Hesi Comprehensive Review for the Nclex-Pn Examination (2017)

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HESIComprehensive Review for theNCLEX-PN® ExaminationFIFTH EDITIONHesiEditorTina Cuellar, PhD, APRN, PMHCNS, BC2

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Table of ContentsCover imageTitle pageCopyrightContributing AuthorsReviewersPreface1. Introduction to Testing and the NCLEX-PN® ExaminationThe NCLEX-PN Licensing ExaminationAdministration of the NCLEX-PNTips for NCLEX-PN Success2. Leadership and ManagementLegal Aspects of NursingReview of Legal Aspects of NursingAnswers to ReviewLeadership and ManagementReview of Leadership and ManagementAnswers to ReviewDisaster NursingReview of Disaster NursingAnswers to Review3

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3. Advanced Clinical ConceptsRespiratory FailureReview of Respiratory FailureAnswers to ReviewShockDisseminated Intravascular CoagulationReview of Shock and DICAnswers to ReviewResuscitationReview of ResuscitationAnswers to ReviewFluid and Electrolyte BalanceReview of Fluid and Electrolyte BalanceAnswers to ReviewElectrocardiogramReview of ElectrocardiogramAnswers to ReviewPerioperative CareReview of Perioperative CareAnswers to ReviewHIV InfectionPediatric HIV InfectionReview of HIV InfectionAnswers to ReviewPainReview of PainAnswers to ReviewDeath and GriefReview of Death and GriefAnswers to Review4. Medical-Surgical NursingCaring and Nursing4

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Cultural DiversitySpiritual AssessmentRespiratory SystemReview of Respiratory SystemAnswers to ReviewRenal SystemReview of Renal SystemAnswers to ReviewCardiovascular SystemReview of Cardiovascular SystemAnswers to ReviewGastrointestinal SystemReview of Gastrointestinal SystemAnswers to ReviewEndocrine SystemReview of Endocrine SystemAnswers to ReviewMusculoskeletal SystemReview of Musculoskeletal SystemAnswers to ReviewNeurosensory SystemNeurologic SystemReview of Neurosensory/Neurologic SystemsAnswers to ReviewHematology/OncologyReview of Hematology/OncologyAnswers to ReviewReproductive SystemReview of Reproductive SystemAnswers to ReviewBurnsReview of BurnsAnswers to Review5

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5. Pediatric NursingGrowth and DevelopmentPain Assessment and Management in the Pediatric ClientChild Health PromotionReview of Child Health PromotionAnswers to ReviewRespiratory DisordersReview of Respiratory DisordersAnswers to ReviewCardiovascular DisordersReview of Cardiovascular DisordersAnswers to ReviewNeuromuscular DisordersReview of Neuromuscular DisordersAnswers to ReviewRenal DisordersReview of Renal DisordersAnswers to ReviewGastrointestinal DisordersReview of Gastrointestinal DisordersAnswers to ReviewHematologic DisordersHemophiliaReview of Hematologic DisordersAnswers to ReviewMetabolic and Endocrine DisordersReview of Metabolic and Endocrine DisordersAnswers to ReviewSkeletal DisordersReview of Skeletal DisorderAnswers to Review6. Maternity Nursing6

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Anatomy and Physiology of ReproductionAntepartum Nursing CareReview of Anatomy and Physiology of Reproduction and Antepartum Nursing CareAnswers to ReviewFetal/Maternal Assessment TechniquesReview of Fetal/Maternal Assessment TechniquesAnswers to ReviewIntrapartum Nursing CareReview of Intrapartum Nursing CareAnswers to ReviewNormal Postpartum Period (Puerperium)Review of Normal Puerperium (Postpartum)Answers to ReviewThe Normal NewbornReview of the Normal NewbornAnswers to ReviewComplications of PregnancyReview of Complications of PregnancyAnswers to ReviewPostpartum ComplicationsReview of Postpartum ComplicationsAnswers to ReviewComplications of the NewbornReview of Complications of the NewbornAnswers to Review7. Psychiatric NursingTherapeutic CommunicationReview of Therapeutic Communication and Treatment ModalitiesAnswers to ReviewAnxietyAnxiety DisordersReview of Anxiety and Trauma- and Stressor-Related DisordersAnswers to Review7

