TEST BANK TEST BANK LIPPINCOTTS Q&A REVIEW FOR NCLEX-RN 10TH EDITION

Introduction to the NCLEX-RN® Licensing Examination and Preparation for Test-Taking 1 The NCLEX-RN® Licensing Examination Overview The National Council Licensure Examination for Registered Nurses (NCLEX-RNs®) is administered to graduates of nursing schools to test the knowledge, abilities, and skills necessary for entry-level safe and effective nursing practice. The examination is developed by the National Council of State Boards of Nursing, Inc. (NCSBN), an organization with representation from all state boards of nursing.1 The same examination is used in all 50 states, the District of Columbia, and United States possessions. The exam is also administered at international test centers worldwide.1 Students who have graduated from baccalaureate, diploma, and associate-degree programs in nursing must pass this examination to meet licensing requirements in the United States. The Test Plan The NCSBN prepares the test plan used to develop the licensing examination. The test plan is based on an analysis of current nursing practice and the skills, abilities, and processes nurses use to provide nursing care. Practice Analysis: T he Foundation of the Test Plan The NCLEX-RN test plan is based on the results of a practice analysis conducted every 3 years of the entry-level performance of newly licensed registered nurses and on expert judgment provided by members of the National Council's Examination Committee as well as a Job Analysis Panel of Experts.1• 2• 5 The job analysis asks newly graduated nurses to rank the nursing activities that they perform on a regular basis. The questions used on the test plan, therefore, include those activities that nurses commonly perform. For example, the 2008 RN practice analysis revealed that nursing practice commonly involved activities such as preparing and administering medications, using rights of medication administration; ensuring proper identification of client when providing care; applying 2 principles of infection control (e.g., hand hygiene, room assignment, isolation, aseptic/sterile technique, universal/standard precautions); performing emergency care procedures (e.g., cardiopulmonary resuscitation, abdominal thrust maneuver, respiratory support, automated, external defibrillator); recognizing signs and symptoms of complications and intervening appropriately when providing client care; reviewing pertinent data prior to medication administration (e.g., vital signs, lab results, allergies, potential interactions). Less commonly performed activities included providing care and/or support for a client with nonsubstance related dependencies; assisting client and staff to access resources regarding genetic issues; incorporating alternative/complementary therapies into client plan of care (e.g., music therapy, relaxation therapy), and performing post-mortem care. The National Council of State Boards of Nursing also used the findings from the Practice Analysis activity statements to generate knowledge statements, the knowledge needed by newly licensed nurses to provide safe care. 5 The findings of this second report are used to inform item development for the NCLEX-RN examination. Test Item Writers Nurse clinicians and nurse educators nominated by the Council of State Boards of Nursing to serve as item writers write the test questions on the NCLEX-RN exam. Because the item writers come from a variety of geographical areas and practice settings, the test items reflect nursing practice in all parts of the country. Test Plan Details Test plans, or test blueprints, are developed to indicate the components and the relative weights of the components that will be tested on an exam. Because exams test both content (knowledge) and process (critical thinking, synthesis of information, clinical decision-making), test plans usually have two or three dimensions. The test plan for the NCLEX-RN addresses two components of nursing TABLE 1.1 Test Plan Structure The framework of Client Needs was selected for the NCLEX-RN® examination because it provides a universal structure for defining nursing actions and competencies across all settings for all clients. Client Needs Four major categories of Client Needs organize the content of the NCLEX-RNTest Plan. Two of the four categories are further divided into a total of six subcategories that define the content contained within the two Client Needs categories. These categories and subcategories are: A. Safe, Effective Care Environment 1. Management of Care 2. Safety and Infection Control B. Health Promotion and Maintenance C. Psychosocial Integrity D. Physiological Integrity 1. Basic Care and Comfort 2. Pharmacological and Parenteral Therapies 3. Reduction of Risk Potential 4. Physiological Adaptation Integrated Concepts and Processes The following concepts and processes fundamental to the practice of nursing are integrated throughout the four major categories of Client Needs: • Nursing Process • Caring • Communication and Documentation • Teaching/Learning Copyright by the National Council of State