Related to Depressive Disorders 387 17.13 Antidepressant Medications 388 17.14 Antidepressant Medications: Side Effects and Nursing Interventions 388 17.15 Foods Containing Tyramine 389 17.16 Nursing Diagnoses Related to Mania 389 17.17 Lithium 389 17.18 Lithium: Side Effects and Nursing Interventions 390 17.19 Nursing Diagnoses Related to Schizophrenia 390 17.20 Antipsychotic Medications 390 17.21 Antipsychotic Medications: Side Effects and Interventions 391 17.22 Drugs Used to Treat Extrapyramidal Symptoms 391 17.23 Nursing Diagnoses Related to Suspicious and Paranoid Behaviors 392 17.24 Nursing Diagnoses Related to Personality Disorders 392 Copyright 2010 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. XVI INDEX OF TABLES 17.25 Nursing Diagnoses Related to Alcoholism/ Substance Abuse 394 17.26 Antabuse 394 17.27 Drugs Abused and Treatment 395 17.28 Nursing Diagnoses Related to Abuse 396 17.29 Nursing Diagnoses Related to Rape 396 17.30 Nursing Diagnoses Related to Autistic Disorder 397 17.31 Nursing Diagnoses Related to Organic Brain Disorders 398 18.1 General Rules for Administering Antimicrobials 413 18.2 Antimicrobial Summary 414 18.3 Treatment of Tuberculosis 417 18.4 Actions of Nonnarcotic Analgesics 420 18.5 Adverse Effects of Nonnarcotic Analgesics 421 18.6 Major Side Effects of Antipsychotic Agents 425 18.7 Autonomic Nervous System 427 18.8 Guidelines for Administering Digoxin 429 18.9 Nitroglycerine Highlights 429 18.10 Guidelines for Administering Antiarrhythmics 430 18.11 Anticoagulants 432 18.12 Insulins 435 18.13 Oral Hypoglycemic Agents 437 18.14 Steroid Dosage Equivalents 438 18.15 Major Side Effects of Cancer Chemotherapeutic Agents 446 18.16 Cancer Chemotherapeutic Agents 448 18.17 Active and Passive Immunity 449 18.18 Recommended Childhood Immunization Schedule 450 18.19 Adult Immunization Schedule 451 19.1 Vitamins 462 19.2 Minerals 464 19.3 Exchange Groups for Diabetic Diet 469 19.4 Glycemic Index 470 Copyright 2010 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. XVII PREFACE This review book was expressly developed and written to help the licensed/vocational nurse graduate to study and prepare for the all-important NCLEX-PN® examination. Taking this exam can be a stressful experience since it constitutes a major career milestone, and success on the NCLEX is the key to beginning a successful practice as a licensed practical/ vocational nurse. The role the new LPN/ LVN is expected to play in the current healthcare system has expanded enormously. This book was written with respect and a keen appreciation for this level of nursing. ORGANIZATION, CONTENT, AND FEATURES The content and design of this new text has been carefully constructed to reflect the NCLEX-PN® test plan effective April 2008, beginning with an introductory chapter on how to prepare for the NCLEX-PN®. Chapter 1, How to Prepare for NCLEX-PN®, includes: • Detailed explanation of the current test plan • Information on how the test is constructed • How to apply to take the exam • Data on scoring and notification of results • Tips on how to plan your study and prepare successfully Chapter 2, Essential Concepts, covers general care measures and is designed to help the student review basic nursing care measures commonly asked on the licensure exam. These measures apply across disease boundaries; in short, they are the type of care measures that apply to most clients, no matter what the actual diagnosis may be. The chapters that follow are organized so concepts that apply across the spectrum of body systems are discussed first to lay a foundation and reduce unnecessary repetition. The Nursing Process as it applies to the LPN/LVN is an integral focal point in the design of this book. NANDA 2010–2011 diagnoses are in every chapter in table format for easy reference. Individual chapters for the older adult client, perioperative client, oncology, nutrition/special diets and pharmacology address concepts applicable across the broad spectrum of diseases. Conceptual discussion is then followed by the review of the practical application of related nursing care measures. All the body systems are addressed in individual chapters, as are the more specialized areas of female reproductive/maternity, mental health, and pediatrics. Each chapter concludes with a number of sample questions that are written to mimic the NCLEX style and test the reader’s mastery of the subject. Following each set of questions are the answers and rationales for those questions giving the reader a powerful learning experience. There are eight comprehensive practice tests at the end of this text comprised of 100 questions similar in content and style to the types of questions asked on the actual licensure exam. Each question has been “coded” for the student in the areas of Nursing Process, category of Client Need (from the NCLEX Test Plan), Cognitive Level, and Subject Area. This allows the student to identify individual strengths and weaknesses allowing for maximum focus and efficient use of study time. Answers and rationales for each question follow each test. The CD-ROM included with this book holds an additional 3000 unique questions that allow students to test their knowledge and test-taking skills in two Copyright 2010 