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Somatic Symptom Disorder and Related DisordersReview of Somatic Symptom Disorder and Related DisordersAnswers to ReviewDissociative DisordersReview of Dissociative DisordersAnswers to ReviewPersonality Disorders (DSM-5 Criteria)Review of Personality DisordersAnswers to ReviewEating DisordersReview of Eating DisordersAnswers to ReviewMood DisordersReview of Mood DisordersAnswers to ReviewSchizophrenia Spectrum and Other Psychotic DisordersReview of Thought DisordersAnswers to ReviewSubstance AbuseReview of Substance Abuse DisorderAnswers to ReviewChildhood and Adolescent DisordersReview of Childhood and Adolescent DisordersAnswers to Review8. Gerontologic NursingTheories of AgingPhysiologic ChangesPsychosocial ChangesDementiaHealth Maintenance and Preventive CareEnd-of-Life CareReview of Gerontologic NursingAnswers to Review8

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A. NANDA-Approved Nursing Diagnoses and DefinitionsB. Normal ValuesIndex9

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Copyright3251 Riverport LaneSt. Louis, Missouri 63043HESI COMPREHENSIVE REVIEW FOR THE NCLEX-PN®EXAMINATION,FIFTH EDITIONISBN: 978-0-323-42933-7Copyright © 2018 by Elsevier, Inc. All rights reserved.No part of this publication may be reproduced or transmitted in any form or byany means, electronic or mechanical, including photocopying, recording, or anyinformation storage and retrieval system, without permission in writing fromthe publisher. Details on how to seek permission, further information about thePublisher’s permissions policies and our arrangements with organizations suchas the Copyright Clearance Center and the Copyright Licensing Agency, can befound at our website: www.elsevier.com/permissions.This book and the individual contributions contained in it are protected undercopyright by the Publisher (other than as may be noted herein).NoticesKnowledge and best practice in this field are constantly changing. As newresearch and experience broaden our understanding, changes in researchmethods, professional practices, or medical treatment may become necessary.Practitioners and researchers must always rely on their own experience andknowledge in evaluating and using any information, methods, compounds,or experiments described herein. In using such information or methods, theyshould be mindful of their own safety and the safety of others, includingparties for whom they have a professional responsibility.With respect to any drug or pharmaceutical products identified, readers areadvised to check the most current information provided 1) on proceduresfeatured or 2) by the manufacturer of each product to be administered toverify the recommended dose or formula, the method and duration ofadministration, and contraindications. It is the responsibility of practitioners,relying on their own experience and knowledge of their patients, to make10

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diagnoses, determine dosages and the best treatment for each individualpatient, and 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 topersons or property as a matter of products liability, negligence or otherwise,or from any use or operation of any methods, products, instructions, or ideascontained in the material herein.Previous editions copyrighted 2015, 2012, and 2008.NANDA International Nursing Diagnoses: Definitions and Classifications2012–2014; Herdman T.H. (Ed.); copyright © 2012, 1994–2012 NANDAInternational; Published by John Wiley & Sons, Limited.NCLEX®, NCLEX-RN®, and NCLEX-PN®are Registered Trademarks of theNational Council of State Boards of Nursing, Inc.International Standard Book Number: 978-0-323-42933-7Content Strategist:Jamie BlumContent Development Manager:Billie SharpAssociate Content Development Specialist:Samantha DaltonPublishing Services Manager:Jeff PattersonBook Production Specialist:Bill DroneDesign Direction:Ryan CookPrinted in CanadaLast digit is the print number: 98765432111

