MOSBY'S COMPREHENSIVE REVIEW OF NURSING FOR THE NCLEX-RN EXAMINATION 20TH EDITION Patricia M. Nugent, Judith S. Green AND Mary Ann Hellmer ISBN: 978-0-323-07895-5 867 PAGES - $8.49   Add to cart

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MOSBY'S COMPREHENSIVE REVIEW OF NURSING FOR THE NCLEX-RN EXAMINATION 20TH EDITION Patricia M. Nugent, Judith S. Green AND Mary Ann Hellmer ISBN: 978-0-323-07895-5 867 PAGES

MOSBY'S COMPREHENSIVE REVIEW OF NURSING FOR THE NCLEX-RN EXAMINATION 20TH EDITION By: Patricia M. Nugent, RN, EdD Judith S. Green, RN, MA Mary Ann Hellmer Saul, RNCS, PhD Phyllis K. Pelikan, RN, MA ISBN: 978-0-323-07895-5 867 PAGES Contents Introduction for Students Preparing for the NCLEX-RN® Examination, 1 UNIT 1 FOUNDATIONS OF NURSING PRACTICE 1 Factors Influencing Client Needs and Nursing Care, 7 2 Basics of Nursing Practice, 14 3 Integral Aspects of Nursing Care, 24 4 Foundations of Nursing Practice Review Questions with Answers and Rationales, 51 UNIT 2 MEDICAL-SURGICAL NURSING 5 Growth and Development of the Adult, 88 6 Nursing Care of Clients with Circulatory System (Cardiovascular, Blood, and Lymphatic Systems) Disorders, 91 7 Nursing Care of Clients with Respiratory System Disorders, 119 8 Nursing Care of Clients with Gastrointestinal System Disorders, 137 9 Nursing Care of Clients with Endocrine System Disorders, 169 10 Nursing Care of Clients with Integumentary System Disorders, 185 11 Nursing Care of Clients with Neuromusculoskeletal System Disorders, 197 12 Nursing Care of Clients with Urinary/Reproductive System Disorders, 235 13 Nursing Care of Clients with Infectious Diseases, 249 14 Medical-Surgical Nursing Review Questions with Answers and Rationales, 260 UNIT 3 MENTAL HEALTH/PSYCHIATRIC NURSING 15 Foundations of Mental Health/Psychiatric Nursing, 407 16 The Practice of Mental Health/Psychiatric Nursing, 414 17 Nursing Care of Clients with Disorders Usually First Evident in Infancy, Childhood, or Adolescence, 426 18 Nursing Care of Clients with Disorders Related to Alterations in Cognition and Perception, 431 19 Nursing Care of Clients with Disorders Related to Anxiety and Alterations in Mood, 437 20 Nursing Care of Clients with Disorders Related to Alterations in Behavior, 446 21 Nursing Care of Clients with Sexual and Gender Identity Disorders, 456 22 Mental Health/Psychiatric Nursing Review Questions with Answers and Rationales, 458 UNIT 4 CHILDBEARING AND WOMEN’S HEALTH NURSING 23 Nursing Care to Promote Childbearing and Women’s Health, 519 24 Nursing Care Related to Major Disorders Affecting Women’s Health, 527 25 Nursing Care of Women during Uncomplicated Pregnancy, Labor, Childbirth, and the Postpartum Period, 536 26 Nursing Care of Women at Risk during Pregnancy, Labor, Childbirth, and the Postpartum Period, 550 27 Nursing Care of the Newborn, 565 28 Childbearing and Women’s Health Nursing Review Questions with Answers and Rationales, 579 UNIT 5 CHILD HEALTH NURSING 29 Foundations of Child Health Nursing, 639 30 Nursing Care of Infants, 643 31 Nursing Care of Toddlers, 671 32 Nursing Care of Preschoolers, 690 33 Nursing Care of School-Age Children, 697 34 Nursing Care of Adolescents, 706 35 Child Health Nursing Review Questions with Answers and Rationales, 710 UNIT 6 NCLEX PREPARATION TOOLKIT 36 Comprehensive Examination 1, 772 37 Study Worksheets for Reviewing Your Test-Taking Performance, 818 EDITOR Patricia M. Nugent, RN, EdD Nugent Books, Inc., President Professor Emerita Nassau Community College Garden City, New York ASSOCIATE EDITORS Judith S. Green, RN, MA Professor Emerita Nassau Community College Garden City, New York Mary Ann Hellmer Saul, RNCS, PhD Professor Nassau Community College Garden City, New York EDITOR EMERITA Phyllis K. Pelikan, RN, MA President PKP Books, Inc. Professor Emerita Nassau Community College Garden City, New York 3251 Riverport Lane St. Louis, Missouri 63043 MOSBY’S COMPREHENSIVE REVIEW OF NURSING FOR THE NCLEX-RN EXAMINATION ISBN: 978-0-323-07895-5 Copyright © 2012 by Mosby, Inc., an imprint of Elsevier Inc. 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). NCLEX® and NCLEX-RN® are registered trademarks and service marks of the National Council of State Boards of Nursing, Inc. Working together to grow libraries in developing countries | | 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. Previous editions copyrighted 2009, 2006, 2003, 1999, 1996, 1993, 1990, 1987, 1984, 1981, 1977, 1973, 1969, 1965, 1961, 1958, 1955, 1951, 1949 Library of Congress Cataloging-in-Publication Data Mosby’s comprehensive review of nursing for the NCLEX-RN examination / editor, Patricia M. Nugent ; associate editors, Judith S. Green, Mary Ann Hellmer Saul ; editor emerita, Phyllis K. Pelikan.—20th ed. p. ; cm. Comprehensive review of nursing for the NCLEX-RN examination Rev. ed. of: Mosby’s comprehensive review of nursing for the NCLEX-RN examination / editors, Dolores F. Saxton, Patricia M. Nugent, Phyllis K. Pelikan. Includes bibliographical references and index. ISBN 978-0-323-07895-5 (pbk. : alk. paper) 1. National Council Licensure Examination for Registered Nurses—Study guides. 2. Nursing— Examinations, questions, etc. 3. Nursing—Outlines, syllabi, etc. I. Nugent, Patricia Mary II. Green, Judith S. III. Hellmer Saul, Mary Ann. IV. Title: Comprehensive review of nursing for the NCLEX-RN examination. [DNLM: 1. Nursing—Examination Questions. 2. Nursing—Outlines. WY 18.2] RT55.M64 2012 610.73076—dc23 8 Executive Editor: Kristin Geen Senior Developmental Editor: Jamie Horn Publishing Services Manager: Deborah L. Vogel Project Manager: John W. Gabbert Design Direction: Karen Pauls Printed in the United States of America Last digit is the print number: 9 8 7 6 5 4 3 2 1 v Teresa Burckhalter, MSN, RN, BC Nursing Faculty Technical College of the Lowcountry Beaufort, South Carolina Mary Helen Freter, MS, RN, CNE Assistant Professor of Nursing Health Sciences Division Tulsa Community College Tulsa, Oklahoma Reviewers Norlyn Hyde, RN, BC, MSN, CNS Professor of Nursing Division of Nursing Louisiana Technical University Ruston, Louisiana Norah Johnson, PhD, RN, CPNP Assistant Professor College of Nursing Marquette University Milwaukee, Wisconsin continued vi Pamela Newland, PhD, RN Assistant Professor School of Nursing Southern Illinois University Edwardsville Edwardsville, Illinois Linda Rosier, RN, MSN, IBCLC Associate Professor Nursing Program Montgomery College Takoma Park, Maryland Donna Russo, RN, MSN, CCRN, CNE Nursing Instructor ARIA Health School of Nursing Philadelphia, Pennsylvania Kim Silvey, MSN, RN Assistant Professor Department of Nursing Morehead State University Morehead, Kentucky Katrina Allen Thomas, RN, MSN, CCRN Nursing Instructor Nursing Faulkner State Community College Bay Minette, Alabama Reviewers—cont'd Companion CD Audio Key Points Written by: Sharon Souter, PhD, RN, CNE Dean and Associate Professor Scott and White College of Nursing University of Mary Hardin-Baylor Belton, Texas Narrated by: Carolyn Kruse Above the Dogs St. Peters, Missouri vii vii To my husband Neil, the love of my life Thank you for always being there for me Patricia Nugent To my family Dale and Art, Richard, Eric and Miriam, Cheryl, and Steven Thank you for your unconditional support Judith Green To my children George, Matt, and Meredith for their inspiration and for teaching me so many valuable life lessons Mary Ann