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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Document preview page 1

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McGraw-Hill Review for the NCLEX-RN Examination (2008)

McGraw-Hill Review for the NCLEX-RN Examination (2008) helps you pass with expert-reviewed materials and study tips.

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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Page 3 preview imageMcGRAW-HILLREVIEWFOR THENCLEX-RNEXAMINATIONEdited byFrances D. Monahan, PhD, RN, ANEFProfessorDepartment of NursingSUNY Rockland Community CollegeSuffern, New YorkNew YorkChicagoSan FranciscoLisbonLondonMadridMexico CityMilanNew DelhiSan JuanSeoulSingaporeSydneyToronto
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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Page 4 preview imageCopyright © 2008 by The McGraw-Hill Companies, Inc. All rights reserved. Manufactured in the United States of America. Except as permitted under theUnited States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database orretrieval system, without the prior written permission of the publisher.0-07-159336-5The material in this eBook also appears in the print version of this title: 0-07-146077-2.All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use namesin an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. Where such designations appear inthis book, they have been printed with initial caps.McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs. For moreinformation, please contact George Hoare, Special Sales, at george_hoare@mcgraw-hill.com or (212) 904-4069.TERMS OF USEThis is a copyrighted work and The McGraw-Hill Companies, Inc. (“McGraw-Hill”) and its licensors reserve all rights in and to the work. Use of this work issubject to these terms. Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile,disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work orany part of it without McGraw-Hill’s prior consent. You may use the work for your own noncommercial and personal use; any other use of the work is strict-ly prohibited. Your right to use the work may be terminated if you fail to comply with these terms.THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY,ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CANBE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS ORIMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.McGraw-Hill and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will beuninterrupted or error free. Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless ofcause, in the work or for any damages resulting therefrom. McGraw-Hill has no responsibility for the content of any information accessed through the work.Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages thatresult from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shallapply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise.DOI: 10.1036/0071460772
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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Page 5 preview imageWe hope you enjoy thisMcGraw-Hill eBook! Ifyou’d like more information about this book,its author, or related books and websites,please click here.ProfessionalWant to learn more?
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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Page 6 preview imageDedicated with all my love—first and foremost to the memory of my husband, William T. Monahan,also to my family and friends who support and tolerate me while I work and bring meaning andhappiness to my days:• Michael M. Monahan, my son;• Kerryane T. Monahan, my daughter, and Robson Diniz, my son-in-law;• John Donovan, my brother;• Gerard Donovan, my brother, and Anita Donovan, my sister-in-law;• Claire T. Torpey, my aunt;• Suzanne M. Reynolds;• Mary Ellen Wyllie;• Josephine and James Hammer.Many thanks to all of them.DEDICATIONCopyright © 2008by The McGraw-Hill Companies, Inc. Click here for terms of use.
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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Page 8 preview imagevCONTENTSContributorsxiPrefacexiiiPART I: TESTING SMART. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Chapter 1: Preparing for NCLEX-RN®3Chapter 2: Test and Language Basics9Chapter 3: Sharpening Your Test Taking Skills19PART II: CONTENT REVIEW. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Chapter 4: Test Plan Category: Safe, Effective Care Environment27Sub-category: Management of CareTopics:Legal Rights andResponsibilitiesClient RightsInformation TechnologyConfidentiality/InformationSecurityInformed ConsentAdvance DirectivesEthical PracticeChapter 5: Test Plan Client Needs Category: Safe, Effective Care Environment55Sub-category: Safety and Infection ControlTopics:Accident PreventionDisaster PlanningEmergency Response PlanError PreventionHandling Hazardous andInfectious Materials Home SafetyChapter 6.Test Plan Category: Health Promotion and Maintenance—Part 177Sub-category: NoneTopics:Ant/Intra/Postpartum andNewborn CareConcepts of ManagementDelegationEstablishing PrioritiesSupervisionContinuity of CareResource ManagementCollaboration with theMultidisciplinary TeamErgonomic PrinciplesInjury PreventionMedical and Surgical AsepsisReporting of Incident/Event/Irregular Occurrence/VarianceAdvocacyReferralsCase ManagementConsultationPerformance Improvement/Quality ImprovementStaff EducationSafe Use of EquipmentSecurity PlanStandard/Transmission-Based/Other PrecautionsUse of Restraints/Safety DevicesFor more information about this title, click here
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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Page 9 preview imageviCONTENTSviCONTENTSChapter 7: Test Plan Category: Health Promotion and Maintenance—Part 2131Sub-category: NoneTopics:Growth and DevelopmentAging ProcessDevelopment Stages andTransitionsChapter 8: Test Plan Category: Health Promotion and Maintenance—Part 3175Sub-category: NoneTopics:Health and WellnessHealth ScreeningHealth Promotion ProgramsChapter 9: Test Plan Category: Health Promotion and Maintenance—Part 4207Sub-category: NoneTopics:Techniques of PhysicalAssessmentChapter 10: Test Plan Category: Psychosocial Integrity—Part 1237Sub-category: NoneTopics:Mental Health ConceptsCultural DiversityCoping MechanismsReligious and Spiritual Influenceson HealthChapter 11: Test Plan Category: Psychosocial Integrity—Part 2265Sub-category: NoneTopics:TherapeuticCommunicationTherapeutic EnvironmentChapter 12: Test Plan Category: Psychosocial Integrity—Part 3287Sub-category: NoneTopics:Abuse/NeglectChemical DependencyChapter 13: Test Plan Category: Physiological Integrity325Sub-category: Basic Care and ComfortTopics:Complementary andAlternative TherapiesAssistive DevicesEliminationMobility/ImmobilityExpected Body Image ChangesFamily SystemsBehavioral InterventionsCrisis InterventionHuman SexualityFamily PlanningImmunizationsLifestyle ChoicesHigh-Risk BehaviorsSituational Role ChangesStress ManagementSupport SystemsFamily DynamicsUnexpected Body-Image ChangesGrief and LossEnd of LifePrinciples of Teachingand LearningSensory/Perceptual AlterationsPsychopathologyNon-Pharmacological ComfortInterventionsNutrition and Oral HydrationPalliative/Comfort CarePersonal HygieneRest and Sleep
