Editors JoAnn Zerwekh, MSN, EdD, RN Executive Director Nursing Education Consultants, Inc Ingram, Texas University of Phoenix - Online Campus Nursing Faculty Phoenix, AZ Jo Carol Claborn, MS, RN Executive Director Nursing Education Consultants, Inc Ingram, Texas
Nursing Education Consultants, Inc. PO Box 465 Ingram, Texas 78025 A Study Guide for the NCLEX PN Exam, 6 th ed ISBN 10: 1-892155-14-1 ISBN-13: 978-1-892155-14-6 Copyright 2010 by Nursing Education Consultants, Inc. Notice All rights reserved. No part of this publication may be reproduced or transmitted in any form for by and means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system without permission in writing from the publisher. Permissions may be sought directly from Nursing Education Consultants, Ingram, Texas (1-800-933-7277). You may also place your request online at www.nursinged.com and select Contact. Any procedure or practice described in this book should be applied by the health care practitioner under appropriate supervision in accordance with professional standards of care used with regard to the unique circumstances that apply in each practice situation. Care has been taken to confirm the accuracy of information presented and to describe generally accepted practices. However, the authors, editors, and publisher cannot accept any responsibility for errors or omission or for consequences from application of the information in the book and make no warranty, express or implied with respect to the content of this book. The authors and publisher have exerted every effort to ensure that drug selection and information set forth in this text are in accord with current practice at time of publication. However, in view of the ongoing research, changes in government regulations and the constant flow of information relating to drug therapy, before administering medications, the reader is urged to check current resources on the medication for any change in drug information, and for added warnings and precautions. NCLEX and NCLEX PN are registered trademarks of the National Council of State Boards of Nursing, Inc. ISBN-10: 1-892155-14-1 ISBN-13: 978-1-892155-14-6 Project manager: Lindy Nobles Cover design: Jana Jennings Printed by: Gingerbread Press, Waxahachie, Texas Publishing manager: Mike Cull Printed in the United States of America Last digit is the print number: 6 5 4 3 2 1
Contributors and Reviewers Joanna G. Barnes, MSN, RN ADN Program Coordinator Grayson County College Denison, Texas Sharon I. Decker, PhD, ACNS-BC, ANEF, RN Professor and Director of Clinical Simulations Covenant Health System Endowed Chair in Simulation and Nursing Education Texas Tech University Health Science Center Lubbock, Texas Barbara S. Devitt, MSN, RN Lecturer Louise Herrington School of Nursing Baylor University Dallas, Texas Ashley Garneau, MS, RN Nursing Faculty Gateway Community College Phoenix, Arizona Lt. Col. (Ret.) Michael W. Hutton, MSN, RN Instructor Blinn College Bryan, Texas Susan B. Priest, MSN, CNS, RN Director, Health and Medical Programs Continuing Education Workforce Development; Adjunct Faculty, Associate Degree Nursing Alvin Community College Alvin, Texas Catherine Rosser, EdD, CNA-BC, RN Undergraduate Program Director Louise Herrington School of Nursing Baylor University Dallas, Texas Mary Ann Yantis, BS, MS, PhD, RN Associate Professor of Nursing Louise Herrington School of Nursing Baylor University Dallas, Texas iii