Hellmer Saul To my family The proverbial “Wind beneath my Wings” Phyllis K. Pelikan viii The information in Mosby’s Comprehensive Review of Nursing for the NCLEX-RN® Examination has been totally revised and updated for this 20th edition. The progression of subject matter in each area reflects the consistent approach that has been used throughout the book. Information presented incorporates the latest knowledge, newest trends, and current practices in the profession of nursing. The Introduction for Students Preparing for the Licensure Examination provides information about the NCLEX-RN® Examination, including the classifications used in the test plan structure. It also reviews clues for answering multiple-choice questions, provides examples of alternateformat items, and discusses the comprehensive exams and how to use this book when studying. Foundations of Nursing Practice—Unit I (Chapters 1 through 3)—discusses factors that influence client needs, the basics of nursing practice, and integral aspects of nursing care. These chapters present information essential to the practice of nursing that is common to all of the clinical areas. Content related to Medical-Surgical Nursing is presented in Unit 2 (Chapters 5 through 13); content related to Mental Health/Psychiatric Nursing is presented in Unit 3 (Chapters 15 through 21); content related to Childbearing and Women’s Health Nursing is presented in Unit 4 (Chapters 23 through 27); and content related to Child Health Nursing is presented in Unit 5 (Chapters 29 through 34). Chapters 4, 14, 22, 28, and 35 consist of questions with their answers and rationales that relate to Foundations of Nursing Practice, Medical-Surgical Nursing, Mental Health Nursing, Childbearing and Women’s Health Nursing, and Child Health Nursing, respectively. Chapter 36 in Unit 6 contains a 265-item Comprehensive Exam that mirrors the NCLEXRN ® Examination. Chapter 37 in Unit 6 contains two Study Worksheets: Focus For Study Worksheet—Adapted NCLEX-RN Test Plan and Focus For Study Worksheet—Content Areas. These worksheets promote an individualized assessment that can focus future study. The Medical-Surgical, Mental Health/Psychiatric, Childbearing and Women’s Health, and Child Health Nursing chapters incorporate information from the basic sciences, nutrition, pharmacology, acute and long-term care, and physical and emotional nursing care. We continue to present the material in the traditional clinical groupings for we still believe that when preparing for a comprehensive examination, the average student will study all of the distinct parts before attempting to put them together. Although we believe that in practice the nursing process is continually evolving rather than remaining a clearly defined step-by-step process, we present the content under the following headings: Assessment/Analysis, Planning/Implementation, and Evaluation/ Outcomes. We believe that this grouping avoids needless repetition, recognizes the abilities of our readers, and reflects current practice. Over 4200 questions have been included in this edition of Mosby’s Comprehensive Review of Nursing for the NCLEX-RN® Examination. More than 500 of them are new questions that reflect the increased emphasis on Management of Care, Reduction of Risk Potential, and Alternate Format Items. Although the majority of the questions are multiple-choice, the number of alternate format items (e.g., multiple-response items, ordered-response items, fill-in-the-blank items, hot spot items, and exhibit items) in the book was increased to 618. The questions in Chapters 4, 14, 22, 28, and 35 are grouped according to the chapter in which the content of the question is presented. For every question in this edition and on the CD-ROM we have provided rationales that state the reason why the correct answer is correct, as well as why the incorrect answers are incorrect. To further assist the user in studying/reviewing by a specific content area, the questions are classified according to Client Need, Cognitive Level, Nursing Process, Integrated Process (if applicable), and Reference. The Reference category at the end of each answer/rationale refers the student to the chapter and major headings under which the content in the question is presented in more detail in Mosby’s Comprehensive Review of Nursing for the NCLEX-RN Examination. One Comprehensive Exam is included in this textbook and on the Companion CD, along with a second Comprehensive Exam that appears only on the Companion CD-ROM. These Preface ix comprehensive exams provide an opportunity for the test taker to experience testing situations that approximate the NCLEX-RN®. To parallel the NCLEX-RN®, the first 75 questions in each test reflect the minimal testing experience for students taking the NCLEX-RN®. The total number of 265 questions in each test reflects the maximum number of questions that a student can take on the NCLEX-RN®. On the CD all of the questions in the comprehensive exams have been analyzed as to Client Need, Cognitive Level, Nursing Process, Integrated Processes (if applicable), and Reference to content in Mosby’s Comprehensive Review of Nursing for the NCLEX-RN Examination. The Companion CD-ROM contains the 2245 questions from the book, as well as 1965 additional test questions that can be used in both study and test format. These questions also have been categorized by Client Need, Cognitive Level, Nursing Process, and Integrated Process (if applicable). Whether the test taker answers these questions in a written or computerized format the information being tested remains constant. To reinforce learned information and build confidence in taking a computerized test, we suggest that students practice answering questions on this CD to simulate the computerized NCLEX-RN®. The Companion CD has three practice modes: Study, Quiz, and Exam. The Study and Quiz modes allow a selection of topics and categories to create an exam consisting of as many items as desired. The Study mode provides immediate feedback and rationales as each question is answered. The Quiz mode provides an analysis of performance once all the questions on the exam have been answered. The Exam mode includes two Comprehensive Exams with 265 questions each that will appear in random order each time the test is taken. A third option, Comprehensive Exam Random generates 265 questions randomly from all questions available. Content selection allows for a choice of questions by client need, step of the nursing process, or content area to individualize a focused study. The Companion CD also includes brand new mp3 key point summaries that can be downloaded for on-the-go review. All of the questions used in this edition have been submitted by outstanding educators and practitioners/health care providers of nursing. Initially the editorial board reviewed all questions, selecting the most pertinent for inclusion in a mass field-testing project or analysis by a panel of expert nursing educators. Students graduating from baccalaureate, associate degree, and diploma nursing programs in various locations in the United States provided a diverse group for the mass field-testing project or focus group sessions. Results were statistically analyzed. This analysis, in addition to the input from the panel of expert nursing educators, was used to select questions for inclusion in the book. We would like