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. different ways: learning or test mode. In learning mode, immediate feedback is given after each question is answered. The feedback consists of an explanation for the correct answer as well as incorrect answers. If the test mode option is chosen, the student will receive a score after the test is completed. Questions answered incorrectly may be reviewed at this time. In either mode, once the practice test is completed, the student has the ability to view and print the results broken down into bar graphs that represent the areas of the test plan, subject area, and nursing process. This element gives the student a clear and concise presentation for enormous amounts of information that further enhance and maximize study time. The concept, scope, and design of this text represent a commitment, through continuing education, to help the graduate LPN/LVN reach a full professional potential. Good luck on your NCLEX-PN® Examination! XVIII PREFACE Copyright 2010 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. XIX CONTRIBUTORS TEST ITEM WRITERS Lenore Boris, RN, BSN, MS, JD New York State Public Employees Federation Organizer Albany, New York Teresa Burkhalter, RN, BS, MSN Nursing Faculty Technical College of the Lowcountry Beaufort, South Carolina Judy Draper, GNP, BC Nurse Practitioner LIFE (Living Independently For Elders) University of Pennsylvania, School of Nursing Philadelphia, Pennsylvania Judith M. Hall, RNC, MSN, IBCLC, ICCE, FACCE Lactation Consultant and Childbirth Educator Fredericksberg, Virginia Lieutenant Matthew P. McMahon, RN, BSN Nurse Corps, U.S. Navy Bureau of Medicine and Surgery Washington, D.C. Carol Nelson, RN, BSN, MSN Spokane Community College Spokane, Washington Marguerite Barondeau Washnok, APRN, MS, DNP Associate Professor Presentation College Aberdeen, South Dakota REVIEWERS Terry Ardoin, RN, CCM Louisiana Technical College Charles B. Coreil Campus Ville Platte, Louisiana Mary E. Arnold, RN, BSN, MA Director VOCN Program Blinn College Bryan Campus Bryan, Texas Gyl Ann Burkhard, RN, BSN, MS Instructor OCM BOCES Syracuse, New York Teresa Burkhalter, RN, BS, MSN Nursing Faculty Technical College of the Lowcountry Beaufort, South Carolina Esther Gonzales, RN, MSN, MSEd. Del Mar College Corpus Christi, Texas Bonnie Grusk, RN, MSN Continuing Education Coordinator for Health Professions Illinois Valley Community College Oglesby, Illinois Sheila Guidry, RN, LPN, BSN, DSN, PhD. Wallace Community College Dothan, Alabama Copyright 2010 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. XX CONTRIBUTORS Janet Tompkins McMahon, RN, MSN Assistant Professor of Nursing Francis Marion University Florence, South Carolina Carol Nelson, RN, BSN, MSN Spokane Community College Spokane, Washington Linda Walline Associate Dean of Instruction Central Community College Grand Island, Nebraska Copyright 2010 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. 1 C H A P T E R 1 HOW TO PREPARE F OR NCLEX-PN® CHAPTER OUTLINE 2 Questions You Might Have About the Examination 5 Tips for Test Taking 6 Tips on How to Prepare for NCLEX-PN® Copyright 2010 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. 12 NCLEX-PN® Review The practice of nursing is regulated by the states to assure the public that only those nurses who have the necessary knowledge and skills are licensed to practice. One requirement for becoming a licensed practical/vocational nurse (LPN/LVN) is graduation from an approved school of practical/vocational nursing. Another requirement is passing an examination. All of the states have agreed to use the same examination, NCLEX-PN®. The NCLEX-PN® is designed to assess the candidate’s ability to apply the knowledge needed for entry-level practical/vocational nursing. Once a candidate passes NCLEX-PN® and meets any other requirements the individual state might have, he or she can become licensed as an LPN/LVN. WHAT IS THE NATIONAL COUNCIL OF STATE BOARDS OF NURSING? The National Council of State Boards of Nursing is a council made up of state boards of nursing from all of the states and territories of the United States. The members of this group have decided to use the same examination as one of the requirements for state licensure. The examination is developed by nurses who are experts in nursing and item writing and who have an in-depth understanding of what practical/ vocational nurses need to know. Every three years, the National Council of State Boards of Nursing studies LPN/LVNs who are newly licensed to see what tasks they are doing and what knowledge and skills are required for them to do their jobs. The blueprint or outline for the licensure examination is developed after analyzing the results of the study. The examination is developed to ensure that new graduates have the knowledge and judgmentmaking ability that are necessary to function in the workplace as an LPN/LVN. WHAT IS THE CURRENT TEST PLAN? The current test plan went into effect in April 2008. The test plan, or blueprint, for the examination determines what percentage of questions will be in what area. The test plans are available to the public and can be obtained from the National Council of State Boards of Nursing. The framework for the test plan revolves around client needs because it provides a