Preface This sixth edition of Illustrated Study Guide for the NCLEX-PN Exam continues to provide an up-to-date review book illustrated with graphics, pictures, and cartoon images to enhance your review and retention of critical nursing information. The book contains information specifically designed to assist you in preparing for the National Council Licensure Examination for Practical Nurses (NCLEX-PN ). This text emphasizes the integrated approach to nursing practice that the NCLEX-PN is designed to test. This book s primary purpose is to assist you to thoroughly review facts, principles, and applications of the nursing process. It should alleviate many of the concerns you may have about what, how, and when to study. We have spent a great deal of time studying the NCLEX- PN test format and have incorporated this information into this book. We have included an explanation and examples of alternate format questions. In our review courses, which we have taught across the country, we have identified specific student needs and correlated this information with the test plan in order to develop this study guide. Study questions are at the end of each chapter for you to check your reading and comprehension. In addition, there are over 1400 test questions available online for practicing your testing skills. We have designed graphics that highlight important information to make the book more visually appealing: HIGH ALERT TEST ALERT: Identifies important concepts that are reflected on the PN Practice Analysis from the National Council of State Boards of Nursing, Inc. NURSING PRIORITY: Assists to distinguish priorities of nursing care and includes both geriatric and pediatric nursing priorities. Disease conditions are easily located by this design element. Home Care can be found under the Nursing Interventions section. Medication information is easily found in chapter appendixes. High Alert medications identified by Joint Commission and the Institute for Safe Medication Practices are noted by this symbol. The comments from our review course participants, as well as extensive faculty reviews on our fifith edition, have helped to shape the development of this sixth edition. We hope this text will prove even more beneficial to nursing faculty, students, and graduate nurses. Thank you for allowing us to be part of your success in nursing. JoAnn Zerwekh Jo Carol Claborn iv
Acknowledgements We wish to express our appreciation to our children - Ashley Garneau, Tyler Zerwekh, Mike Brown, Kimberley Aultman, and Jaelyn Conway who have watched their mothers write and revise books throughout their childhood and now as adults continue to support our endeavors - for this we are most grateful! To Robert and John, thank you for your tolerance, love, and willingness to continue to share and support us in the midst of our hectic professional lives. A special note of thanks to CJ Miller, RN, BS, our cartoonist, who has worked with us from the beginning of the Memory Notebooks of Nursing and the past few editions of Nursing Today: Transition & Trends, and more recently with the Mosby s Memory Notecard series. She continues to brighten our day and brings to all of our books, images and cartoons that are so unique. The revision of a book offers the opportunity to be responsive to nursing faculty and students who have utilized the book. We appreciate their comments and suggestions for the production of this sixth edition. It is our pleasure to express an appreciation