to take this opportunity to thank Kristin Geen, Executive Editor, for her masterful leadership; Jamie Horn, Senior Developmental Editor, for her dedication to this project and for keeping us focused; Johnny Gabbert, Project Manager, for being always available and having the answers to all of our questions; Karen Pauls, Designer, for taking a complex manuscript and making it easy on the eyes and brain; Debbie Prato, Copyeditor, for ensuring a crisp, accurate manuscript; and finally Eloise DeHaan, Proofreader, for her meticulous attention to detail in relation to content and format. In addition, we recognize the exemplary work of the Contributing Authors, Contributing Item Writers, and Reviewers that reflects their dedication and expertise. We thank our proofreaders Erin Mitchell, Frances Timcheck, Kathleen Ashker, Cheryl Wolff, and Dorene Lebowitz for their help in the final stages of manuscript preparation. A special thank you goes to Barbara Vitale for work over and beyond the call of her content editorial duties. We especially appreciate our families for their patience and understanding when the production of this book consumed most of our time and energy. Patricia M. Nugent Judith S. Green Mary Ann Hellmer Saul x Contents Introduction for Students Preparing for the NCLEX-RN® Examination, 1 Overview, 1 Classification of Questions, 1 General Clues for Answering Multiple-Choice Questions, 2 Alternate Item Formats, 3 Comprehensive Examinations, 5 Companion CD, 5 How to Use This Book When Studying, 5 Taking the Licensure Examination, 6 UNIT 1 FOUNDATIONS OF NURSING PRACTICE 1 Factors Influencing Client Needs and Nursing Care, 7 Concepts from Sociology, 7 Hierarchy of Needs, 10 Individual Factors Affecting Health, 10 Stress Response, 11 Grieving Process, 11 Health-Illness Continuum and Rehabilitation, 11 Type of Condition Affecting Client, 13 Level of Preventive Care, 13 2 Basics of Nursing Practice, 14 Nursing Process, 14 Ensuring Quality Health Care, 14 Communication, 14 Teaching-Learning, 17 Leadership and Management, 17 Nursing Practice and the Law, 19 Medication Administration, 21 3 Integral Aspects of Nursing Care, 24 Pain, 24 Infection, 27 Fluid, Electrolyte, and Acid-Base Balance, 34 Perioperative Care, 40 Neoplastic Disorders, 45 Emergency Situations, 49 4 Foundations of Nursing Practice Review Questions with Answers and Rationales, 51 Questions, 51 Answers and Rationales, 67 UNIT 2 MEDICAL-SURGICAL NURSING 5 Growth and Development of the Adult, 88 The Young Adult (Age 20 to 44 Years), 88 The Middle-Age Adult (Age 45 to 59 Years), 88 The Young-Older Adult (Age 60 to 74 Years), 89 The Middle-Older Adult (Age 75 to 84 Years) and Old-Older Adult (Age 85+ Years), 89 6 Nursing Care of Clients with Circulatory System (Cardiovascular, Blood, and Lymphatic Systems) Disorders, 91 Overview, 91 Major Disorders of the Circulatory System (Cardiovascular, Blood, and Lymphatic Systems), 107 7 Nursing Care of Clients with Respiratory System Disorders, 119 Overview, 119 Major Disorders of the Respiratory System, 128 8 Nursing Care of Clients with Gastrointestinal System Disorders, 137 Overview, 137 Major Disorders of the Gastrointestinal System, 147 9 Nursing Care of Clients with Endocrine System Disorders, 169 Overview, 169 Major Disorders of the Endocrine System, 173 10 Nursing Care of Clients with Integumentary System Disorders, 185 Overview, 185 Major Disorders of the Integumentary System, 187 11 Nursing Care of Clients with Neuromusculoskeletal System Disorders, 197 Overview, 197 Major Disorders of the Neuromusculoskeletal System, 212 xi 12 Nursing Care of Clients with Urinary/Reproductive System Disorders, 235 Overview, 235 Major Disorders of Urinary/Reproductive Systems, 239 13 Nursing Care of Clients with Infectious Diseases, 249 Overview, 249 Related Procedures: Standard and Transmission-Based Precautions, 249 Major Infectious Diseases, 249 14 Medical-Surgical Nursing Review Questions with Answers and Rationales, 260 Questions, 260 Growth and Development, 260 Circulatory System (Cardiovascular, Blood, and Lymphatic Systems), 260 Respiratory System, 269 Gastrointestinal System, 274 Endocrine System, 285 Integumentary System, 293 Neuromusculoskeletal System, 295 Urinary/Reproductive Systems, 308 Infectious Diseases, 311 Drug-Related, 313 Answers and Rationales, 319 Growth and Development, 319 Circulatory System (Cardiovascular, Blood, and Lymphatic Systems), 320 Respiratory System, 333 Gastrointestinal System, 341 Endocrine System, 356 Integumentary System, 367 Neuromusculoskeletal System, 371 Urinary/Reproductive Systems, 390 Infectious Diseases, 395 Drug-Related Responses, 398 UNIT 3 MENTAL HEALTH/PSYCHIATRIC NURSING 15 Foundations of Mental Health/Psychiatric Nursing, 407 Development of Personality, 407 Physiology, Cognition, Emotions, and Behavior, 409 Anxiety and Coping Behaviors, 410 16 The Practice of Mental Health/Psychiatric Nursing, 414 Legal Concepts Related to Mental Health/Psychiatric Nursing, 414 Community Health Services, 415 Therapeutic Nurse-Client Relationship, 415 Crisis Intervention, 416 Nursing Care in Relation to Violence, 417 Nursing Care in Relation to Therapeutic Modalities, 418 17 Nursing Care of Clients with Disorders Usually First Evident in Infancy, Childhood, or Adolescence, 426 Overview, 426 General Nursing Care Related to Disorders First Evident in Infancy, Childhood, or Adolescence, 426 Major Disorders First Evident in Infancy, Childhood, or Adolescence, 427 18 Nursing Care of Clients with Disorders Related to Alterations in Cognition and Perception, 431 Overview, 431 General Nursing Care of Clients with Disorders Related to Alterations in Cognition and Perception, 431 Major Disorders Related to Alterations in Cognition and Perception, 431 19 Nursing Care of Clients with Disorders Related to Anxiety and Alterations in Mood, 437 Overview, 437 Major Disorders Associated with Anxiety, 437 Major Somatoform Disorders, 440 Major Disorders Related to Alterations in Mood, 442 20 Nursing Care of Clients with Disorders Related to Alterations in Behavior, 446 Overview, 446 Major Disorders Related to Alterations in Behavior, 446 21 Nursing Care of Clients with Sexual and Gender Identity Disorders, 456 Overview, 456 General Nursing Care of Clients with Sexual and Gender Identity Disorders, 456 xii Contents Major Disorders Associated with Sexual and Gender Identity Conditions, 456 22 Mental Health/Psychiatric Nursing Review Questions with Answers and Rationales, 458 Questions, 458 Foundations of Mental Health/Psychiatric Nursing, 458 The Practice of Mental Health/Psychiatric Nursing, 460 Nursing Care of Clients with Disorders Usually First Evident in Infancy, Childhood, or Adolescence, 465 Nursing Care of Clients with Disorders Related to Alterations in Cognition and Perception, 467 Nursing Care of Clients with Disorders Related to Anxiety and Alterations in Mood, 471 Nursing Care of Clients with Disorders Related to Alterations in Behavior, 477 Nursing Care of Clients with Sexual and Gender Identity Disorders, 481 Answers and Rationales, 483 Foundations of Mental Health/Psychiatric Nursing, 483 The Practice of Mental Health/Psychiatric Nursing, 486 Nursing Care of Clients with Disorders Usually First Evident in Infancy, Childhood, or Adolescence, 493 Nursing Care of Clients with Disorders Related to Alterations in Cognition and Perception, 496 Nursing Care