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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Page 10 preview imageCONTENTSviiCONTENTSviiChapter 14: Test Plan Category: Physiological Integrity361Sub-category: Pharmacological and Parenteral Therapies—Part 1Topics:Dosage CalculationMedication AdministrationPharmacological Agents/ActionsPharmacological InteractionsChapter 15: Test Plan Category: Physiological Integrity439Sub-category: Pharmacological and Parenteral Therapies—Part 2Topics:Parenteral/IntravenousTherapyChapter 16: Test Plan Category: Physiological Integrity465Sub-category: Reduction of Risk Potential—Part 1Topics:Diagnostic TestsLaboratory ValuesTherapeutic ProceduresChapter 17: Test Plan Category: Physiological Integrity517Sub-category: Reduction of Risk Potential—Part 2Topics:Vital SignsSystem Specific AssessmentsChapter 18: Test Plan Category: Physiological Integrity551Sub-category: Reduction of Risk Potential—Part 3Topics:Potential for Complicationsfrom Surgical Procedures andChapter 19: Test Plan Category: Physiological Integrity633Sub-category: Physiological Adaptation—Part 1Topics:Alterations in Body SystemsIllness ManagementChapter 20: Test Plan Category: Physiological Integrity677Sub-category: Physiological Adaptation—Part 1Topics:Alterations in BodySystemsIllness ManagementChapter 21: Test Plan Category: Physiological Integrity703Sub-category: Physiological Adaptation—Part 1Topics:Alterations in Body SystemsIllness ManagementCentral Venous Access DevicesBlood and Blood ProductsExpected Effects/OutcomesAdverse Effects/Contraindicationsand Side EffectsPharmacological Pain ManagementTotal Parenteral NutritionDiagnosticTests/Treatments/ProceduresMonitoring Conscious SedationPotential for Complications ofPotential for Alteration in BodySystemsHealth AlterationsSection 1: CardiovascularProblemsSection 2: HematologicProblemsSection 3: Respiratory Problems
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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Page 11 preview imageviiiCONTENTSChapter 22: Test Plan Category: Physiological Integrity735Sub-category: Physiological Adaptation—Part 1Topics:Alterations in Body SystemsIllness ManagementChapter 23: Test Plan Category: Physiological Integrity781Sub-category: Physiological Adaptation—Part 1Topics:Alterations in BodySystemsChapter 24: Test Plan Category: Physiological Integrity797Sub-category: Physiological Adaptation—Part 1Topics:Alterations in Body SystemsIllness ManagementChapter 25: Test Plan Category: Physiological Integrity825Sub-category: Physiological Adaptation—Part 1Topics:Alterations in Body SystemsIllness ManagementChapter 26: Test Plan Category: Physiological Integrity857Sub-category: Physiological Adaptation—Part 1Topics:Alterations in Body SystemsIllness ManagementChapter 27: Test Plan Category: Physiological Integrity875Sub-category: Physiological Adaptation—Part 1Topics:Alterations in BodySystemsChapter 28: Test Plan Category: Physiological Integrity905Sub-category: Physiological Adaptation—Part 1Topics:Alterations in Body SystemsChapter 29: Test Plan Category: Physiological Integrity927Sub-category: Physiological Adaptation—Part 1Topics:Alterations in Body SystemsChapter 30: Test Plan Category: Physiological Integrity945Sub-category: Physiological Adaptation—Part 1Topics:Alterations in Body SystemsIllness ManagementSection 4: Neurologic ProblemsIllness ManagementSection 5: Eye and Ear ProblemsSection 6: MusculoskeletalProblemsSection 7: GastrointestinalProblemsSection 8: Hepatic and BiliaryTract ProblemsSection 10: Urinary ProblemsSection 11: Skin ProblemsIllness ManagementSection 9: Endocrine ProblemsIllness ManagementIllness ManagementSection 12: Male and FemaleReproductive System Problems
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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Page 12 preview imageCONTENTSixChapter 31: Test Plan Category: Physiological Integrity971Sub-category: Physiological Adaptation—Part 2Topics:Fluid and ElectrolyteImbalancesChapter 32: Test Plan Category: Physiological Integrity1013Sub-category: Physiological Adaptation—Part 2Topics:Infectious DiseasesChapter 33: Test Plan Category: Physiological Integrity1039Sub-category: Physiological Adaptation—Part 3Topics:PathophysiologyHemodynamicsPART III: TAKING THE TEST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1071Chapter 34: Practice Test for NCLEX-RN1073Index1267Medical EmergenciesRadiation TherapyUnexpected Response to Therapies
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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Page 14 preview imageCONTRIBUTORSFEATURED EDITORSCharlotte E. Blackwell, RN, BSN, MSEdPharmacologyInstructor, Department of NursingWake Technical Community CollegeRaleigh, North CarolinaJudy E. White, RNC, MA, MSNMaternal-Child Health and Sample Test QuestionFaculty, Southern Union State Community CollegeOpelika, AlabamaCONTRIBUTORSSusan E. Abbe, PhD, RNNursing Curriculum SpecialistConnecticut Community-Technical CollegesHartford, ConnecticutSharon A. Aronovitch, PhD, APRN, BC, CWOCNFaculty, School of NursingExcelsior CollegeAlbany, New YorkMary Sharon Boni, PhD, RN, CCRNProfessor & DeanSchool of Nursing and Allied Health AdministrationFairmont State UniversityFairmont, West VirginiaSusan R. Bulecza, RN, MSN, CNS, APRN, BCFlorida Department of HealthOffice of Public Health PreparednessTallahassee, FloridaPatricia D. Coyne, RNC, MSN, MPAMaternal-Newborn InstructorCochran School of NursingYonkers, New YorkAdjunct Professor, Maternal-Newborn NursingRockland Community CollegeSuffern, New YorkPaula M. Crawford, RN, MSNAssistant ProfessorNursing DepartmentOrange County Community CollegeMiddletown, New YorkDale A. Lange Crispell, RN, BSN, MAInstructor, Department of NursingSUNY Rockland Community CollegeSuffern, New YorkMary Rose Driggers, RN, MSNLPN-ADN Online Program Director and Nursing InstructorHealth Technology DivisionDavidson Country Community CollegeLexington, North CarolinaMiriam Freud, RN, MSNDirector, Adult Day Care CenterFriedwald Center for Rehabilitation & NursingNew City, New YorkAnne Hussey, BS, MSEd, RN (Retired)Education Specialist School NursePortsmouth Middle SchoolPortsmouth, New HampshireLaima M. Karosas, PhD, APRNAssociate Professor of NursingQuinnipiac UniversityHamden, ConnecticutDorothea Lever, RN, MS, CDE, CCRNAssociate Professor and CoordinatorDepartment of NursingSUNY Rockland Community CollegeSuffern, New YorkLisa L. Lombard, MDDiplomat American Board of AnesthesiologyBoston, MassachusettsJana Henson Lyner, MSN, RNFaculty, Department of NursingPensacola Junior CollegePensacola FloridaM. Bridget Nettleton, PhD, RN,Dean, School of NursingExcelsior CollegeAlbany, New YorkTina Peer, MS, RNAssistant Professor of NursingAssociate Degree Nursing ProgramCollege of Southern IdahoTwin Falls, IdahoxiCopyright © 2008by The McGraw-Hill Companies, Inc. Click here for terms of use.