to the individuals who assisted us in the technical preparation and production of this sixth edition. Our sincere appreciation to: Lindy Nobles, our technical assistant, for assisting us in the preparation and typesetting of the manuscript into a working design for publishing. Jana Jennings, for helping us with the arduous task of putting together detailed tables, boxes, and appendices. Elaine Nokes, our administrative assistant, who keeps everything organized and running smoothly for our business. Mike Cull, our publisher at Gingerbread Press, for always coming through for us in all of our printing needs. Thank you to all! v
Contents 1 TESTING STRATEGIES FOR THE NCLEX-PN EXAMINATION, 1 Test Plan, 1 What is Computer Adaptive Testing?, 3 Taking the NCLEX Examination, 4 NCLEX Test-Taking Strategies, 5 Tips for Test-Taking Success, 19 Study Habits, 20 Decrease Anxiety, 21 2 HEALTH IMPLICATIONS ACROSS THE LIFE SPAN, 23 Long-Term Care, 23 Care of the Chronically Ill Client, 24 Growth and Development, 24 Communicable Diseases, 28 Cancer, 34 Study Questions: Health Implications Across the Life Span, 39 3 NURSING CONCEPTS, 41 Steps of the Nursing Process, 41 Health Assessment, 42 Health Teaching, 42 Basic Nursing Skills, 43 Immobility, 48 Pain, 49 End-Of-Life Care, 52 Perioperative Care, 53 Disaster Planning, 59 Legal Implications, 59 Management of Health Care Workers, 63 Study Questions: Concepts of Nursing Management, 64 Appendix 3-1: Positioning and Body Mechanics, 66 Appendix 3-2: Analgesics, 67 4 PHARMACOLOGY, 69 General Concepts of Pharmacology, 69 Medication Administration, 70 Forms of Medication Preparations, 75 Calculation of Medication Dosages, 76 vi Study Questions: Pharmacology, 77 Appendix 4-1: Conversions, 78 Appendix 4-2: Abbreviations and Symbols, 78 Appendix 4-3: List of Do Not Use Abbreviations, Acronyms, and Symbols Approved by The Joint Commission (TJC), 79 Appendix 4-4: Abbreviations and Symbols That Are Recommended But Not Yet Mandated By The Joint Commission (TJC) for Inclusion in the Official Do Not Use List, 79 5 HOMEOSTASIS, 80 Fluid and Electrolytes, 80 Intravenous Fluid Replacement Therapy, 82 Infiltration, 82 Phlebitis, 82 Circulatory Overload, 83 Acid-Base Balance, 83 Inflammation, 85 Infection, 85 Immune System, 88 Anaphylactic Reaction, 89 Systemic Lupus Erythematosus (SLE), 90 Acquired Immunodeficiency Syndrome (AIDS), 91 Pediatric Acquired Immunodeficiency Syndrome, 93 Study Questions: Homeostasis, 95 Appendix 5-1: Potassium Imbalances, 97 Appendix 5-2: Potassium Medications, 97 Appendix 5-3: Sodium Imbalances, 98 Appendix 5-4: Medications to Correct Sodium Imbalance, 98 Appendix 5-5: Calcium Imbalances, 99 Appendix 5-6: Medications to Correct Calcium Imbalance, 99 Appendix 5-7: Antiinflammatory Medications, 100 Appendix 5-8: Nonsteroidal Antiinflammatory Drugs (NSAIDs) and Acetaminophen, 101 Appendix 5-9: Infection Control Procedures, 102 Appendix 5-10: Antibiotic Medications, 104 Appendix 5-11: Antiretroviral Therapy (ART), 107 Appendix 5-12: Medications for Allergic Reactions, 108