Boards of Nursing, Inc. All rights reserved. care: (1) client needs categories and (2) integrated processes, such as the nursing process, caring, communication and documentation, and teaching/ learning. (See Table 1.1.) Representative items test knowledge of these components as they relate to specific health care situations in all of the four major areas of client needs. The questions developed for the test plan are written to test nursing knowledge and the ability to apply nursing knowledge to client situations. Client Needs The health needs of clients are grouped under four broad categories: (1) safe, effective care environment; (2) health promotion and maintenance; (3) psychosocial integrity; and (4) physiologic integrity. Two of these categories include subcategories of related and specified needs. (See Table 1.2.) The percentage of test items in each subcategory on the NCLEX-RN examination is shown in Figure 1.1. The NCLEX-RN® Licensing Examination 3 Understanding the category of client needs is key ( ) to recognizing the types of questions that are found on the licensing exam and the relative emphasis given to the category based on the percentage of questions from that category on the exam. Integrated Processes The NCLEX-RN test plan also is organized according to four integrated processes. These include the nursing process, caring, communication and documentation, and teaching/learning. (See Table 1.1 and Figure 1.1.) The Nursing Process The NCLEX-RN test plan includes questions from all steps of the nursing process. The five phases of the nursing process are: (1) assessment, (2) analysis, (3) planning, (4) implementation, and (5) evaluation. Assessment. Assessment involves establishing a database. The nurse gathers objective and subjective information about the client, and then verifies the data and communicates information gained from the assessment. Analysis. Analysis involves identifying actual or potential health care needs or problems based on assessment data. The nurse interprets the data, collects additional data as indicated, and identifies and communicates the client's nursing diagnoses. The nurse also determines the congruency between the client's needs and the ability of the health care team members to meet those needs. Planning. Planning involves setting outcomes and goals for meeting the client's needs and designing strategies to attain them. The nurse determines the goals of care, develops and modifies the plan, collaborates with other health team members for delivery of the client's care, and formulates expected outcomes of nursing interventions. Implementation. Implementation involves initiating and completing actions necessary to accomplish the defined goals. The nurse organizes and manages the client's care; performs or assists the client in performing activities of daily living; counsels and teaches the client, significant others, and health care team members; and provides care to attain the established client goals. The nurse also provides care to optimize the achievement of the client's health care goals; supervises, coordinates, and evaluates delivery of the client's care as provided by nursing staff; and records and exchanges information. Evaluation. Evaluation determines goal achievement. The nurse compares actual with expected outcomes of therapy, evaluates compliance with prescribed or proscribed therapy, and records and describes the client's response to therapy or care. The nurse also modifies the plan, as indicated, and reorders priorities. 4 Introduction to the NCLEX-RN® Licensing Examination and Preparation for Test-Taking TABLE 1.2 Categories and Subcategories of Client Needs A. Safe, Effective Care Environment 1. Management of Care-Providing and directing nursing care that enhances the care delivery setting to protect clients, family/significant others and health care personnel. Related content includes but is not limited to: • Advance Directives • Advocacy • Case Management • Client Rights • Collaboration with Multidisciplinary Team • Concepts of Management • Confidentiality/Information Security • Consultation • Continuity of Care • Delegation • Establishing Priorities • Ethical Practice • Informed Consent • Information Technology • Legal Rights and Responsibilities • Performance Improvement (Quality Improvement) • Referrals • Supervision 2. Safety and Infection Control-Protecting clients, family/significant others and health care personnel from health and environmental hazards. Related content includes but is not limited to: • Accident/Injury Prevention • Emergency Response Plan • Ergonomic Principles • Error Prevention • Handling Hazardous and Infectious Materials • Home Safety • Reporting of Incident/Event/Irregular OccurrenceNariance • Safe Use of Equipment • Security Plan • Standard Precautionsrrransmission-Based Precautions/Surgical Asepsis • Use of Restraints/Safety Devices B. Health Promotion and Maintenance The nurse provides and directs nursing care of the client and family/significant others that incorporates the knowledge of expected growth and development principles, prevention