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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Page 15 preview imagexiiCONTRIBUTORSPatricia Sue Ragsdale, MSN, RNAssistant Professor of NursingUniversity of Arkansas at Little RockLittle Rock, ArkansasJoyce Grant Scott, MSN, BSN, ASN, CLNC, RNAssociate Professor of NursingUniversity of Arkansas at Little RockLittle Rock, ArkansasLovely Varghese, MSN, FNP, BC, CNOREducator, Department of Nursing EducationColumbia Presbyterian Medical CenterNew York, New YorkSusan M. Wicks, RNc, BS, MSAdvanced Medical-Surgical Nursing FacultyCochran School of NursingSt. John’s Riverside Health Care SystemYonkers, New YorkNCLEX-RN PresenterPace UniversityPleasantville, New YorkDenise D. Wilson, PhD, APN, FNP, ANPAssociate ProfessorMennonite College of NursingIllinois State UniversityNormal, IllinoisFamily Nurse PractitionerMedical Hills Internists & PediatricsBloomington, Illinois
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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Page 16 preview imagexiiiPREFACEDearSoon-to-be Registered Nurse,The purpose of this book is to help you be successful onthe NCLEX-RN® examination so that you can obtain yourlicense as a registered nurse. You have worked long and hardto successfully complete your basic nursing program. Nowthe one thing between you and your license is the NCLEX-RN examination.This book is designed to guide your review study. Thereis a vast amount of nursing knowledge and it can be organ-ized and focused upon in different ways. This book isdesigned to review the content most likely to appear on theexamination and approach it from the perspective of theexamination. Thus, the book begins with a discussion of thetest itself to direct your focus. Because time is a limited andvaluable commodity for all of you as you begin life afternursing school, strategies for studying in the most effective,time-efficient manner also are discussed.A unique feature of this text is a preparatory chapter onlanguage. Despite advanced study, you may often have a fewwordswhosemeaningswereneverclearlymastered.Encountering one of these words in a test question can resultin a wrong answer. Hence, some of the words that are oftenused in nursing but are prone to being misunderstood areidentified, defined, and their use illustrated in sentencesreflective of nursing practice. There is also a chapter on test-taking strategies. You may have already used many of these,but reviewing them as a unit helps to ensure that you areapproaching the NCLEX-RN with the sharpest test-takingskills possible. The chapter even provides exercises to allowyou to practice key skills.The next 30 chapters of the book present the review ofnursing content. The title of each chapter consists of one ofthe major NCLEX-RN test plan categories followed by thesubcategories and topics from the plan to be covered in thatchapter. Precise headings found on the NCLEX-RN test planhave been used to help you think about the content in thesame way that the test is organized and the questions aredesigned. There are separate sections in the text dealing withthe child-bearing client and with gerontology just as thereare in the test plan. Care of the pediatric client is incorpo-rated throughout the text.Icons in the margin are alerts thatthe information applies specifically to a pediatric client or achild-bearing client.To help you recognize and learn critical points of con-tent, the following alerts, which highlight key pieces ofinformation, have been included in the chapters:Assessment Alertsare key considerations related toassessing a particular type of client. These are factorswith potential for significant impact on the client’shealth status if they not recognized and usually repre-sent variations from the norm.Nursing Intervention Alertsare dos and don’ts of practicethat have significant import for the client’s well being andthat apply to a specific client problem not to all clients.Clinical Alertsare specific items of information uniqueto a health problem, treatment, or test, which if notknown can lead to incorrect interpretation of a clinicalsituation and an incorrect nursing action.Practice Alertsarecriticalguidelinessuchaslegalrequirements or standards, which relate to the practiceof nursing in general.In addition to the alerts, complications and client teach-ing are highlighted areas because each is a separate sectionon the NCLEX-RN test plan. A complications heading fol-lows the Rx heading in the presentation of health problems,surgery, treatments, and diagnostic tests whenever there aresignificant complications that should be known. In addition,there is a table summarizing complications related to majordisorders. A section on client teaching, which lists specificinformation that needs to be taught to the client, is part ofthe presentation of virtually every health problem and majordiagnostic or treatment modality.Think Smart—Test Smartboxes found throughout thebook are designed to make you stop and think about the dif-ferences between similar or frequently confused words orconcepts,thedifferentwaystheinformationcouldbeworded, how questions could be asked in different ways totest the same content, or to identify a memory trick relatedto content to be learned.Also unique to this book are worksheets at the end ofeach chapter. These worksheets allow you to actively engagewith the content; help to further “cement” content intomemory; and provide a check of your understanding of basicfacts and concepts. This is important because NCLEX-RN isprimarily a test of application of knowledge and one cannotapply what one does not know.Copyright © 2008by The McGraw-Hill Companies, Inc. Click here for terms of use.
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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Page 17 preview imagexivPREFACEOf course, the book also contains hundreds of practicequestions. Practice questions are given at the end of eachchapter as well as in the last chapter of the book, which con-sists of 198 pages of questions. Questions are in NCLEX-RNformat and consist of both traditional multiple choice as wellas the newer alternative style items. For all questions, thecorrect answer is explained; for multiple-choice questions,reasons why options are incorrect are also given. In manycases, these explanations are “mini lectures,” which serve tosynthesize and or highlight an area of information. Thus thecontent review chapters and the final question chapter worktogether to present key concepts for review.I believe that this book will help you be successful onthe NCLEX-RN. It is based on more than 25 years of teach-ing nursing students and giving NCLEX-RN review classes. Iwish you success on the examination and hope that you findnursing a fulfilling and rewarding profession.Sincerely,Fran Monahan, PhD, RN, ANEF
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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Page 18 preview imagePart ITESTINGSMARTCopyright © 2008by The McGraw-Hill Companies, Inc. Click here for terms of use.