Contents vii 6 PSYCHIATRIC NURSING CONCEPTS AND CARE, 109 Self-Concept, 109 Cultural Competence, 110 Body Image, 110 Obesity, 110 Stroke, 111 Amputation, 111 Pregnancy, 111 Cancer, 111 Enterostomal Surgery, 111 Human Sexuality, 111 Concept of Loss, 112 Psychosocial Assessment, 113 Mental Status Examination, 113 Coping/Defense/Ego/Mental Mechanisms, 113 Therapeutic Nursing Process, 114 Therapeutic Nurse-Client Communication Techniques, 115 Intervention Modalities, 115 Anxiety, 118 Abuse, 122 Rape, 124 Child-Related Disorders, 124 Eating Disorders, 125 Psychiatric Considerations of Older Adults, 126 Personality Disorders, 128 Alcohol Dependence (Alcoholism), 129 Affective Disorders, 133 Schizophrenic Disorders, 135 Paranoid Disorders, 137 Study Questions: Psychiatric Nursing Concepts and Care, 139 Appendix 6-1: Alzheimer s Medications, 140 Appendix 6-2: Antianxiety Agents, 141 Appendix 6-3: Antimanic Medications, 142 Appendix 6-4: Antidepressant Medications, 143 Appendix 6-5: Antipsychotic (Neuroleptic) Medications, 145 7 SENSORY SYSTEM, 146 Physiology of the Eye, 146 Glaucoma, 146 Cataract, 148 Retinal Detachment, 148 Age-Related Macular Degeneration (AMD), 149 Conjunctivitis, 150 Eye Trauma, 150 Physiology of the Ear, 150 Otitis Media, 151 Hearing Loss, 152 Balance Disorders, 152 Study Questions: Sensory System, 154 Appendix 7-1: Ophthalmic and Hearing Diagnostics, 155 Appendix 7-2: Ophthalmic Medications, 156 Appendix 7-3: Nursing Procedure: Ear and Eye Irrigation, 157 8 ENDOCRINE SYSTEM, 158 Physiology of the Endocrine System, 158 Hyperpituitary: Acromegaly, 158 Diabetes Insipidus, 159 Hyperthyroidism, 159 Hypothyroidism, 160 Hyperparathyroidism, 161 Hypoparathyroidism, 162 Diabetes Mellitus, 162 Hypoglycemia (Insulin Reaction), 168 Pancreatitis, 169 Cancer of the Pancreas, 169 Pheochromocytoma, 170 Addison s Disease (Adrenocortical Insufficiency/ Adrenal Hypofunction), 170 Cushing s Syndrome (Adrenal Cortex Hypersecretion/Hypercortisolism), 171 Study Questions: Endocrine System, 172 Appendix 8-1: Endocrine Diagnostics, 173 Appendix 8-2: Medications Used in Endocrine Disorders, 174 9 HEMATOLOGIC SYSTEM, 176 Physiology of the Blood, 176 Anemias, 176 Sickle Cell Anemia, 178 Polycythemia Vera (Primary), 179 Leukemia, 179 Lymphomas, 181 Hemophilia, 181 Disseminated Intravascular Coagulation, 182 Disorders of the Spleen, 182 Study Questions: Hematologic System, 183 Appendix 9-1: Hematologic Diagnostics, 184 Appendix 9-2: Hematologic Medications, 185 Appendix 9-3: Guidelines for Monitoring Blood Transfusions, 186 Appendix 9-4: Hematopoietic Stem Cell Transplant, 187
viii Contents 10 RESPIRATORY SYSTEM, 188 Physiology of the Respiratory System, 188 Hypoxia, 191 Pneumothorax, 193 Chest Trauma, 194 Pulmonary Embolism, 195 Croup Syndromes, 195 Respiratory Syncytial Virus (Bronchiolitis), 197 Tonsillitis, 197 Pneumonia, 198 Tuberculosis, 199 Chronic Obsructive Pulmonary Disease (COPD), 200 Asthma, 201 Cystic Fibrosis, 202 Pulmonary Edema, 203 Cancer of the Larnyx, 204 Cancer of the Lung, 206 Study Questions: Respiratory System, 208 Appendix 10-1: Pulmonary Diagnostics, 210 Appendix 10-2: Respiratory Medications, 212 Appendix 10-3: Sudden Airway Obstruction, 214 Appendix 10-4: Water-Sealed Chest Drainage, 215 Appendix 10-5: Artificial Airways, 217 Appendix 10-6, Suctioning Through Artificial Airways, 219 Appendix 10-7: Oxygen, 220 Appendix 10-8: Nursing Procedure: Sputum Specimen Collection, 221 Appendix 10-9: Mechanical Ventilators, 222 11 VASCULAR SYSTEM, 223 Physiology of the Vascular System, 223 Atherosclerosis, 223 Hypertension, 224 Peripheral Arterial Disease (Peripheral Vascular Disease), 226 Thromboangiitis Obliterans (Buerger s Disease), 229 Raynaud s Disease, 229 Aneurysm, 229 Shock (Severe Hypotension), 231 Chronic Venous Insufficiency and Venous Stasis Ulcers, 232 Varicose Veins, 233 Thrombophlebitis, 234 