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Contributing AuthorsSafa'a Al-Arabi, PhD, RN, MSN, MPH,Associate Professor and AcceleratedBSN Track Administrator, School of Nursing, University of Texas MedicalBranch, Galveston, TexasSharon L. Colley, PhD, MSN, BSN, RN, CNE,MSN Program Coordinator,Associate Professor, School of Nursing, Ferris State University, Big Rapids,MichiganClaudine Dufrene, PhD, RN-BC, GNP-BC, CNE,Assistant Professor, Caroland Odis Peavy School of Nursing, University of St. Thomas, Houston, TexasTiffany Jakubowski, BSN, RN, ONC, CMSRN,Adjunct Nursing Faculty,Front Range Community College, Longmont, ColoradoSandra R. Jemison, RN, MSN,Assistant Professor, Cox College of Nursingand Health Sciences, Springfield, MissouriNecole Leland, MSN, RN, PNP, CPN,School of Nursing, University ofNevada, Las Vegas, NevadaKatherine Ralph, MSN, RN,Curriculum Manager, Elsevier12

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ReviewersKristen M. Bagby, RN, MSN, CNL,Staff Nurse, St. Louis Children’sHospital, St. Louis, MissouriJudy Carlyle, RN,MNS Nursing Administration and Education, NursingEducation, Arkansas Rural Nursing Education Consortium (ARNEC),Nashville, ArkansasAbimbola Farinde, Pharmacist, PhD,Professor, College of Business,Columbia Southern University, Orange Beach, AlabamaChristina Flint, RN, MSN, MBA,Assistant Professor, Nursing, University ofIndianapolis, Indianapolis, IndianaJudith M. Hochberger, PhD, RN,Assistant Professor, Nursing, RosemanUniversity, Henderson, NevadaLisa Tardo-Green, ABD, MSN, RN,Assistant Professor, Associate DegreeNursing, Cabarrus College of Health Sciences, Concord, North CarolinaLaura Williams, MSN, CNS, ONC, CCNS,Clinical Nurse Specialist, Centerfor Nursing Research and Advanced Nursing Practice, Orlando Health,Orlando, Florida13

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PrefaceWelcome toHESI Comprehensive Review for the NCLEX-PN®Examinationwithonline study exams by HESI.Congratulations! This outstanding review manual with the companionEvolve site is designed to prepare nursing students for what is likely the mostimportant examination they will ever take, the NCLEX-PN LicensingExamination. As a graduate of a PN nursing program, the student has the basicknowledge required to pass tests and perform safely and successfully in theclinical area.HESI Comprehensive Review for the NCLEX-PN®Examinationwith the companion Evolve site allows the nursing student to prepare for theNCLEX-PN licensure exam in a structured way.• Organize basic nursing knowledge previously learned.• Review content learned during basic nursing curriculum.• Identify weaknesses in content knowledge so that study efforts can befocused appropriately.• Develop test-taking skills so application of safe nursing practice fromknowledge can be demonstrated.• Reduce anxiety level by increasing ability to correctly answer NCLEX-typequestions.• Boost test-taking confidence by being well prepared and knowing what toexpect.14