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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Page 20 preview image3CHAPTER 1Preparing forNCLEX-RN®PART 1: THE TESTPurpose of NCLEX-RN®The purpose of this examination is to protect the safety ofthepublic.Theexaminationisdesignedtodeterminewhether candidates for licensure as registered nurses havethe minimum level of knowledge needed to practice compe-tently, knowledgeably, and safely at an entry level.In preparing for the examination, key words from thestated purpose of the examination that you should thinkabout are minimum level, safely, and entry level. Thesewords can help focus your preparation and ease yourmind. What they tell you is that the examination questionswill test general principles and commonly encounteredpatient care situations. The focus will not be on testingobscure pieces of knowledge applicable only rarely inpractice. Neither will the test focus on situations thatdemand a complexity of judgment, which can be expectedonly with time and experience. What can be expected tobe stressed are nursing assessments and actions that pro-tect patients from harm. This means that in preparing, youmust give special attention to facts and procedures thatpromote physical safety, emotional safety, and protectionfrom, or early identification of, disease complications oriatrogenic problems.Development of the NCLEX-RN®Knowing the basic process by which the examination isdeveloped will further help direct your preparation. Itwill reinforce the fact that the questions focus on criticalinformation regularly used by new graduates in dailypractice.NCLEX-RN®hasbeendevelopedbytheNationalCouncil of State Boards of Nursing (NCSBN) and is updatedon the basis of a work-study analysis of what new graduatesdo in the workplace. All aspects of nursing practice areobserved and then classified into categories and subcate-gories. These categories and subcategories then form thebasis of the test plan, which specifies the content to be cov-ered and the number of questions to be asked related to eacharea. Job analyses are done periodically and the test plan ischanged, if required, according to the results. This ensuresthat the test remains accurate and consistent with currentpractice. Content of the examination is matched to the scopeof practice.In selecting the content to be tested, there are two majorconsiderations: the frequency with which the information isneeded in day-to-day practice and the criticality of the infor-mation to the patient.The test questions are written by nurses who practice ina setting where they work with new graduates. The ques-tions are carefully edited for any type of bias. They are alsoreviewed for clarity and correctness of the key by other prac-titioners. This ensures that the questions and answers repre-sent accepted principles of safe practice and not a regionalpractice or opinion.The Test Plan ContentThe content is organized around four categories of humanneeds, which have been identified by the NCSBN. The fourcategories and their related subcategories are as follows:• Safe, effective care environment—Management of care—Safety and infection control• Health promotion and maintenance—Growth and development through the lifespan—Prevention and early detection of disease• Psychosocial integrity—Coping and adaptation—Psychosocial adaptation• Physiological integrity—Basic care and comfort—Pharmacological and parenteral therapies—Reduction of risk potential—Physiological adaptationEach of these subcategories constitutes 5–13% of thetest except for Reduction of Risk Potential and PhysiologicalAdaptation each of which accounts for 12–18% of the totalquestions.Copyright © 2008by The McGraw-Hill Companies, Inc. Click here for terms of use.
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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Page 21 preview image4PART I: Testing SmartIntegrated throughout each of the client needs cate-gories are the steps of the nursing process, caring, commu-nication and documentation, and teaching and learning.NCLEX-RN®StyleIn preparing for any examination, it is always helpful tohave some idea of what to expect in terms of style. Thishelps prevent surprises, which can be distracting and cancreate anxiety. Knowing about the examination style inadvance, helps free your mind to focus on the content of thequestions. Some key points about the style of the NCLEX-RN®are that it• uses the term “client,” not “patient,” to refer to the recipi-ent of care.• is an integrated examination, that is, it covers clients of allages, backgrounds, and levels of health or illness.• is gender neutral.• is reviewed to remove any culturally biased terms.• has primarily a multiple-choice format: stem and fouroptions only one of which is the answer to the question.• includes some other types of questions, for example,—those that require the test taker to fill in the blanks withnumerals or words rather than selecting an answer froma list of four options.Example:What is the normal heart rate in a newborn?_____beats per minute.—those that contain pictures/diagrams and ask the testtaker to identify a particular site by touching the correctarea on the diagram.Example:Where would the nurse auscultate for the apical pulse?The test taker has to touch an area on a diagram of thechest. If the test taker touches the correct area or “hotspot,” the answer is correct.—those that present a list of assessment findings or nurs-ing actions, etc., and ask the test taker to identify allthose that are appropriate for a particular type ofpatient.Example:Which of the following are risk factors for cancer of thebreast?Mark all that apply.■Family history■Nulliparity■Age over 50 years■Late menopause■Breast-feeding■Cigarette smoking■Provides a drop-down calculator as needed.Administration of the NCLEX-RN®To be admitted to the NCLEX-RN®, you need• an Authorization to Text letter (This is sent to you uponreceipt of application and fees and verification of eligibility.)• two forms of ID—one of which must be a photograph IDand both of which must be signedNCLEX-RN®is administered by computer. Taking thetest on the computer is not complicated; it only requires useof the SPACE bar, the ENTER key, and for fill-in-the-blankanswers, the keyboard. For multiple-choice and other similarquestions, the cursor is moved to highlight the optionselected as the answer by pressing the SPACE bar. When theoption(s)selectedishighlighted,theENTERbuttonispressed. Then there is an opportunity to check your answerselection. If the option(s) highlighted is not the answer youwant to give, you may change to another. If the answer youwish to give is highlighted, you press the ENTER key a sec-ond time to register your answer. Some very important pointsfor you to remember about taking the examination are that• after the ENTER key is pressed a second time to registeryour answer, there is no returning to the question orchanging the answer.• every question must be answered; you cannot skip aquestion.• there is no penalty for guessing.Number of Questions on the NCLEX-RN®As a test taker, you of course, would like to know as part ofyour mental preparation and planning for the examination,how many questions you will be asked. For the NCLEX-RN®,there is no precise answer to this question because it is a com-puter adaptive test (CAT). This means that the computerselects the next question based on whether your answer tothe previous question was right or wrong. If the previousanswer was correct, the computer will select a slightly moredifficult question for the next one; if the answer was incor-rect, the computer will present a slightly easier question.Thus, each person takes a unique test. The maximum num-ber of questions a candidate can have is 265. However, thecomputer is programmed to make a decision of competent orincompetent based on the level of difficulty of questionsanswered correctly or incorrectly so relatively few candidatesreceive 265 questions. The minimum number of questions acandidate can receive is 75. Of these 75, 15 pretest items, i.e.,items that are being tested for future use, are interspersed.These pretest items do not influence your passing or failing.Examination TimeIn preparing for an examination, it is also important to knowhow much time you will be allowed to complete it. The totaltime allowed for the NCLEX-RN®is 6 hours. If at the end of6 hours, you have not answered enough questions for the