Study Questions: Vascular System, 235 Appendix 11-1: Vascular Diagnostics, 237 Appendix 11-2: Antihyperlipidemic Medications, 238 Appendix 11-3: Anticoagulants/Antiplatelets, 239 Appendix 11-4: Antihypertensive Medications, 240 Appendix 11-5: Diuretics, 241 Appendix 11-6: Medications Used for Treatment of Shock, 242 12 CARDIAC SYSTEM, 243 Physiology of the Cardiac System, 243 Angina Pectoris (Chronic Angina), 245 Unstable Angina Pectoris, 246 Myocardial Infarction, 247 Heart Failure, 249 Rheumatic Heart Disease, 251 Infective Endocarditis (Bacterial), 252 Pericarditis, 252 Cardiovascular Disease in Pregnancy, 253 Congenital Heart Disease, 253 Study Questions: Cardiac System, 254 Appendix 12-1: Cardiac Diagnostics, 256 Appendix 12-2: Cardiac Medications, 258 Appendix 12-3: Cardiopulmonary Resuscitation (CPR) for Health Care Providers, 261 Appendix 12-4: Cardiac Conduction and Dysrhythmias, 263 Appendix 12-5: Pacemakers, 264 13 GASTROINTESTINAL SYSTEM, 265 Physiology of the Gastrointestinal (GI) System, 265 Nausea and Vomiting, 266 Constipation, 267 Diarrhea, 268 Oral Cancer, 269 Gastroesophageal reflux Disease (GERD), 270 Obesity, 170 Peptic Ulcer Disease (PUD), 271 Pyloric Stenosis, 273 Appendicitis, 273 Acute Abdomen, 274 Intestinal Obstruction, 275 Diverticular Disease, 277 Hernias, 278 Inflammatory Bowel Disease, 278 Gastritis and Gastroenteritis, 279 Hirschsprung s Disease, 280 Cancer of the Colon and Rectum, 280 Celiac Disease (Malabsorption Syndrome), 281 Hemorrhoids, 282 Study Questions: Gastrointestinal System, 282
Contents ix Appendix 13-1: Gastrointestinal System Diagnostics, 284 Appendix 13-2: Gastrointestinal Medications, 286 Appendix 13-3: Antiulcer Agents, 289 Appendix 13-4: Parenteral Nutrition, 290 Appendix 13-5: Nursing Procedure: Nasogastric Tubes, 291 Appendix 13-6: Nursing Procedure: Enteral Feeding, 292 Appendix 13-7: Nursing Procedure: Enemas, 293 Appendix 13-8: Care of the Client with an Ostomy, 294 14 HEPATIC AND BILIARY SYSTEM, 296 Physiology of the Hepatic and Biliary System, 296 Jaundice, 296 Hepatitis, 297 Hepatic Cirrhosis, 299 Cancer of the Liver, 301 Liver Transplantation, 301 Cholelithiasis and Cholecystitis, 302 Study Questions: Hepatic and Biliary System, 303 Appendix 14-1: Diagnostics of the Hepatic and Biliary System, 305 15 NEUROLOGICAL SYSTEM, 307 Physiology of the Neurological System, 307 Increased Intracranial Pressure (ICP), 310 Brain Tumors, 314 Head Injury, 315 Hydrocephalus, 316 Reye s Syndrome, 317 Stroke (Brain Attack), 317 Cerebral Aneurysm, Subarachnoid Hemorrhage, 320 Meningitis, 321 Encephalitis, 322 Spinal Cord Injury, 322 Myasthenia Gravis, 325 Multiple Sclerosis, 326 Guillain-Barré Syndrome, 327 Amyotrophic Lateral Sclerosis (ALS), 328 Muscular Dystrophy, 328 Cerebral Palsy, 329 Parkinson s Disease (Paralysis Agitans), 329 Headache, 330 Trigeminal Neuralgia, 331 Bell s Palsy, 331 Study Questions: Neurological System, 332 Appendix 15-1: Neurologic System Diagnostics, 334 Appendix 15-2: Antiepileptics, 336 Appendix 15-3: Cholinergic (Anticholinesterase) Medications, 337 Appendix 15-4: Antiparkinsonism Agents, 337 Appendix 15-5: Seizure Disorders, 338 Appendix 15-6: Aphasia, 339 16 MUSCULOSKELETAL AND CONNECTIVE TISSUE SYSTEM, 340 Physiology of the Musculoskeletal System, 340 Herniated Intervertebral Disk, 342 Scoliosis, 343 Fractures, 343 Specific Fractures, 347 Hip Replacement, 348 Total Knee Replacement, 349 Osteoporosis, 349 Osteomyelitis, 350 Malignant Bone