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OrganizationChapter 1,Introduction to Testing and the NCLEX-PN®Examination,gives anoverview of the NCLEX-PN Licensing Exam history and a test plan for theexamination. A review of the nursing process (updated with the latestNANDA-approved nursing diagnoses), client needs, and prioritizing nursingcare is also presented.Chapter 2,Leadership and Management,reviews the legal aspects of nursing,leadership, and management, along with disaster nursing.Chapter 3,Advanced Clinical Concepts,presents nursing assessment (datacollection), analysis (nursing diagnosis), planning, and intervention at thepractical nurse level. Respiratory failure, shock, disseminated intravascularcoagulation (DIC), resuscitation, fluid and electrolyte balance, acid-basebalance, electrocardiography (ECG), perioperative care, HIV, pain, and deathand grief are reviewed.Chapters 4 through 8,Medical-Surgical Nursing, Pediatric Nursing,Maternity Nursing, Psychiatric Nursing,andGerontologic Nursing,arepresented in traditional clinical areas.Each clinical area is divided into physiologic components, but essentialknowledge about basic anatomy, medications, nutrition, communication, clientand family education, acute and chronic care, leadership and management, andclinical decision-making are integrated throughout the different components.Open-ended style questions appear at the end of each chapter, whichencourage the student to think in depth about the content presented throughoutthe individual chapter. When a variety of learning mechanisms is used,students have the opportunity to comprehensively prepare for the NCLEX.These strategies include the following:• Reading the review book.• Discussing content with others.• Answering open-ended questions.• Practicing with study exams that simulate the licensure examination.These learning experiences are all different ways that students should use toprepare for the NCLEX. The purpose of the open-ended questions appearing atthe end of the chapter is not a focused practice session on managing NCLEX-style multiple-choice questions, but instead this learning approach allows formore in-depth thinking about the particular topics in the chapter. Practice withmultiple-choice–style questions alone cannot provide the depth of criticalthinking and analysis possible with the short-answer–style questions at the endof the chapter. Additionally, the open-ended questions provide a summaryexperience that helps students focus on the main topics that were covered in thechapter. Teachers use open-ended–style questions to stimulate the critical-thinking process, andHESI Comprehensive Review for the NCLEX-PN®15

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Examinationfacilitates the critical-thinking process by posing the same type ofquestions the teacher might ask.When students need to practice multiple-choice–style questions, the StudyExams offer extensive opportunities for practice and skill-building to improvetheir test-taking abilities. The Study Exams contain seven content-specificexams (Medical-Surgical Nursing, Pharmacology, Pediatrics, Fundamentals,Maternity, Psychiatric-Mental Health Nursing, and Gerontology) and twocomprehensive exams patterned after categories on the NCLEX. The StudyExams can be accessed as many times as necessary, and no questions arerepeated. For instance, the Medical-Surgical exam does not contain questionsthat are on the Pediatrics exam. The purpose of providing these exams is toallow practice and exposure to the critical-thinking–style questions thatstudents will encounter on the NCLEX. However, the Study Exams should notbe used to predict performance on the NCLEX. Only the HESI Exit Exam—asecure, computerized exam that simulates the NCLEX test plan and hasevidenced-based results from numerous research studies indicating a high levelof accuracy in predicting NCLEX success—is offered as a true predictor ofNCLEX performance. Students are allowed unlimited practice on each StudyExam so that they can have the opportunity to review all of the rationales forthe questions.Here is a plan for students to use with the companion Evolve site:• Trial 1: Take the PN Practice Exam without studying for it to determine yourareas of strengths and weaknesses.• Trial 2: After going over the content that relates to the practice questions on aparticular practice test (for instance, Pediatrics, Medical-Surgical, Maternity),review that section of the manual and take the test again to determinewhether you have been able to improve your scores.• Trial 3: Purposely miss every question on the exam so that you can viewrationales for every question.• Trial 4: Take the exam again under timed conditions at the pace that youwould have to progress to complete the NCLEX in the time allowed(approximately 1 minute per question). Find out whether being placed undertiming constraints affects your performance.• Trial 5: Put the exam away for a while and continue review and remediationwith other textbook resources, results of any secure exams that you are takingat your school, and other study aids. Take the practice exams again after thisstudy period to see whether your performance improves with in-depth studyand a few weeks’ break from the questions.Trial 5 represents a good activity in preparation for the HESI Exit Exampresented in your final semester of the program, especially if you have not usedthe Evolve question site for several weeks. Repeated exposure to the questions,however, will make them less useful over time because students tend tomemorize the answers. For this reason, these tests are useful only for practiceand are not a prediction of NCLEX-PN success. The tendency to memorize thequestions after viewing them multiple times falsely elevates the student’s scores16