of Clients with Disorders Related to Anxiety and Alterations in Mood, 501 Nursing Care of Clients with Disorders Related to Alterations in Behavior, 511 Nursing Care of Clients with Sexual and Gender Identity Disorders, 516 UNIT 4 CHILDBEARING AND WOMEN’S HEALTH NURSING 23 Nursing Care to Promote Childbearing and Women’s Health, 519 Health Promotion, 519 Family Planning, 521 Related Procedures, 523 Related Pharmacology, 525 24 Nursing Care Related to Major Disorders Affecting Women’s Health, 527 Major Disorders Affecting Women’s Health, 527 25 Nursing Care of Women during Uncomplicated Pregnancy, Labor, Childbirth, and the Postpartum Period, 536 Prenatal Period, 536 Intrapartum Period (Labor and Birth), 540 Postpartum Period, 547 26 Nursing Care of Women at Risk during Pregnancy, Labor, Childbirth, and the Postpartum Period, 550 Tests to Identify and/or Monitor High-Risk Pregnancy, 550 Nursing Care of Pregnant Women with Special Needs, 551 Nursing Care of Pregnant Women with Preexisting Health Problems, 552 Nursing Care of Women with Complications during the Prenatal Period, 555 Nursing Care of Women with Complications During the Intrapartum Period, 559 Nursing Care of Women with Complications During the Postpartum Period, 563 27 Nursing Care of the Newborn, 565 Foundations of Nursing Care for Newborns, 565 Nursing Care of High-Risk Newborns, 572 28 Childbearing and Women’s Health Nursing Review Questions with Answers and Rationales, 579 Questions, 579 Nursing Care to Promote Childbearing and Women’s Health, 579 Nursing Care Related to Major Disorders Affecting Women’s Health, 581 Nursing Care of Women during Uncomplicated Pregnancy, Labor, Childbirth, and the Postpartum Period, 584 Nursing Care of Women at Risk during Pregnancy, Labor, Childbirth, and the Postpartum Period, 592 Nursing Care of the Newborn, 598 Answers and Rationales, 603 Nursing Care to Promote Childbearing and Women’s Health, 603 Nursing Care Related to Major Disorders Affecting Women’s Health, 606 Nursing Care of Women during Uncomplicated Pregnancy, Labor, Childbirth, and the Postpartum Period, 610 Nursing Care of Women at Risk during Pregnancy, Labor, Childbirth, and the Postpartum Period, 622 Nursing Care of the Newborn, 631 UNIT 5 CHILD HEALTH NURSING 29 Foundations of Child Health Nursing, 639 Growth and Development of the Child, 639 Play, 640 The Family, 640 Age-Related Responses to Pain, 641 Principles Related to Medications for Children, 642 Contents xiii 30 Nursing Care of Infants, 643 Growth and Development, 643 Health Promotion of Infants, 644 Hospitalization of Infants, 647 Health Problems That Begin in Infancy and May Persist through Childhood (Nursing Care Includes Care of the Infant and Child), 647 Gastrointestinal Malformations, 649 Cardiac Malformations, 653 Neurologic Malformations, 657 Genitourinary Malformations, 659 Skeletal Malformations, 660 Health Problems that Develop during Infancy, 663 31 Nursing Care of Toddlers, 671 Growth and Development, 671 Health Promotion of Toddlers, 672 Hospitalization of Toddlers, 673 Health Problems Most Common in Toddlers, 673 32 Nursing Care of Preschoolers, 690 Growth and Development, 690 Health Promotion of Preschoolers, 690 Hospitalization of Preschoolers, 691 Health Problems Most Common in Preschoolers, 691 33 Nursing Care of School-Age Children, 697 Growth and Development, 697 Health Promotion of School-Age Children, 697 Hospitalization of School-Age Children, 697 Health Problems Most Common in School-Age Children, 698 Skin Infections and Infestations, 704 34 Nursing Care of Adolescents, 706 Growth and Development, 706 Health Promotion during Adolescence, 706 Hospitalization of Adolescents, 707 Health Problems Most Common in Adolescents, 707 35 Child Health Nursing Review Questions with Answers and Rationales, 710 Questions, 710 Nursing Care of Infants, 710 Nursing Care of Toddlers, 719 Nursing Care of Preschoolers, 726 Nursing Care of School-Age Children, 729 Nursing Care of Adolescents, 732 Answers and Rationales, 735 Nursing Care of Infants, 735 Care of Toddlers, 748 Nursing Care of Preschoolers, 758 Nursing Care of School-Age Children, 763 Nursing Care of Adolescents, 768 UNIT 6 NCLEX PREPARATION TOOLKIT 36 Comprehensive Examination 1, 772 Review Questions: Part A, 772 Review Questions: Part B, 778 Answers and Rationales: Part A, 792 Answers and Rationales: Part B, 799 37 Study Worksheets for Reviewing Your Test-Taking Performance, 818 Introduction, 818 How to Maximize Use of the Comprehensive Examinations, 818 How to Develop a Focus for Study, 818 This page intentionally left blank 1 OVERVIEW The NCLEX-RN® examination is integrated and comprehensive. Nursing candidates are required to answer questions that necessitate a recognition and understanding of the physiologic, biologic, and social sciences, as well as the specific nursing skills and abilities involved in a given client situation. This textbook and CD contain a total of 4210 questions. They include objective multiple-choice questions, as well as alternate-format questions (615 items) such as multiple-response items, ordered-response items, fill-in-the-blank items, hot spot items, exhibit items, and audio items. To answer the questions appropriately, a candidate needs to understand and correlate certain aspects of anatomy and physiology, the behavioral sciences, fundamentals of nursing, the effects of medications administered, the client’s attitude toward illness, and other pertinent factors such as legal responsibilities, leadership and management, and critical thinking. Most questions are based on nursing situations similar to those with which candidates have had experiences because they emphasize the nursing care of clients with representative common health problems. Some questions, however, require candidates to apply basic principles and techniques to clinical situations with which they have had little, if any, actual experience. To prepare adequately for an integrated comprehensive examination, it is necessary to understand the discrete parts that compose the universe of material under consideration. This is one of the major principles of learning that has contributed to the development of Mosby’s Comprehensive Review of Nursing for the NCLEX-RN® Examination. Using this principle, the text begins with Unit 1—Foundations of Nursing Practice. The information in this unit is essential to each of the major clinical areas: Unit 2—Medical-Surgical Nursing, Unit 3—Mental Health/Psychiatric Nursing, Unit 4—Childbearing and Women’s Health Nursing, and Unit 5—Child Health Nursing. Chapters at the end of each unit contain questions that test the student’s knowledge of principles and theories underlying nursing care specific to the content within the unit. The questions represent a variety of situations, in a variety of settings, and with a variety of nursing objectives. Each question has rationales for the correct answer and incorrect options, as well as a classification of the question that reflects the NCLEX-RN® examination test plan. The following descriptions are presented to assist in the understanding of these classifications. 