Tumors, 351 Rheumatoid Arthritis, 351 Osteoarthritis, 352 Gout, 353 Study Questions: Musculoskeletal and Connective Tissue System, 353 Appendix 16-1: Diagnostic Studies, 355 Appendix 16-2: Medications, 356 Appendix 16-3: Amputations, 358 Appendix 16-4: Assistive Devices for Immobility, 359 17 REPRODUCTIVE SYSTEM, 360 Physiology of the Reproductive System, 360 Prostate Disorders, 361 Inflammatory Disorders (Male), 364 Undescended Testes (Cryptorchidism), 365 Testicular Tumors (Cancer), 365 Hydrocele and Varicocele, 366 Erectile Dysfunction (ED), 366 Cystocele and Rectocele, 366 Vaginal Inflammatory Conditions, 367 Dysfunctional Uterine Bleeding, 367 Endometriosis, 368 Pelvic Inflammatory Disease, 368 Sexually Transmitted Diseases, 369 Cervical Cancer, 372 Breast Carcinoma, 372 Study Questions: Reproductive System, 375 Appendix 17-1: Medications Used in Reproductive System Disorders, 376 Appendix 17-2: Hormone Replacement, 377
x Contents 18 URINARY-RENAL SYSTEM, 378 Physiology of the Kidney and Urinary Tract, 378 Urinary Tract Infections, 380 Urinary Calculi, 382 Hypospadias and Epispadias, 383 Nephrotic Syndrome, 383 Glomerulonephritis, 385 Wilms Tumor (Nephroblastoma), 385 Acute Renal Failure, 386 Chronic Renal Failure, 388 Renal Transplant, 389 Dialysis, 390 Renal Tumors, 391 Study Questions: Urinary-Renal System, 391 Appendix 18-1: Diagnostics of the Urinary-Renal System, 393 Appendix 18-2: Renal Medications, 395 Appendix 18-3: Immunosuppressive Medications, 396 Appendix 18-4: Urinary Diversion, 397 Appendix 18-5: Nursing Procedure: Urine Specimen Collection, 399 Appendix 18-6: Nursing Procedure: Urinary Catheterization, 400 19 INTEGUMENTARY SYSTEM, 402 Physiology of the Skin, 402 Acne Vulgaris, 403 Atopic Dermatitis, 403 Psoriasis, 403 Contact Dermatitis, 404 Pressure Ulcer, 404 Impetigo, 405 Cellulitis, 406 Fungal (Dermatophyte) Infections, 406 Parasitic Infestations, 406 Viral Infections, 407 Malignant Melanoma, 407 Burns, 408 Study Questions: Integumentary System, 410 Appendix 19-1: Skin Diagnostic Studies, 411 Appendix 19-2: Medications Used in Skin Disorders, 412 Appendix 19-3: Topical Antibiotics for Burn Treatment, 413 20 MATERNAL CARE, 414 Contraception, 414 Normal Pregnancy Cycle: Physiological Changes, 414 Prenatal Care, 415 Fetus, 418 Fetal and Maternal Assessment Testing, 419 Complications Associated with Pregnancy, 421 Labor and Delivery, 423 Nursing Interventions During Labor and Delivery, 424 Operative Obstetrics, 425 Episiotomy, 425 Forceps Delivery, 428 Cesarean Birth, 428 Induction of Labor, 428 Complications Associated with Labor and Delivery, 429 Hemorrhage in the Pregnant Client, 430 Multifetal Pregnancy, 430 Prolapsed Cord, 430 Postpartal Data Collection, 432 Complications of the Postpartum, 434 Study Questions: Maternal Care, 436 Appendix 20-1: Contraceptive Methods, 438 Appendix 20-2: Magnesium Sulfate, 440 Appendix 20-3: Oxytocic Medications and Prostaglandins to Cause Uterine Contractions, 440 Appendix 20-4: Tocolytic Agents to Suppress Labor, 441 Appendix 20-5: RhoGAM, 442 21 NEWBORN, 443 Normal Newborn, 443 High-Risk Newborn, 447 Respiratory Distress, 450 Cleft Lip and Cleft Palate, 450 Esophageal Atresia with Tracheoesophageal Fistula, 451 Imperforate Anus, 451 Neural Tube Defects, 451 Neonatal Sepsis, 452 Isoimmune Hemolytic Disease of the Newborn, 452 Infant of a Diabetic Mother, 453 Study Questions: Newborn, 453 CHAPTER STUDY QUESTIONS: ANSWERS AND RATIONALES, 455 INDEX, 473