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on the study exams.Additional assistance for students to study for the NCLEX-PN LicensingExamination can be obtained from a variety of products in the Elsevier family.Many nursing schools have also adopted the following resources:• HESI Examinations—a comprehensive set of examinations designed toprepare nursing students for the NCLEX exam. These enable customizedremediation from Mosby and Saunders textbooks that saves time for facultyand students. Each student is given an individualized report detailing examresults and is allowed to view questions and rationales for items that wereanswered incorrectly. The electronic remediation, a complimentary feature ofthe HESI specialty and exit exams, can be obtained on the subject matter inwhich the student did not answer a question correctly.• HESI-PN Practice Test—a test that provides an introduction to real-worldclient situations with critical-thinking questions. These questions covernursing care for clients with a wide range of physiologic and psychosocialalterations and a related coordination of client care, pharmacology, andnursing concepts.• HESI Complete PN Case Study Collection—prepares students to managecomplex patient conditions and make sound clinical judgments. These onlinecase studies cover a broad range of physiologic and psychosocial alterations,in addition to related coordination of care, pharmacology, and therapeuticconcepts.• HESI Live Review—a Live Review Course presented by an expert facultymember who has received training by the Manager of Review Courses forElsevier Review and Testing. Students are presented with a workbook andpractice NCLEX-style questions that are used during the course.• eBooks—online versions of the all Mosby and Saunders textbooks used in thestudent’s Nursing Curriculum. Search across titles, highlight, make notes,and more—all on your computer.• Elsevier Simulations—using virtual clinical cases, standardized simulationscenarios, and electronic documentation software, Elsevier Simulations allowstudents to practice and apply skills in a controlled, monitored environment.• Evolve Courses—created by experts using instructional design principles, thisinteractive content engages students with reading, animation, video, audio,interactive exercises, and assessments.17

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Introduction to Testing and theNCLEX-PN®Examination18

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The NCLEX-PN Licensing ExaminationA. The main purpose of a licensing examination such as the NCLEX-PN is toprotect the public.B. The NCLEX-PN is:1. Developed by the National Council of State Boards of Nursing.2. Administered by the State Board of Nursing.3. Designed to test the candidate’s capability for safe and effective nursingpractice by measuring current, entry-level practical nursing behavior.Job Analysis StudiesA.“Essential” knowledge on the NCLEX-PN test is determined by practiceanalysis studies.B. Practical nurses (PNs or vocational nurses [VNs]) submit statements aboutthe frequency of nursing activities and the related impact on client safety.HESI HintThe 2015 LPN/VN Practice Analysis: Linking the NCLEX-PN Examination toPractice (Vol. 58) determines how frequently new practical nurses performmore than 150 types of nursing care activities. From the analysis, the 2017NCLEX-PN Test Plan (effective April 1, 2017) identifies four major clientneeds categories, and two of those categories are further divided into a totalof six subcategories and five fundamental nursing processes. They provide abasis for establishing a minimum level of knowledge and skills for PNs touse with a diverse patient population, in any setting, and within the lawsand rules of each state (Table 1.1,Client Needs,and Table 1.2,Practical/Vocational Nursing Processes).HESI HintFor more information on the NCLEX-PN Test Plan and content related toeach category, go to www.ncsbn.org.The Nursing Process and Nursing DiagnosesA. PN role in the nursing process: Practical nurses use the nursing process tocritically think and problem solve (see Table 1.2).B. Practical nurses assist the health care team to gather and organize data andrecognize client needs and problems regardless of the client’s developmentalstage or the health care setting. They also assist the RN in formulating nursing19