1 INTRODUCTION Introduction for Students Preparing for the NCLEX-RN® Examination CLASSIFICATION OF QUESTIONS Every question in the book and in both comprehensive exams is classified by the following categories: Client Need, Cognitive Level, Integrated Process, Nursing Process, and a Reference to content within Mosby’s Comprehensive Review of Nursing for the NCLEX-RN® Examination. In the Comprehensive Exams the percentage of test questions assigned to each Client Need category and subcategory reflects the 2010 NCLEX-RN Test Plan. These percentages are included adjacent to the specific Client Need category. CLIENT NEED These categories reflect activities most frequently performed by entry-level nurses. 1. Safe and Effective Care Environment Management of Care (16% to 22%): These questions provide or direct the nursing activities that promote the delivery of care to clients, family members, significant others, and other health care personnel. Safety and Infection Control (8% to 14%): These questions address the protection of clients, family members, significant others, and health care personnel from health and environmental hazards. 2. Health Promotion and Maintenance (6% to 12%) These questions provide or direct the nursing care of the client, family members, and significant others. They include knowledge of the principles of growth and development, prevention and/or detection of health problems, and interventions to achieve optimum health. 3. Psychosocial Integrity (6% to 12%) These questions provide or direct the nursing care that supports and promotes the emotional, mental, and social well-being of the client, family members, and significant others experiencing stressful events, as well as clients with acute or chronic mental health illness. 4. Physiological Integrity Basic Care and Comfort (6% to 12%): These questions address the provision of comfort and support in the performance of the activities of daily living. These include elimination, mobility, hydration, nutrition, hygiene, comfort, rest, and sleep. 2 Introduction for Students Preparing for the NCLEX-RN® Examination Pharmacological and Parenteral Therapies (13% to 19%): These questions address the provision of care related to the administration of medications, parenteral therapies, and blood products. Reduction of Risk Potential (10% to 16%): These questions address the nursing care that may limit the likelihood of the development of complications or health problems related to existing disorders, treatments, or procedures. Physiological Adaptation (11% to 17%): These questions address the provision and management of the nursing care for clients with acute, chronic, or life-threatening physical health problems. COGNITIVE LEVEL This category reflects the thinking processes required to answer the question. Knowledge: These questions require the test taker to recall information from memory. For example, they involve knowledge of facts, principles, generalizations, terminology, and trends. Comprehension: These questions require the test taker to understand information. They involve the interpretation, paraphrasing, and summarization of information, as well as the determination of implications and consequences of information. Application: These questions require the test taker to use information, principles, or concepts. They involve identifying, manipulating, changing, or modifying information as well as performing mathematical calculations. Analysis: These questions require the test taker to interpret a variety of information. It involves the recognition of commonalities, differences, and interrelationships among data, concepts, principles, and situations. INTEGRATED PROCESS Integrated processes are fundamental components critical to the practice of nursing. They include the nursing process, caring, communication and documentation, and teaching and learning. Because the nursing process (a scientific problem-solving process that involves critical thinking) is essential to all nursing care, it is included in each answer/rationale. Caring: These questions reflect interactions between the nurse and client/significant others that demonstrate mutual trust and respect. They include the nursing care that provides support, encouragement, hope, and compassion. Communication/Documentation: These questions involve verbal and nonverbal interactions between the nurse and client, significant others, and members of the health care team. Client status, events, and interventions are communicated and documented according to rights, responsibilities, and standards of care. Teaching/Learning: These questions include nursing assessments and interventions that relate to the attainment of knowledge, skills, or attitudes that meet client needs. PHASES OF THE NURSING PROCESS This category reflects the problem-solving process used by nurses to identify client needs, plan and implement nursing care, and evaluate client responses to care. Assessment/Analysis: This phase requires the nurse to obtain objective and subjective data from primary and secondary sources, to identify and group significant data, and to communicate this information to other members of the health team. This phase also requires the nurse to interpret data gathered through assessment in order to make nursing decisions. Client and family needs are identified, and short-term and long-term goals/outcomes are set. Planning/Implementation: This phase requires the nurse to design and implement a regimen with the client, family, and other health team members to achieve goals/outcomes set during the assessment/analysis phase. It also requires setting priorities for intervention. The client may be given total care or may be assisted and encouraged to perform activities of daily living or follow the regimen prescribed by the health care provider. In addition, it involves activities such as counseling, teaching, and supervising health team members. Evaluation/Outcomes: This phase requires the nurse to determine the effectiveness of nursing care. Care is reviewed, the client’s response to intervention is identified, and a determination is made as to whether the client has achieved the predetermined outcomes and goals. It also includes the appraisal of factors that influence goal achievement (e.g., the client’s abilities to fulfill the health care plan—physical, emotional, financial) and modification of the original plan as needed. REFERENCE Each question in the book and questions in both comprehensive examinations on the CD refer the test taker to the section where the related content concerning the question is within Mosby’s Comprehensive Review of Nursing for the NCLEX-RN® Examination. This promotes a review of the specific information as it relates to the question and permits a more thorough review of related information. GENERAL CLUES FOR ANSWERING MULTIPLE-CHOICE QUESTIONS On a multiple-choice test, the question and possible answers are called a test item. The part of the item that asks the question or poses a problem is called the stem. All of the possible answers presented are called options. One of the options is the correct answer or key; the remaining options are incorrect. The incorrect options are called distractors because their major purpose is to distract the test taker from the correct answer. A. Read the question carefully before looking at the answers. 1. Determine what the question is really asking; look for key words. 