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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Page 22 preview imageCHAPTER 1Preparing for NCLEX-RN®5computer to determine whether you are competent, you failby default. Based on the maximum of 265 questions and themaximum time of 6 hours (360 minutes), there is slightlymore than one and a third minutes allowed per question.However, since few candidates receive the maximum allow-able number of questions, the time available is generallymore. Nonetheless, time is not unlimited so you should notspend excessive time on any one question.Report of Pass—FailForty-eight hours after you take the test, the Board of Nurs-ing in the state where you are applying for licensure gets thepass/fail result. The Board then checks that all other require-ments for licensure are met, and then sends out your results.Results are only reported in writing and never by telephone.If you have failed the examination, it may be taken againin 3 months. How many times the test may be repeateddepends on the State Board of Nursing.NCLEX MythsThe NCLEX-RN®is one of the most important examinationsthat nurses ever take. To reach the point of taking the exami-nation, much time, energy, and money have been invested andmany sacrifices have been made. Because of these facts, youwill hear many stories about the examination and receivemuch advice. This type of impromptu shared informationoften contributes to “myths” about the NCLEX-RN®, whichserve as sources of undue anxiety. Some of the more commonmyths, and the corrections to them, are presented below.The number of questions one receives indicates pass or fail.—Thisis not true. Candidates can answer the minimum number ofquestions, all of which are difficult, correctly and pass. Othercandidates can answer the minimum number of questions, allof which are easy, and fail. It is not the number of items but thedifficulty of the items that determines pass or fail.Extra long tests are given randomly to selected test takers.—Thisis not true. The number of questions is determined by thedifficulty of questions you answer correctly or incorrectly.One needs to memorize everything.—This is not true. Thetest is looking at determining safe, entry-level practicebased on the job analysis of what new graduates actuallydo in the work place. It is also testing generally acceptedstandards/methods of care. It is not testing rare, regionallyvariable information.How good you are with the computer determines how well youdo on the examination.—The Educational Testing Servicehas done research on the question as to whether computerskill influences examination performance. The resultsshow that the test-taker’s computer skill does not influ-ence the score on the examination.For more information about NCLEX, see the NCLEXCandidate Bulletin which can be accessed at the NCSBNWeb site www.ncsbn.org.PART 2: STUDYING FOR THE TESTStudy smart and study well!Remember, this is your future. Itrepresents short-term sacrifice for a long-term gain.Identify Areas for Intensive ReviewEvaluate your own strengths and weaknesses. Often, it is atemptation to spend most of your study time reviewingmaterial you already know quite well. This is because whatyou know best is most often material that you like, find easy,and are interested in (that is why you learned it well in thebeginning). It is comfortable material and makes you feelgood about taking the examination.Avoid this pitfall. Spendmost of the time on what you do not know so well.Begin identifying what you do not know so well by think-ing about what areas you did least well on in nursing school orhad the least experience with—write them down. These maybe broad areas of practice, for example, pediatrics or mentalhealth/psychiatric nursing or specific topics such as acid—basebalance, burns, or problems of the nervous system. If you arenot a recent graduate, also identify those things that you didwell in nursing school but have not had any recent experiencewith; these areas will need review but not as much time as thoseareas you did not know really well in the beginning. Be carefulabout assuming that since you have a lot of experience in apractice area you do not need to review. Remember NCLEX isa theory/textbook-oriented examination. The questions andanswers are based on what “should be” in practice, not on theshortcuts and improvisations that “are.” Whether you are a newor a not-so-new graduate, review the list of topics in theNCLEX-RN®test plan found in this book and judge your levelof comfort with each, referring of course to the list you made asthe first part of this exercise. Mark with two checks those top-ics you feel you really do not know; make one check by thosethat you probably do not know really well. This will serve as aguide to make sure you review the areas most important to you.Select Backup Review MaterialsThis book, like all review books, is written in an abbreviatedformat that assumes basic understanding and focuses on keypoints. If you never mastered an area well or you encountercontent in this book that you do not understand the basis of,it is important to go to a basic classroom text for clarificationand additional discussion.NCLEX-RN®utilizes selected texts as references. Lists oftext books are sent to schools of nursing with directions toindicate those which are used in the curriculum and to addany that are used but do not appear on the list. Referencetexts are selected based on the extent of use in schools ofnursing. Questions are designed to address basic principlesof practice about which all texts agree, not to test aboutuncommon pieces of information, which are debatable. Thecurrent list can be accessed at the NCSBN Web site.
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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Page 23 preview image6PART I: Testing SmartDevelop a Realistic Schedule for ReviewDividing up material into achievable goals is smart. Eachtime you meet a goal, you feel more positive about yourselfand your ability to deal with the material and the examina-tion. This reduces stress and hence supports your ability tobe successful. There are different ways to develop a realisticschedule. One way is to determine the number of days untilyou are scheduled to take the NCLEX-RN®. Also, determinehow many hours on how many of these days can you realis-tically study. Be sure to allow for down time. After all, no onecan study without a break and everyone must eat, sleep,bathe, etc. Tally total available study times/hours. Nowassign study times/hours to the topics for review. Workingfrom the test plan topics that you have marked according tohow well you feel you know them, assign hours first to thetopics needing in-depth review. These are the most impor-tant topics to review because you have already acknowl-edged that you do not feel you know them. Next, assignstudy times to those topics, which you decided you probablydo not know well, and then to those needing a less-detailedreview. Finally, place the topics in the order you will studythem. Alternate hard and easy topics and topics you likewith those you do not like—this will help keep you fromshortening your scheduled study time.To have enough time to study well you may need tomake some temporary changes in your lifestyle. You mayneed to take time off from work, negotiate sharing of house-hold tasks with others in the house, delay some projects oractivities, and limit your social life. Only you can determinewhat is the best approach to ensure the time you needfor study but as you consider your options remember—cramming is not one of them. It will not work. There is waytoo much material.Select a Study Place That Works for YouYour study place should be quiet and convenient. A placeyou will be undisturbed but with space for your study mate-rials. It should have good light to facilitate reading withoutdeveloping eyestrain and/or a headache, a comfortable seat,and an ambient temperature that is not so warm that itmakes you sleepy and not so cold that it distracts you fromstudying. Lying in bed or on a couch to study is not a goodidea as it is at best relaxing, and at worst, sleep-inducing. Acertain level of awake alertness is necessary for successfulstudying.Select a Study Time That Works for YouDifferent people are most alert at different times of the day.Some people are “morning people” and concentrate best onfirst getting up; others are night people and concentrate bestin the evening. Some people have periods of best function attwo different times of the day. Analyze yourself to determinewhen your most productive intellectual periods are and thenplan to study the most challenging material during thesetimes. Plan to review material that needs less intense study atother times. If you have family responsibilities around whichyou must organize study time, involve family members inplanning how to make your best study times available forworking on your NCLEX-RN®review.Make Use of All Available Time for StudyYou can learn a great deal, relatively painlessly, by makinggood use of small amounts of available time throughout theday. You may have done this during nursing school. If so,recall some of your strategies. If not, begin to develop time-effective study techniques now.Examples of how you can capitalize on bits of unusedtime:• Review a brief set of laboratory values, the principles of anursing procedure, or assessment parameters for a specificdisease in the 5 minutes before you take a shower, thenuse the time in the shower to repeat them to yourself.• Write information to be learned on an index card(s) andstudy when standing in line at the grocery store or whenwaiting to pick children up at the school bus, etc.Prepare Yourself for StudyingCollect your notes, books, pens, highlighters, etc.Eliminate potential distractions: Shut off the cell phone; getout of range of the land phone; shut off the TV, CD player,and radio.Go to the bathroom.Refresh yourself: Wash your face and hands. Brush yourteeth.Get something to drink.Do whatever you need to do so that you will not feel uncom-fortable or have to interrupt your studying.Study EffectivelyWhen you study, engage yourself with the content; mechan-ical reading of notes is useless. Research shows that themore actively you engage with the content, the better youlearn. So take notes, underline or highlight, repeat contentout loud; walk back and forth while you memorize; try tothink what questions could be asked about the subjectbeing reviewed.Useasequenceofstudy—rest/reward—review.Forexample, study for 50 minutes. Take a 10-minute break.Reward yourself. Have a cup of tea or take a shower. Do not getinvolved in a mentally demanding activity that will cause youto lose your focus on the examination material. Take 10 min-utes to review the material you just studied. As you review,mark any areas for which you think, “I don’t really know that”or “I had forgotten about that.” Go back and review the markedareas at the beginning of your next day’s study.