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diagnoses and developing plans of care.C. The National Conference of the North American Nursing DiagnosisAssociation (NANDA) guides nurses in the selection of nursing interventionsfor the purpose of achieving specific outcomes; outcomes and interventions areassociated with specific diagnoses (Table 1.3,Components of a Nursing Diagnosis,and Appendix A,NANDA-Approved Nursing Diagnoses).HESI HintA nursing diagnosis is not a medical diagnosis because a nursing diagnosis:Is subject to nursing management.May or may not come from a medical diagnosis.Is formulated and written by nurses.Is implemented from nursing orders (care plan and nursing interventions).Prioritizing Nursing Care on NCLEX-PNA. Many NCLEX-PN test items are designed to test your ability to set priorities.B. Some examples include:1. Identify the MOST IMPORTANT client needs.2. Identify the MOST IMPORTANT nursing intervention.3. Which nursing action should be done FIRST?4. Which client should be cared for FIRST?Examination Item FormatsA. Several different item types (alternate item formats) are presented on theNCLEX-PN examination.TABLE 1.1Client Needs with Threaded Integrated Processes: Caring, ClinicalProblem Solving, Culture & Spirituality, Communication & Documentation,and Teaching & Learning20

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Based on the results of the2014 LPN/VN Practice Analysis: Linking the NCLEX-PN Examination toPractice(Vol. 58). The percentages indicate the amount of questions written for each client needcategory in the2015 NCLEX-PN Test Plan.Adapted from National Council of State Boards of Nursing, Inc. NCLEX-PN Examination: Test Plan forthe National Council Licensure Examination for Licensure Practical/Vocational Nurses, 2015, Chicago,IL. www.ncsbn.org.1. The majority of the questions are multiple-choice items with four choices(answers) from which to choose one correct answer.2. Multiple-response items require the candidate to select one or moreresponses from five to seven choices. The item instructs the candidate tochooseallthat apply.3. Fill-in-the-blank questions require the candidate to calculate the answerand type in the numbers.4. Hot-spot items require the candidate to identify an area on a picture orgraph and click on the area.5. Chart/exhibit format presents a chart or exhibit that the candidate needsto read to be able to answer the problem.22

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TABLE 1.2Practical/Vocational Integrated Nursing ProcessesTABLE 1.3Components of a Nursing Diagnosis6. Ordered response items require a candidate to rank order or moveoptions to provide the correct order of actions or events.7. Graphic format items require the candidate to choose the correct graphicin response to the question.8. Audio format items require the candidate to listen to an audio clip usingheadphones and then select the correct option that applies to the audioclip.B. There is no set percentage of alternate items on the NCLEX-PN examination.All examination items are scored either right or wrong. There is no partial creditin scoring any examination questions.23

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Administration of the NCLEX-PNA. The NCLEX-PN Computer Adaptive Testing (CAT) is administered atPearson Professional Centers in the United States, selected by the NationalCouncil of State Boards of Nursing (NCSBN).B. Pearson VUE is responsible for adapting the NCLEX-PN examination to theCAT format, processing candidate applications, and transmitting test results toits data center for scoring.C. The NCSBN generates the NCLEX-PN test items.Understanding CATA. NCLEX-PN consists of 85 to 205 multiple-choice or alternative format items.B. The candidate is presented with a test item.1. If the question is answered correctly, a slightly more difficult item follows,and the level of difficulty increases with each item until an item is missed.2. If the question is answered incorrectly, a slightly less difficult item follows,and the level of difficulty decreases with each item until the candidateanswers an item correctly.C. The process continues until the candidate has achieved a definite “pass” or“fail” score. A message indicating that the candidate has completed theexamination appears on the screen.D. The item number the candidate is currently answering appears in the upperright side of the screen.E. The greatest number of items appearing on your examination is 205.Taking the TestA. A test administrator provides each candidate with an erasable note boardthat may be replaced as needed while testing. A candidate may not bring his orher own note boards, scratch paper, or writing instruments to the examination.B. You must answer each question before proceeding to the next one. Returningto a question or skipping a question is not allowed during testing. You will notbe able to change an answer once you proceed to the next question; this worksin your favor.C. When taking the examination, read carefully and maintain a reasonable pace.Time Frame and BreaksA. The candidate receives up to 5 hours to complete the examination. The 5hours include a tutorial, sample questions, breaks, and completion of theexamination.B. Two programmed optional breaks are given, one after 2 hours of testing andanother after 3½ hours of testing. A candidate may take an unscheduled breakat any time. All breaks count against testing time.24