2. Read each answer thoroughly and see if it completely covers the material asked by the question. Alternate Item Formats 3 3. Narrow the choices by immediately eliminating answers you know are incorrect. B. Because few things in life are absolute without exceptions, avoid selecting answers that include words such as always, never, all, every, and none. Answers containing these key words are rarely correct. C. Attempt to select the answer that is most complete and includes the other answers within it. An example might be as follows. A stem might ask “A child’s intelligence is influenced by:” and three options might be genetic inheritance, environmental factors, and past experiences. The fourth option might be multiple factors, which is a more inclusive choice and therefore the correct answer. D. Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. E. Watch for grammatical inconsistencies. If one or more of the options is not grammatically consistent with the stem, the alert test taker can identify it as a probable incorrect option. When the stem is in the form of an incomplete sentence, each option should complete the sentence in a grammatically correct way. F. Avoid selecting answers that state hospital rules or regulations as a reason or rationale for action. G. Look for answers that focus on the client or are directed toward feelings. H. If the question asks for an immediate action or response, all of the answers may be correct, so base your selection on identified priorities for action. I. Do not select answers that contain exceptions to the general rule, controversial material, or degrading responses. J. Reread the question if the answers do not seem to make sense, because you may have missed words such as not or except in the statement. K. Do not worry if you select the same numbered answer repeatedly, because there usually is no pattern to the answers. L. Mark the number next to the answer you have chosen. M. Answer every question because on the NCLEX-RN® exam you must answer a question before you can move on to the next question. ALTERNATE ITEM FORMATS In addition to multiple-choice questions, the NCLEX-RN® exam includes alternate-format questions. These questions consist of five types: multiple-response items, ordered-response (drag and drop) items, fill-in-the-blank items, hot spot, and exhibit items. The following examples reflect these alternate item formats. MULTIPLE-RESPONSE ITEM Multiple-response items pose a question and then include a list of responses that may or may not answer the question. The test taker is directed to indicate all the correct options. The nurse suspects that a postpartum client is experiencing postpartum depression without psychotic features. Which assessment findings support this conclusion? Select all that apply. 1. _____ Delusions 2. _____ Somnolence 3. _____ Ambivalence 4. _____ Increased appetite 5. _____ Emotional lability Answer: 2, 4, 5. 1 Delusions occur 50% of the time with postpartum depression with psychotic features. 2 A yearning for sleep, sleeping heavily, and an inability to go back to sleep if awakened are all associated with postpartum depression without psychotic features. 3 Ambivalence is experienced by many postpartum women and during postpartum blues. With postpartum depression without psychotic features the woman is often fearful, anxious, angry, and despondent. 4 Women with postpartum depression without psychotic features often have odd food cravings (often desserts) and tend to binge eat and gain weight. 5 These women are irritable, and their behavior escalates with little provocation. They experience spontaneous crying episodes and have severe anxiety and panic attacks. Client Need: Psychosocial Integrity; Cognitive Level: Analysis; Nursing Process: Assessment/Analysis; Reference: Ch 25, Postpartum Period, Data Base ORDERED-RESPONSE (DRAG AND DROP) ITEM Ordered-response items present information or a series of statements and then ask the test taker to place them in order of priority. A client is receiving an IV piggyback oxytocin (Pitocin) infusion to induce labor. The client experiences three contractions that are 90 seconds long and occur less than 2 minutes apart. List in order of priority the nursing actions that should be taken. 1. ______ Administer oxygen 2. ______ Call the health care provider 3. ______ Interrupt the oxytocin infusion 4. ______ Assess maternal/fetal responses 5. ______ Document fetal/maternal responses Answer: 3, 1, 4, 2, 5. 3 The dose of oxytocin is excessive, causing prolonged, intense uterine contractions that can precipitate uterine rupture. The oxytocin (Pitocin) must be stopped immediately. 1 Excessive contractions decrease blood flow to the placenta; this can result in fetal heart rate decelerations (e.g., bradycardia, diminished variability, late decelerations) and fetal hypoxia. Oxygen will improve the amount of oxygen being supplied to the placenta and eventually to the fetus. 4 Maternal and fetal responses to the cessation of the oxytocin infusion and the administration of oxygen should be evaluated next. The mother and fetus are the priority. 4 Introduction for Students Preparing for the NCLEX-RN® Examination 2 The health care provider should be notified as soon as the initial interventions are implemented and the maternal and fetal responses are evaluated. 5 Documentation of the event (e.g., length and intensity of contractions, nursing interventions, maternal and fetal responses, and notification of the health care provider) is done last after the needs of the mother and fetus are met. Client Need: Pharmacological and Parenteral Therapies; Cognitive Level: Analysis; Nursing Process: Planning/Implementation; Reference: Ch 26, Induction or Stimulation of Labor, Nursing Care of Women during Induction or Stimulation of Labor FILL-IN-THE-BLANK ITEM Fill-in-the-blank items involve a calculation. The question presents information and requires the test taker to manipulate the information to solve the problem posed, and then the test taker must record the solution to the problem. The health care provider prescribes an IVPB infusion of 500 mg of an antibiotic to be added to 50 mL of normal saline to be administered four times daily. The antibiotic is supplied in singledose vials containing 1 g each. The directions advise that the instillation of 0.8 mL of normal saline will yield 1.2 mL of solution. How much antibiotic solution should be added to the 50 mL of normal saline? Record your answer using one decimal place. Answer: __________ mL Answer: 0.6 mL. First convert 500 mg to 1 g by using ratio and proportion. Then solve the problem by using ratio and proportion. Desire 500 mg = X g Have 1000 mg 1 g 1000X = 500 X = 500 ÷1000 X = 0.5 g Desire 0.5 g = X mL Have g mL 1 1 2.X = 0.5 ×1.2 X = 0.6 mL Client Need: Pharmacological and Parenteral Therapies; Cognitive Level: Application; Nursing Process: Planning/Implementation; Reference: Ch 2, Medication Administration, Nursing Responsibilities Related to Medication Administration HOT SPOT ITEM* Hot spot items present a problem in relation to a figure. You are asked to answer the question by placing an X over an area on the figure. These items may focus on areas to be assessed or sites of clinical manifestations. A nurse is assessing a client with the diagnosis of hypoparathyroidism. As part of the assessment the nurse assesses the client for Chvostek’s sign. Place an X where the nurse should tap to elicit this sign. *Image from Thompson JM and others: Mosby's manual of clinical nursing, ed 5, St. Louis, 2001, Mosby. Answer: Low serum calcium