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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Page 24 preview imageCHAPTER 1Preparing for NCLEX-RN®7To keep up your motivation, you can also do things likeputting signs on your wall that say “You can do it.” or “Thiswill be over in__days.” You can plan to go out to eat or buya new dress if you meet your goal. Again, think about whatmotivational tricks work for you and use them.Know When to StopWhen scheduling study, it is also important to recognizewhen you have studied to your capacity. Your time is valu-able and you do not want to waste it by trying to studywhen you are beyond your ability to concentrate. It is betterto take a break or accomplish something else that needs toget done and then return to studying with refreshed con-centration. You will learn more in the end. So, again analyzeyourself. You did a lot of studying in nursing school. Whatis the length of time you can usually concentrate? What arethe telltale signs of when you are no longer learning effec-tively? Take these factors into consideration as you schedulestudy.WORKSHEETQUESTIONSDo you have key facts from this chapter on your NCLEX-RN®knowledge ring? Complete the worksheet below to helpyou check.1. Why is passing the NCLEX-RN®a requirement for being licensed as a registered nurse?2. At what level of practice is the NCLEX-RN®designed to measure competence?3. What are the two major considerations in the selection of content to be tested on the NCLEX-RN®?4. Who are the writers of NCLEX-RN®test questions?5. What is the predominant type of question found on the NCLEX-RN®?6. How many questions does one have to get right in order to pass the NCLEX-RN®?7. What is the maximum length of time that one can take to complete the NCLEX-RN®?8. Do you need to be proficient in use of a computer in order to do well on NCLEX-RN®?9. Can you skip a question on NCLEX-RN®and go back to it if you are not sure of the answer?10. Does having the test stop when only 75 questions have been answered mean that you have failed?
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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Page 25 preview image8PART I: Testing SmartANSWERS & RATIONALESWORKSHEET ANSWERS1. Why is passing the NCLEX-RN®a requirement for being licensed as a registered nurse?AnswerTo protect the safety of the public by limiting the practice of Registered Nursing to those individuals who have passedan examination, which documents ability to practice competently, knowledgeably, and safely.2. At what level of practice is the NCLEX-RN®designed to measure competence?AnswerEntry-level Registered Nurse Practice.3. What are the two major considerations in the selection of content to be tested on the NCLEX-RN®?AnswerFrequency with which the information is needed in day-to-day practice and the criticality of the information to thepatient.4. Who are the writers of NCLEX-RN®test questions?AnswerRegistered nurses who work with new graduates in their practice.5. What is the predominant type of question found on the NCLEX-RN®?AnswerMultiple-choice question.6. How many questions does one have to get right in order to pass the NCLEX-RN®?AnswerIt varies because NCLEX-RN®is a computer adaptive test and the decision on whether a test taker passes or fails isbased on the difficulty of the questions answered and not on the absolute number.7. What is the maximum length of time that one can take to complete the NCLEX-RN®?Answer6 hours.8. Do you need to be proficient in use of a computer in order to do well on NCLEX-RN®?AnswerNo, studies have shown that computer proficiency has no effect on passing or failing.9. Can you skip a question on NCLEX-RN®and go back to it if you are not sure of the answer?AnswerNo, a question cannot be skipped and once a question has been answered and the ENTER key has been hit the sec-ond time to register the answer, one cannot go back to the question.10. Does having the test stop when only 75 questions have been answered mean that you have failed?AnswerWhen the test stops after the minimum of 75 questions have been answered can mean one either passed or failed. Thepass/fail decision is based on the difficulty of the questions answered correctly or incorrectly, not on the number.
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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Page 26 preview imageCHAPTER 2Test and LanguageBasics9To answer an examination question correctly, knowing thesubject content is not enough. You have to clearly under-stand each part of the question in the context of nursingand correctly interpret the meaning of the question itself.Because nursing is a practice profession and the NCLEX-RN is measuring basic practice competencies, questionstypically contain a clinical scenario followed by the ques-tion stem. In the case of multiple-choice questions, optionsfollow.When taking an examination, it is important for you torecognize each of these question parts, so read the followingdefinitions and look at the example carefully.•Clinical scenario: This part of the question tells you aboutthe clinical situation.•Stem: This part of the question contains the actual prob-lem/question to be answered.•Options: These are the answer choices provided. Optionsare also called alternatives and in the case of traditionalmultiple-choice questions, consist of one correct answer(the key) and three distracters or incorrect answers.It is important that you read and understand each of theseparts correctly for a lot of reasons.• Facts provided in the scenario are often critical to select-ing the best answer to the question. If these facts are notcorrectly understood, it is difficult to select the bestanswer.• If the question being asked is not correctly understood,distracters, which sometimes answer a different questionthan the one asked in the stem or assume information notprovided in the stem or in the scenario, are more likely tobe perceived as the correct answer.• Mostquestionsalsocontainkeywords.Thesearewords that direct the answer; hence, attention to themalong with clear understanding of their meaning isessential.KEY WORDSBecause key words are so important in determining the cor-rect answer to a question, a list of frequently used key wordsis presented below for your review. Note that some of thewords are negative.FirstPriorityNextBestMostLeastAppropriateInappropriateLastSuitableNotEarlyLateImmediatelyInitialOnlyAfterEveryExpectedContraindicatedPartialUnexpectedIndependentlyCommonUncommonThe following question illustrates the use and impor-tance of a key word:When giving medications to a client, what should thenurse do first?1. Position the client2. Check the client’s identity3. Explain what he/she is going to do4. Ask how the client is feelingIn this example, all options are correct nursing actionswhen giving medications but which one is the correctCopyright © 2008by The McGraw-Hill Companies, Inc. Click here for terms of use.