and/or early detection of health problems, and strategies to achieve optimal health. Related content includes but is not limited to: • Aging Process • Ante/Intra/Postpartum and Newborn Care • Developmental Stages and Transitions • Health and Well ness • Health Promotion/Disease Prevention • Health Screening • High Risk Behaviors • Lifestyle Choices • Principles of Teaching/Learning • Self-Care • Techniques of Physical Assessment C. Psychosocial Integrity The nurse provides and directs nursing care that promotes and supports the emotional, mental, and social well-being of the client and family/significant others experiencing stressful events, as well as clients with acute and chronic mental illness. Related content includes but is not limited to: • Abuse/Neglect • Behavioral Interventions • Chemical and Other Dependencies • Coping Mechanisms • Crisis Intervention • Cultural Diversity • End of Life Care • Family Dynamics • Grief and Loss • Mental Health Concepts • Religious and Spiritual Influences on Health • Sensory/Perceptual Alterations • Stress Management • Support Systems • Therapeutic Communication • Therapeutic Environment D. Physiological Integrity The NCLEX-RN® Licensing Examination 5 The nurse promotes physical health and wellness by providing care and comfort, reducing client risk potential, and managing health alterations. 1. Basic Care and Comfort-Providing comfort and assistance in the performance of activities of daily living. Related content includes but is not limited to: • Assistive Devices • Elimination • Mobility/Immobility • Non-Pharmacological Comfort Interventions • Nutrition and Oral Hydration • Personal Hygiene • Rest and Sleep 2. Pharmacological and Parenteral Therapies-Providing care related to the administration of medications and parenteral therapies. Related content includes but is not limited to: • Adverse Effects/Contrai ndications/Side Effects/1 nteractions • Blood and Blood Products • Central Venous Access Devices • Dosage Calculation • Expected Actions/Outcomes • Medication Administration • Parenteral/Intravenous Therapies • Pharmacologic Agents/Actions • Pharmacological Pain Management • Total Parenteral Nutrition 3. Reduction of Risk Potential-Reducing the likelihood that clients will develop complications or health problems related to existing conditions, treatments, or procedures. Related content includes but is not limited to: • Changes/Abnormalities in Vital Signs • Diagnostic Tests • Laboratory Values • Potential for Alterations in Body Systems • Potential for Complications of Diagnostic Tests/Treatments/Procedures • Potential for Complications from Surgical Procedures and Health Alterations • System Specific Assessments • Therapeutic Procedures 4. Physiological Adaptation- Managing and providing care for clients with acute, chronic, or life-threatening physical health conditions. Related content includes but is not limited to: • Alterations in Body Systems • Fluid and Electrolyte Imbalances • Hemodynamics • Illness Management • Medical Emergencies • Pathophysiology • Unexpected Response to Therapies Copyright by the National Council of State Boards of Nursing, Inc. All rights reserved. 6 Introduction to the NCLEX-RN® Licensing Examination and Preparation for Test-Taking fiGURE 1.1 Test Plan and Distribution of Content Client Needs Categories Management of Care 16-22% Safe Effective Care Environment Safety & Infection Control 8-14% Health Promotion Health Promotion and and Maintenance Maintenance 6-12% Psychological Psychosocial Integrity Integrity 6-12% -. -. I I Basic Care and Comfort - 6-12% - Pharmacological & Parental Therapies Physiological 13-19% Integrity I I I Reduction of Risk Potential 13-19% I I - Physiological Adaptation 11 -17% 0 2 4 6 8 20 22 Percentage of Items on NCLEX-RN® Exam Copyright by the National Council of State Boards of Nursing, Inc. All rights reserved. The five phases of the nursing process are equally important. Therefore, each is represented by an equal number of items on the NCLEX-RN and all are integrated throughout the exam. In this book, you will have opportunities to respond to questions involving all five steps of the nursing process. Caring The caring process refers to interaction between the nurse, client, and family in a way that conveys mutual respect and trust. The nurse offers encouragement and hope to clients and their families while providing nursing care. Questions about the caring process are threaded throughout the licensing exam to test the candidate's attitudes and values for caring for and about clients. In this book, you will have the opportunity to respond to questions that test your ability to apply the caring process in a variety of situations. Communication and Documentation Another element of the licensing exam test plan evaluates the nurse's ability to communicate with clients, families, and health team members. The test also includes questions about documenting nursing care according to standards of nursing practice. In this book, you will be presented with questions that ask you to determine the most effective way to