levels increase the movement of sodium across excitable membranes; depolarization occurs more easily. Tapping the face just below and in front of the ear stimulates the facial nerve; in the presence of hypocalcemia, muscle twitching on one side of the mouth, nose, and cheek occurs (Chvostek’s sign). Client Need: Physiological Adaptation; Cognitive Level: Analysis; Nursing Process: Assessment/Analysis; Reference: Ch 9, Hypoparathyroidism, Nursing Care EXHIBIT ITEM Exhibit items present a situation and ask a question. A variety of objective and subjective information is presented about the client in formats such as the hospital record (e.g., laboratory test results, results of diagnostic procedures, progress notes, health care provider orders, medication administration record, health history), physical assessment data, and nurse/client interactions. After analyzing the information presented, the test taker answers the question. These questions usually reflect the analysis level of cognitive thinking. How to Use This Book When Studying 5 Vital Signs Temperature: 97.7° F (36.5° C) Heart rate: 110 beats per minute Respiration: 40 breaths per minute Blood pressure: 100/64 Physical Assessment Thin appearance Experiencing fatigue Height and weight at 25th percentile for age Pale mucous membranes and conjunctiva Laboratory Values WBC: 6000/mm3 RBC: 2.7 × 106/μL Hb: 7.8 g/dL Hct: 22.3% Platelets: 278,000 μL A parent brings a 4-year-old child to the clinic because the child is no longer able to keep up with older siblings when playing sports in the yard. The nurse obtains the child’s vital signs, performs a physical assessment, and reviews the child’s laboratory reports. What should be the nurse’s primary intervention? 1. Preventing bleeding 2. Instituting contact precautions 3. Initiating a strict intake and output 4. Monitoring for cardiac decompensation Answer: 4 This child is severely anemic. The decreased red blood cells (the expected range for a 4-year-old is 4.0 to 5.5 × 106/μL), low hematocrit (the expected range for a 4-yearold is 30% to 40%), and low hemoglobin (the expected range for a 4-year-old is 9.5 to 14 g/dL) place the child at risk for cardiac decompensation and heart failure. The child’s cardiovascular status must be monitored closely. 1 There is no information to indicate that the child is at risk for bleeding. The child’s platelet count is within the expected range of 150,000 to 400,000/mm3. 2 The child’s WBC count is within the expected range of 5000 to 10,000/mm3. There is no information to indicate that the child has an infection. 3 Although this may be done, it is not the priority. Client Need: Reduction of Risk Potential; Cognitive Level: Analysis; Nursing Process: Planning/Implementation; Reference: Ch 31, Iron Deficiency Anemia, Data Base COMPREHENSIVE EXAMINATIONS AND FOCUS FOR STUDY WORKSHEETS Mosby’s Comprehensive Review of Nursing for the NCLEX-RN® Examination contains two comprehensive examinations, one in chapter 36 and one on the enclosed Companion CD. These tests approximate the NCLEX-RN® test plan. The first 75 questions in each examination reflect the minimum testing experience for students taking the NCLEX-RN® examination. The 265 questions in each test reflect the maximum number of questions a student will be asked on the NCLEX-RN® exam. The questions require the test taker to cross clinical disciplines and respond to individual and specific needs associated with given health problems. Rationales are also provided for the correct answers and the incorrect options to these questions. In addition, each question is classified according to client need, cognitive level, integrated process, and nursing process, and a reference is provided as to where the content in the question can be found in Mosby's Comprehensive Review of Nursing for the NCLEX-RN Examination. The purpose of these comprehensive tests is to provide students with an opportunity to simulate the NCLEX-RN® exam experience at the completion of a personalized program review. In chapter 37, Focus for Study Worksheets, two tools are present to help students analyze their test performance and provide information for designing a plan for study. The Focus for Study Worksheet—Adapted NCLEX-RN Test Plan addresses the classifications used to reflect content on the NCLEX-RN examination. The Focus for Study Worksheet—Content Areas reflects content within the domain of nursing and where the information can be found in Mosby's Comprehensive Review of Nursing for the NCLEX-RN Examination. COMPANION CD The Companion CD contains the 2245 questions that are in the book and an additional 1965 bonus questions, for a total of 4210 questions. Of these questions, 615 are alternate format items. It contains three practice modes: Study, Quiz, and Exam. The Study and Quiz modes allow the test taker to select topics and categories to create an exam consisting of as many items as desired. The Study mode provides immediate feedback and rationales as each question is answered. The Quiz mode provides an analysis of the test taker’s performance once all of the questions on the exam have been answered. The Exam mode includes two Comprehensive Exams with 265 questions each that will appear in random order each time a test is taken. A third option, Comprehensive Exam Random, generates 265 questions randomly from all of the questions available. Items can be selected by client need, the step of the nursing process, and the content area so that the test taker can focus studying based on a self-assessment of individual needs or the results of a personal analysis from the Study Worksheets. HOW TO USE THIS BOOK WHEN STUDYING A. Start in one area. Study the material covered by the section. Refer to other textbooks to find additional details if you are unsure of a specific fact. B. Answer the questions following the area. As you answer each question, write a few words about why you think that answer is correct; in other words, justify why you selected that answer. If an answer you provide is a guess, mark the question to identify it. This will permit you to recognize areas that need further review. It will also help you to see how correct your “guessing” can be. Remember: on the licensure examination you must answer each question before moving on to the next question. 6 Introduction for Students Preparing for the NCLEX-RN® Examination C. Record the answer by circling the number of the option you believe is correct. D. Compare your answers with those provided. If you answered the item correctly, check your reason for selecting the answer with the rationale presented. If you answered the item incorrectly, read the rationale to determine why the option you selected was incorrect. In addition, you should review the correct answer and rationale for each item answered incorrectly. If you still do not understand your mistakes, review the material pertaining to these questions. The Content Area following the answers and rationales informs you of the area within Mosby’s Comprehensive Review of Nursing for the NCLEX-RN® Examination where you can find related information included in the question. You should carefully review all questions and rationales for items you identify as guesses because you do not have mastery of the material being questioned. E. Following the rationales for the correct answer and the incorrect options, you will find that each question in the book is classified according to Client Need, Cognitive Level, Integrated Process, Nursing Process, and Reference. These categories were described previously in this Introduction and should help you to understand the question in relation to the NCLEX-RN® examination test plan. F. After you have completed the area questions, begin taking the comprehensive tests because they will assist you in applying knowledge and principles from the specific clinical area to any nursing situation. 