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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Page 27 preview image10PART I: Testing SmartDirections: Read each of the following questions. If thequestion contains a key word, underline it.1. Which clinical manifestation would the nurse expectwhen assessing a client admitted with a diagnosis ofbacterial pneumonia?2. Which sign should alert the nurse to a potentialproblem in a client with a history of a CVA?3. What is the primary goal for the hospice care of aclient with lung cancer?4. Which nursing intervention should be given priority inthe plan of care for a teenager with sickle cell anemia?5. The nurse is assessing the nutritional status of aclient who is 3 months pregnant. Which informationis most important for the nurse to obtain?6. The nurse is obtaining a health history of a debili-tated client with sacral pressure ulcers. Which ques-tion should the nurse ask to elicit information effec-tively about the client’s dietary intake?7. Which behavior by a client with a newly createdcolostomy should alert the nurse to the need forteaching regarding skin care?8. What is the best way to assess for shortness ofbreath in a 3-year-old client with congenital heartdisease?9. The nurse is assessing a family’s ability to provideemotional support to a family member diagnosedwith cancer. Which observation is most essential?10. In analyzing a teenage primipara’s need for teaching,the clinic nurse should ask which question?11. Which finding should the nurse expect when check-ing urinary output of a client with SIADH?12. Which information would be most helpful whenpreparing to do a home assessment prior to dischargeof a low birth weight newborn?13. Why is it important to monitor pulse rate in a clienton digoxin?14. A 25-year-old woman comes to the clinic com-plainingoflowerleftabdominalpain.Whichadditional information should the nurse obtaininitially?15. Which assessment question should receive priority?FREQUENTLYMISUNDERSTOOD/MISREADENGLISH WORDSAlmost everyone has one or more words that he/she somehowlearned incorrectly and as a result misunderstands its precisemeaning. These can be very common, simple words and oftenthe person is unaware of the error. This can be a particularproblem when English is a person’s second language, or is notthe language of the household. Words that are similar inspelling and in pronunciation are particularly at risk of beingmisread, misused, or misunderstood. Because errors of thistype can cause an NCLEX-RN question to be answered incor-rectly, a list of potentially misleading, common English wordsfollows. Each word is followed by its definition and a sentenceillustrating its use in nursing practice. You should read eachone carefully and ask yourself if you were clear about the useof the word and its meaning. If your answer is Yes—great! Ifthe answer is No, mark the word to be reviewed again.Accept—to agree or receive.Examples:The client accepted the diagnosis of breast cancer withsurprising calm.The client accepted the nurse’s recommendation that allhis drugs be ordered at the same pharmacy.Except—indicates something is to be omitted or left out.Example: All the assessment findings except the rash areconsistent with a lower respiratory infection.Advice—suggestion, guidance, or counsel.Example: The client asked the nurse for advice on thebest way to apply the ileostomy bag.Advise—to give a suggestion, guidance, or counsel.Example: The nurse advised the new mother to nap inthe afternoon when the baby is sleeping.Assent—to agree to.Example: The nurse assented to a change in unit assign-ment for the day.Ascent—to rise or to climb.Example: The ascent of carbon monoxide levels in anenclosed area when a car is left running is rapid and canresult in fatality.Breath—air pulled into the lungs in one inhalation.answer is determined by the qualifying word “first.” The firstaction is to check the client’s identity.Practiceidentifyingkeywordsbycompletingthefollowing exercise:WORKSHEET 1: IDENTIFICATION OF KEY WORDS
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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Page 28 preview imageCHAPTER 2Test and Language Basics11Example: Take a deep breath and hold it while I listenwith the stethoscope over your lungs.Breathe—the act of inhaling and exhaling air from the lungs.Example: Breathe in slowly and deeply through yourmouth.Caster—wheel on a swivel.Example: Many pieces of hospital equipment such as IVpumps and over-the-bed tables are on casters for ease oftransport.Castor—oil from castor beans, used as a laxative.Example: A single dose of castor oil was ordered as partof the prep for the client’s upcoming bowel surgery.Charted (Not chartered)—entered in the client record.Example: The nurse charted the appearance of thewound in the client’s record.Sight (Not site or cite)—vision.Example: Eyesight typically declines with age.Site (not cite)—location.Example: The planned donor site for the skin graft wasthe left, upper, outer thigh.Coarse (not course)—rough, uneven.Example: The skin of clients with hypofunction of thethyroid is often coarse in texture.Course—progression, order, direction.Example: The course of the disease is characterized byexacerbations and remissions.Compliment—praise.Example: The supervisor complimented the nurse onher efficient handling of the multiple emergency admis-sions, which occurred during her shift.Complement—add to or mix well.Example: Participation in a support group can comple-ment individual counseling.Complaint—expression of something wrong.Example: The client’s chief complaint was a sharp painin the left chest.Compliant—willing to follow requirements or directions.Example: The client verbalized a desire to be compliantwith the medication regimen but stated he could not bebecause he could not afford to buy the medicationsordered.Continuous—going on without stopping.Example: The client was receiving continuous feedingsvia a nasogastric tube.Continually—happening at regular intervals or again andagain.Example: The client continually complained of nauseawhile receiving the antibiotic.Defective—faulty or abnormal.Example: The neonate was diagnosed with a defectivemitral valve.Deficient—lack of.Example: Genetic syndromes characterized by deficientchromosomal material are more often fatal than thosecharacterized by excess chromosomal material.Dessert (not desert)—sweet foods served at the end of ameal.Example: The nurse advised the client to eliminatedesserts as a step in controlling weight.Uninterested (not disinterested)—not caring.Example: The client appeared markedly uninterested inlearning about the prescribed diet.Elicit—draw out information.Example: The nurse’s questions while obtaining theclient history are designed to elicit complete, accurateinformation on which to base a nursing diagnosis.Illicit—illegal.Example: When obtaining a history, questions shouldbe asked about the use of prescription drugs, over-the-counter drugs, herbal preparations, nutritional supple-ments, and illicit drugs.Imminent (not Eminent)—about to happen.Example: An aura, unique to the individual, is often thesign of an imminent seizure.Farther—greater distance.Example: The client should be ambulating farther thanthe bathroom.Further—more.Example: Before discharging the client, the physiciandecided further discussion with the family concerningplans for home care was necessary.Former—the first of two. (Latter refers to the second oftwo.)Example: Nausea and vomiting are common side effectsto some medications.The former is a symptom becauseit cannot be seen, felt, or heard by an external observer;the latter is a sign because it can be observed.Healthy—not ill, well.Example: The child appeared healthy.Healthful—promoting wellness.Example: Adequate daily intake of calcium is healthful.Lose—misplace, be deprived of.Example:Clientslosecentralvisionwithmaculardegeneration; they lose peripheral vision with glau-coma.