universal structure for nursing competencies and actions for a variety of clients in a variety of settings. Integrated concepts and processes are threaded throughout the categories of client needs because they are basic to the practice of nursing. Table 1–1 lists the basic categories, subcategories, and integrated concepts and processes. The fi rst category, safe, effective care environment, has been divided into two sections. The fi rst is called coordinated care and includes items related to legal and ethical concerns such as informed consent, client rights, confi dentiality, advance directives, and ethical practice. Coordinated care also includes practice concerns such as setting priorities, consultation with health care team members, referral process, resource management (making client care assignments), supervision, incident/irregular occurrence reports, continuous quality improvement, and staff education. The second section under safe, effective care environment is called safety and infection control and includes such topics as accident and error prevention, medical and surgical asepsis, standard (universal) and other precautions, handling hazardous and infectious materials, proper use of restraints, disaster planning, and security plan. The health promotion and maintenance category contains questions relating to growth and development from the fetus to the older adult including normal pregnancy, labor and delivery, and postpartum and newborn care. It also includes normal growth Questions You Might Have About the Examination Table 1–1 NCLEX-PN® Test Plan A. Safe, effective care environment 1. Coordinated care (12%–18% of total questions) 2. Safety and infection control (8%–14% of total questions) B. Health promotion and maintenance (7%–13%) C. Psychosocial integrity (8%–14%) D. Physiological integrity 1. Basic care and comfort (11%–17%) of total questions 2. Pharmacological therapies (9%–15% of total questions) 3. Reduction of risk potential (10%–16% of total questions) 4. Physiological adaptation (11%–17% of total questions) Integrated concepts and processes include: clinical problem solving (nursing process), caring, communication and documentation, and teaching and learning. Adapted from the NCLEX-PN® Test Plan for the National Council Licensure Examination for Practical/Vocational Nurses, April 2008. Source: Delmar/Cengage Learning Copyright 2010 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. HOW TO PREPARE FOR NCLEX-P1N® 3 and development of infants, children, and adults, including the elderly. Family planning and human sexuality are included. There are also questions related to prevention and early detection of disease. Questions related to disease prevention may include immunization and health promotion efforts such as lifestyle changes and health screening, including breast self-examination and testicular self-examination. Also included are questions on techniques for collecting physical data. The third category, psychosocial integrity, includes questions that relate to the client’s ability to cope with and adapt to illness or stressful events. Questions might be related to grief and loss, situational role changes, or unexpected body image changes (such as amputation, mastectomy, or colostomy). Therapeutic communication, mental health concepts, and behavior management are included. End-of-life issues and religious and spiritual infl uences on health are also included in this section. There are also questions related to the care of clients with acute or chronic mental illness and cognitive psychosocial disturbances. Questions may relate to the care of clients who have been victims of elder or child abuse or neglect or sexual abuse. There also might be questions related to chemical dependency. Crisis intervention and therapeutic environment can also be included. The fourth and largest category is physiological integrity, which includes four sections. The fi rst section is basic care and comfort. Questions might relate to helping clients with activities of daily living or with using assistive devices (canes, crutches, walkers, or a Hoyer lift); caring for clients who have contact lenses, hearing aids, or artifi cial eyes; providing personal hygiene; providing for rest and sleep; positioning clients; and transfer techniques, body mechanics, and concepts related to mobility and immobility. Also included are questions on nutrition, oral hydration and tube feedings, and elimination including catheters and enemas. There might be questions on palliative care and nonpharmacological pain interventions. The second section under physiological integrity is pharmacological therapies. This section includes administering medications and monitoring clients who are receiving parenteral therapies. Questions might relate to the actions of medications as well as expected effects, side effects, contraindications, interactions, and untoward effects. The third section is reduction of risk potential. These questions relate to reducing the client’s potential for developing complications or health problems related to treatments, procedures, or existing conditions. To answer these questions correctly, you need to understand basic pathophysiology. This knowledge includes topics such as diagnostic tests, therapeutic