1. Arrange a quiet, uninterrupted time span for each part of a comprehensive test. 2. Avoid spending excessive time on any one question. Most questions can be answered in 1 to 2 minutes. 3. Make educated guesses when necessary. 4. Read carefully and answer the question asked; pay attention to specific details in the question. 5. Try putting questions and answers in your own words to test your understanding. G. To help analyze your mistakes on the comprehensive examinations and to provide a data base for making future study plans, Study Worksheets follow each of the comprehensive tests. These worksheets are designed to aid you in identifying and recording errors in the way you apply information and to help you identify and record gaps in knowledge. H. After completing your worksheets, do the following: 1. Identify the frequency with which you made particular errors. As you review material in class notes or this review book, pay special attention to acquiring information related to content that you found difficult on the tests. 2. Identify the topics you want to review. It might be helpful to set priorities; review the most difficult topics first so you will have time to review them more than once. I. Use the Companion CD to individualize your style of review. Use one or more of the practice modes (e.g., Study, Quiz, and Exam) to personalize your focus of study based on a self-assessment of needs and/or an analysis of your Study Worksheets. TAKING THE LICENSURE EXAMINATION The computerized NCLEX-RN® exam is an individualized testing experience in which the computer chooses your next question based on the ability and competency you have demonstrated on previous questions. The minimum number of questions will be 75 and the maximum 265. You must answer each question before the computer will present the next question, and you cannot go back to any previously answered questions. Remember that you do not have to answer all of the questions correctly to pass. The following are crucial requisites for doing well on the licensure examination: • A sound understanding of the subject • The ability to follow explicitly the directions given at the beginning of the test • The ability to comprehend what is read • The patience to read each question and set of options carefully before deciding how to answer the question • The ability to use the computer correctly to record answers • The determination to do well • A degree of confidence 7 CONCEPTS FROM SOCIOLOGY BASIC CONCEPTS A. Every human society has a process for socialization of its members 1. Cultural groups establish rules and codes of conduct using a system of rewards and punishment to govern members, and these become norms, values, and mores of a group a. Reward leads to acceptance as a member of a group b. Punishment for antisocial behavior leads to rejection and separation from a group 2. Role of members includes specified rights, duties, attitudes, and actions 3. Social boundaries separate one group from another; nonmembers have limited social contacts with members; causes a segmentation of relationships and provides few rewarding experiences for nonmembers 4. Leader’s influence is limited to conditions placed on leader by total group B. A society is a reflection of all functional relationships that occur among its individual members; participation in society is a major influence on an individual’s intellect, creativity, memory, thinking, and feeling C. Society or a group can change because of conflict among members 1. Conflict is greatest when there is absence of certain members, introduction of new members, or change in leadership 2. Ensuing reorganization goes through three stages a. Tension: caused by conflict b. Integration: members learn about “the other’s” problem c. Resolution: reconstruction of group’s norms and values 3. Resolution of conflict and restoration of equilibrium a. Occurs when members interact with one another and group is dynamic b. Conflicts are not resolved when groups are rigid with fixed ideas FOUNDATIONS OF NURSING PRACTICE UNIT 1 7 CHAPTER 1 Factors Influencing Client Needs and Nursing Care CULTURE AND HEALTH A. General influences 1. Culture defines for its people what is important and what is true and real 2. Age, ethnicity, gender, education, income, and belief system (e.g., worldview, religion, or spirituality) make up sociocultural profile of clients 3. Clients’ perceptions of health and illness, their help-seeking behavior, and adherence to treatment depend on beliefs, social norms, and cultural values 4. When clients face increased stressors, suffering, or pain, belief systems play a greater role in their lives 5. Ethnocentrism: belief that one’s own culture is generally right or best 6. Assimilation: integration of common values, beliefs, attitudes, and behaviors of dominant culture 7. Common sociocultural stressors: stereotyping, intolerance, stigma, prejudice, discrimination, and racism B. Implications for nurses 1. Nurses should be in touch with their own personal and cultural experiences 2. Culturally competent nurses have an understanding of cultural diversity to provide care within a context that is appropriate for clients 3. Nurses must have a holistic perspective to assess sociocultural context of clients from different cultures Nurses must appreciate that clients bring their own cultures, attitudes, and belief systems to a situation 4. Together, nurse and client should agree on the nature of a client’s coping responses and set goals and behavioral outcomes within client’s sociocultural context 5. Degree of compatibility between client’s and nurse’s belief systems often determines greater satisfaction with treatment, adherence to therapeutic regimens, and treatment outcomes SOCIETY AND HEALTH A. Role of society 1. Societies traditionally are responsible for caring for their ill 8 CHAPTER 1 Factors Influencing Client Needs and Nursing Care 2. Society’s role in health maintenance and prevention of disease has intensified 3. Society’s provision for health maintenance includes a. Establishment of public health care agencies for supervision, prevention, and control of disease and illness; protection of food, water, and drug supplies; development of public education programs b. Awarding scholarships/grants for health education and research c. Development of unemployment insurance programs and Workers’ Compensation insurance; laws to ensure universal health insurance d. Establishment of Social Security and Medicare programs; establishment of social welfare services and Medicaid programs e. Supervision of medical and hospital insurance programs B. Health care agencies function as a subculture of society 1. Employees develop both written and unwritten agency policies that a. Set standards of acceptable behavior for both clients and staff

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