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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Page 29 preview image12PART I: Testing SmartLoose—opposite of tight.Example: Loose bowel movements can be a problem forclients following an intestinal resection.Nauseous—inducing a feeling of nausea.Example: The nauseous smell of the drainage made thedressing difficult to change.Nauseated—experiencing nausea.Example: The client became nauseated 2 hours after thechemotherapy was administered.Past—time gone by, ago.Example: The time is past that medications could havehelped; now surgery is the only option.Passed—moved along, went away, departed, succeeded ona test.Examples:The suppository passed the rectal sphincter without dif-ficulty.The client passed a renal calculus last evening.Patient—recipient of care.Example: The patient thanked the nurse for making hercomfortable.Patience—tolerance or understanding.Example: Patience is often needed when dealing withsick children.Peace—calmness, tranquility.Example: Helping the client achieve peace of mind is agoal of the hospice nurse.Piece—part or section.Example: The piece of the Foley catheter that inflates tohold the catheter in the urinary bladder is called theballoon.Personal—private.Example: Use of personal information about clients isgoverned by the HIPAA regulations.Personnel—employees.Example: Nurses are licensed health care personnel.Prescribe—order for.Example:Thenursepractitionerprescribedtheantibiotic Cipro for the client with a urinary tractinfection.Proscribe—prohibit.Example: Leaving the unit with the narcotics key is pro-scribed.Principal—of major importance.Example: A principal use of digitalis is to strengthenthe contraction of the myocardium in cases of heartfailure.Principle—a truth.Example: The principle underlying use of a fan for cool-ing is that one of the ways heat is lost from the body isby convection.Proceed—go on, continue.Example:Thenurseproceededwiththedressingchange after the client had stopped coughing.Precede—go before.Example: Mild signs of an upper respiratory infectionpreceded the development of the rash.Quite—a great deal.Example: The client was quite verbal regarding hisopinion of his care.Quit—leave or stop.Example: The client stated he wished he could quitsmoking.Rise—get oneself up.Example: The client who had a CVA said to the nurse “Ilook forward to the day I can rise out of the bed in themorning without assistance.”Raise—lift or elevate an object or person.Example: During a breast examination, the client needsto raise her arms over her head so the contours of thebreast can be inspected.Stationary—not moving.Example: The brake on the wheelchair should be setwhen the client is being moved in or out of the chair inorder to keep the chair stationary and help prevent theclient from falling.Stationery—paper.Example: Official letters should be written on stationeryimprinted with the agency letterhead.Statute—legal restriction.Example: The statute of limitation for malpractice casesdiffers state to state.Stature—person’s size.Example: The client’s stature was consistent with a diag-nosis of hypopituitary dwarfism.Adequate—sufficient.Example: It is the nurse’s responsibility to determine ifthe client’s 24-hour fluid intake and output is adequate.Aggravate—make worse.Example: Straining at stool will aggravate hemor-rhoids.Allay—put at rest or cause to subside.Example: Providing the client with information about aprocedure to be done can allay anxiety.
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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Page 30 preview imageCHAPTER 2Test and Language Basics13Anticipate—take up or use ahead of time.Example: Prior to entering an isolation room, it is impor-tant that the nurse anticipate client needs so that she isprepared with knowledge and equipment to provide theneeded care.”Avoid—keep away from.Example:Immunosuppressedclientsneedtoavoidcrowds because of the risk of exposure to infection.Competitive—contest between rivals.Example: In competitive inhibition of enzyme activity,the inhibitor competes with the substrate for binding onthe enzyme.Compromised—to endanger.Example: Circulation to the lower extremities is com-promised when the client is in lithotomy position.Assume—take for granted.Example: The nurse should never assume the client hasunderstood instructions; validation of understanding byrepeating the instructions or by return demonstration isalways necessary.At least—the very minimum.Example: If the client refuses to lie in the prone posi-tion, at least have him lie on his side.”Confer—consult or to bestow.Example: The Client Care team conferred to determinethe best approach to manage the bladder retraining pro-gram of a newly admitted client.Deny—declare not to be true.Example: Clients sometimes deny use of illegal drugsbecause they fear the reaction of the health care provider.Determine—to come to a decision or to obtain first handknowledge.Example: To determine the causative organism of awound infection, a culture is done.Differentiate—discriminate or identify differences.Example: When examining the chest, it is important todifferentiate between crackles and wheezes.Exacerbate—worsen.Example: Exposure to cold and damp can exacerbatethe symptoms of a sinus infection.Enhance—augment.Example: Comfort measures such as clean linen, a backrub, and pleasant music can enhance the action of painmedications.Excessive—more than acceptable, exorbitant.Example: The bleeding was excessive following thesurgery.Expectorate—cough up and spit out mucus.Example: To prevent spread of infection, the nurseinstructed the client to expectorate into a tissue and dis-pose of it in the provided plastic bag.Flushed—any tinge of red.Example: The client’s face was flushed and he was warmto the touch.Flaccid—without resistance.Example: A flaccid muscle is one with less than normal tone.Tense—rigid, feeling nervous.Examples:A sign of increased intracranial pressure in a neonate isa tense fontanelle.The client complained of feeling extremely tense when-ever an interview with the psychiatrist was scheduled.Hoarseness—grating sounds.Example: Hoarseness is a characteristic symptom oflaryngitis.Impinge—come into close contact.Example: The CAT scan showed that the tumor wasimpingingontherecurrentlaryngealnervethusaccounting for the hoarseness.Inept—not apt, unable to do well.Example: The client remained inept at handling theinsulin syringe, so additional teaching was planned.Insulation—prevent transfer of electricity, heat, or sound.The insulation in the walls of hospital rooms helps clients torest by decreasing nose heard from other areas of the unit.Intact—without injury.Example: The client’s skin remained intact despite thelong period of bed rest.Isolation—loneliness, separation.Examples:Clients having intracavitary radiation treatments are atrisk for feelings of isolation.Clients presenting with active, drug resistant tuberculo-sis are placed in isolation.Lead to—results in.Example: An untreated streptococcal sore throat canlead to glomerulonephritis in susceptible children.Least likely—in the smallest degree, lowest chance.Example: The client least likely to develop constipa-tion is the one with a liberal fluid and roughage intake,who exercises regularly, and obeys the urge to defecate.Most likely—to the greatest degree, highest chance.Example: Of antibiotics, diuretics, or calcium channelblockers, the drugs most likely to cause allergic reactionsare the antibiotics.
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McGraw-Hill Review for the NCLEX-RN Examination (2008) - Page 31 preview image14PART I: Testing SmartWORKSHEET 2: VOCABULARYDirections:Match the definitions in column B with the words in column A.Column AColumn B1. ____Sitea.something to be left out2. ____Coarseb.progress3. ____Imminentc.without intending to4. ____Deficientd.rough5. ____Formere.create a tendency to6. ____Enhancef.saturate7. ____Impingeg.location8. ____Tenseh.a truth9. ____Predisposei.at any time10. ____Sedentaryj.unable to do well11. ____Exceptk.inactive12. ____Principall.shaky13. ____Loosem. opposite of tight14. ____Exacerbaten.eliminate15. ____Profuseo.pouring forthp.easy goingq.of major importancer.cause discomforts.rigidt.worsenu.about to happenv.first of twow.misplacex.augmenty.lack ofz.come into close contactLiberally—freely, unchecked.Example: The client should be encouraged to use theCalamine lotion liberally to control the itch of thepoison ivy.Predispose—create a tendency to.Example: Use of immunosuppressant drugs predisposesthe client to infection.Permit—let.Example: Elevating a Foley catheter drainage bag abovethe level of the client’s pelvis permits backflow of urineinto the bladder.Profuse—pouring forth.Example: Vaginal drainage was yellow, profuse, andmalodorous.Refrain—keep oneself from doing.Example: The client was instructed to refrain from lift-ing anything over 5 lbs following repair of his hernia.Sparingly—frugally.Example: It is important to apply the skin preparationsparingly in accordance with the directions.Spasm—involuntary contracture.Example: The client complained of repeated leg spasmsduring the night.Sedentary—physically inactive.Example: A sedentary lifestyle predisposes to obesity.Check your basic test vocabulary by completing the fol-lowing vocabulary exercise.
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