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C. When candidates take a break, they must leave the testing room and will berequired to provide a fingerprint before and after the break.Results and ScoringA. When the candidate answers the minimum number of items (85) and hasperformed with 95% certainty above or below the passing standard, thecomputer test stops and calculates whether the candidate has passed or failed.B. If a candidate has answered the maximum number of items (205) and is notat the end of the 5-hour limit, the candidate’s ability estimate is precise. So if theability estimate is at or above the passing standard, the candidate passes, and ifthe ability estimate is at or below the passing standard, the candidate fails.C. If a candidate has run out of time (5-hour limit) and has not answered themaximum number of items (205) but shows a consistent pattern above thepassing standard, then the candidate will pass even if he or she has run out oftime.D. A specific passing score is recommended by the NCSBN. All states requirethe same score to pass, so if you pass in one state, you are eligible to practicenursing in any other state.HESI HintResults are not given at the testing centers. Results are mailed to thecandidate by the boards of nursing about 1 month after taking theexamination. The testing center staff does not have access to test results. TheNCSBN does not want the testing center to be in a position of managingcandidates’ reactions to scores, nor does it want those waiting to take theirexaminations to be influenced by such reactions.Item StrategyA. Every question must be answered to move to the next question, so makeyour best guess if you are not sure of the answer.B. One or more choices are likely to be very wrong. Quickly eliminate thosechoices that do not answer the question.C. Decide between two choices by:1. Rereading the question for qualifiers or other words that specify what thequestion is asking.2. Rereading the choices and deciding what makes them different from oneanother.3. Examining the choice; it may contain correct information but not answerthe question.4. Using information from Maslow’s Hierarchy of Needs (Table 1.4) orErikson’s Stages of Development (Table 1.5) to choose the correct response.D. Trust your instincts. The first response you have is a gut instinct and is an25

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educated guess. Do not second-guess yourself.TABLE 1.4Maslow’s Hierarchy of NeedsTABLE 1.5Stages of Development and Associated Physical Characteristics26

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Tips for NCLEX-PN SuccessOverall PlanningA. Eat a well-balanced diet and drink plenty of water.B. Maintain a normal exercise program. This is the perfect activity for a studybreak.C. Get plenty of sleep while studying because you will study more efficientlywhen well rested.D. Limit your social life for this short period of time before the examination sothat you have plenty of time to study. This will help you achieve your goal ofbecoming a nurse.E. Eliminate alcohol and recreational drugs from your lifestyle because the timeinvolved in their use will waste the time you have to prepare for the test.F. Avoid negative people and think positively. Stay away from people whohave test anxieties or project their problems onto you. Sometimes this person isa fellow classmate, a colleague, or your best friend. They will still be presentwhen the examination is over. Right now you need to take care of yourself;therefore, surround yourself with positive, optimistic people.1. Write “I WILL BE SUCCESSFUL!” on a sticky note, and put it where youwill see it every day.2. Choose a relaxation and affirmation method that you are comfortable withand that meets your needs.3. Repeat to yourself, “I have the knowledge to successfully complete theNCLEX-PN.”Study SkillsLogically, you will study less familiar topics more than those you have alreadymastered. When developing a study plan, consider the following:A. Study plan.1. Study every day, except the night before the exam, until you take theexamination. Schedule study time on your daily calendar.2. Make a list of topics you want to study in order of importance.3. Build your confidence by alternating areas of strength with areas that needfurther review.B. Vary learning techniques: study alone, study in a group, or study content orsample NCLEX-PN questions.C. Organize the material in each topic. Increasing the time you work with thematerial will increase your knowledge base and confidence. Use organizationalmethods such as:1. Write your own fill-in-the-blank tests.2. Prepare flash cards.3. Rewrite material in your own words.4. Make charts and tables of the material.27

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5. Label or explain pictures.D. Rewrite test questions in your own words, with special emphasis onunderstanding the rationale.E. Identify areas for further review, and seek clarification for completeunderstanding.F. Develop test-taking skills to demonstrate your knowledge. This is veryimportant because these skills help increase your ability to:1. Determine what each question is asking.2. Eliminate test responses or answers that are obviously incorrect.3. Identify the best response or prioritize.G. Know what to expect. Remember: “Knowledge is power” when you knowwhat to expect. In addition, your confidence will soar, and your anxiety willdecrease.H. Read the NCLEX-PN Candidate Bulletin.Test-Day PreparationA.Test-Day Checklist:Gather all necessary materials the night before theexamination and put them in a large envelope.1. Admission ticket2. Directions to the testing center3. Identification4. Money for lunch5. Glasses or contact lensesB.Approved Items:Candidates are allowed to bring only identification formsinto the testing room. The following items are not allowed: watches, candy,chewing gum, food, drinks, purses, wallets, pens, pencils, beepers, cellularphones, Post-it®notes, study materials or aids, or calculators.C.Allow Plenty of Traveling Time:Plan to arrive 30 minutes early. Allow fortraffic jams and time for parking. Arriving early will give you a chance to getsettled before beginning the test.D.Dress Comfortably:Dress in loose layers so that you can adjust yourclothing to the temperature of the testing room.E.Do Not Discuss the Examination:Avoid discussing the examination duringbreaks and while waiting to take the examination.F.Avoid Distraction:If the typing noise of other test takers is a problem, askthe test administrator for earplugs, which are available at each center.28

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Leadership and Management29

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Legal Aspects of NursingLaws Governing NursingA. Nurse Practice Acts provide the laws that control and regulate nursingpractice in each state to protect the public from harm. Under the law, thepractice of nursing is restricted to licensed professionals. All states have nursingpractice acts, and these laws contain state standards for nursing care.B. Nurse Practice Acts govern the practical nurse’s (PN) responsibility inassigning, supervising, and accepting assignments and making assignments.Each state sets educational and examination requirements for that state.1. Assignments should be commensurate with the nursing personnel’seducational preparation, skills, experience, and knowledge.2. The PN should supervise care provided by nursing personnel delegated bya registered nurse (RN) or assigned PN. Some states do not authorize PNsto delegate nursing care.3. Unstable patient and sterile or invasive procedures should be assigned toand supervised by RNs (these should be supervised by an RN at all times,but laws related to this may differ among states).4. Documentation is a legal document.Organization of LawsA. Laws are divided into two large groups: criminal (public) law and civil(private) law. Criminal laws are crimes against the country, state, or localgovernment (Table 2.1,Organization of Law). Constitutional, administrative, andcriminal are the three types of criminal law. Civil law is separated into twolarge groups: contract and tort law. Tort law is further divided into intentionaland unintentional torts.CrimeA. Nurses remain bound by all criminal laws, although court cases involvingnurses generally involve tort laws. Crimes occur when criminal statutes areviolated. These acts are crimes against the state (government), they usuallyinclude intent, and they are punishable by the state.B. A crime is committed when:1. The act is contrary to a criminal law or statute.2. An act is not performed when a legal obligation exists to perform the act—for example, refusing to assist in childbirth if the refusal results in injury tothe child.3. Two or more persons agree to commit a crime—that is, criminalconspiracy.4. One person is aware a crime is being committed and helps another personin committing the crime. Both participants are equally guilty.30

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