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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  Edited by Frances D. Monahan, PhD, RN, ANEF Professor Department of Nursing SUNY Rockland Community College Suffern, New York New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto

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    Copyright © 2008 by The McGraw-Hill Companies, Inc. All rights reserved. Manufactured in the United States of America. Except as permitted under the United 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 or retrieval system, without the prior written permission of the publisher. 0-07-159336-5 The 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 names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in this 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 more information, please contact George Hoare, Special Sales, at george_hoare@mcgraw-hill.com or (212) 904-4069. TERMS OF USE This 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 is subject 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 or any 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 CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, 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 be uninterrupted or error free. Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, 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 that result 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 shall apply 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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    We hope you enjoy this McGraw-Hill eBook! If you’d like more information about this book, its author, or related books and websites, please click here. Professional Want to learn more?

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    Dedicated 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 and happiness 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. DEDICATION Copyright © 200 8 by The McGraw-Hill Companies, Inc. Click here for terms of use.

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    v CONTENTS Contributors xi Preface xiii PART I: TESTING SMART . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Chapter 1: Preparing for NCLEX-RN ® 3 Chapter 2: Test and Language Basics 9 Chapter 3: Sharpening Your Test Taking Skills 19 PART II: CONTENT REVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Chapter 4: Test Plan Category: Safe, Effective Care Environment 27 Sub-category: Management of Care Topics: Legal Rights and Responsibilities Client Rights Information Technology Confidentiality/Information Security Informed Consent Advance Directives Ethical Practice Chapter 5: Test Plan Client Needs Category: Safe, Effective Care Environment 55 Sub-category: Safety and Infection Control Topics: Accident Prevention Disaster Planning Emergency Response Plan Error Prevention Handling Hazardous and Infectious Materials Home Safety Chapter 6.Test Plan Category: Health Promotion and Maintenance—Part 1 77 Sub-category: None Topics: Ant/Intra/Postpartum and Newborn Care Concepts of Management Delegation Establishing Priorities Supervision Continuity of Care Resource Management Collaboration with the Multidisciplinary Team Ergonomic Principles Injury Prevention Medical and Surgical Asepsis Reporting of Incident/ Event/Irregular Occurrence/ Variance Advocacy Referrals Case Management Consultation Performance Improvement/ Quality Improvement Staff Education Safe Use of Equipment Security Plan Standard/Transmission- Based/Other Precautions Use of Restraints/Safety Devices For more information about this title, click here

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    vi CONTENTS vi CONTENTS Chapter 7: Test Plan Category: Health Promotion and Maintenance—Part 2 131 Sub-category: None Topics: Growth and Development Aging Process Development Stages and Transitions Chapter 8: Test Plan Category: Health Promotion and Maintenance—Part 3 175 Sub-category: None Topics: Health and Wellness Health Screening Health Promotion Programs Chapter 9: Test Plan Category: Health Promotion and Maintenance—Part 4 207 Sub-category: None Topics: Techniques of Physical Assessment Chapter 10: Test Plan Category: Psychosocial Integrity—Part 1 237 Sub-category: None Topics: Mental Health Concepts Cultural Diversity Coping Mechanisms Religious and Spiritual Influences on Health Chapter 11: Test Plan Category: Psychosocial Integrity—Part 2 265 Sub-category: None Topics: Therapeutic Communication Therapeutic Environment Chapter 12: Test Plan Category: Psychosocial Integrity—Part 3 287 Sub-category: None Topics: Abuse/Neglect Chemical Dependency Chapter 13: Test Plan Category: Physiological Integrity 325 Sub-category: Basic Care and Comfort Topics: Complementary and Alternative Therapies Assistive Devices Elimination Mobility/Immobility Expected Body Image Changes Family Systems Behavioral Interventions Crisis Intervention Human Sexuality Family Planning Immunizations Lifestyle Choices High-Risk Behaviors Situational Role Changes Stress Management Support Systems Family Dynamics Unexpected Body-Image Changes Grief and Loss End of Life Principles of Teaching and Learning Sensory/Perceptual Alterations Psychopathology Non-Pharmacological Comfort Interventions Nutrition and Oral Hydration Palliative/Comfort Care Personal Hygiene Rest and Sleep

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    CONTENTS vii CONTENTS vii Chapter 14: Test Plan Category: Physiological Integrity 361 Sub-category: Pharmacological and Parenteral Therapies—Part 1 Topics: Dosage Calculation Medication Administration Pharmacological Agents/Actions Pharmacological Interactions Chapter 15: Test Plan Category: Physiological Integrity 439 Sub-category: Pharmacological and Parenteral Therapies—Part 2 Topics: Parenteral/Intravenous Therapy Chapter 16: Test Plan Category: Physiological Integrity 465 Sub-category: Reduction of Risk Potential—Part 1 Topics: Diagnostic Tests Laboratory Values Therapeutic Procedures Chapter 17: Test Plan Category: Physiological Integrity 517 Sub-category: Reduction of Risk Potential—Part 2 Topics: Vital Signs System Specific Assessments Chapter 18: Test Plan Category: Physiological Integrity 551 Sub-category: Reduction of Risk Potential—Part 3 Topics: Potential for Complications from Surgical Procedures and Chapter 19: Test Plan Category: Physiological Integrity 633 Sub-category: Physiological Adaptation—Part 1 Topics: Alterations in Body Systems Illness Management Chapter 20: Test Plan Category: Physiological Integrity 677 Sub-category: Physiological Adaptation—Part 1 Topics: Alterations in Body Systems Illness Management Chapter 21: Test Plan Category: Physiological Integrity 703 Sub-category: Physiological Adaptation—Part 1 Topics: Alterations in Body Systems Illness Management Central Venous Access Devices Blood and Blood Products Expected Effects/Outcomes Adverse Effects/Contraindications and Side Effects Pharmacological Pain Management Total Parenteral Nutrition Diagnostic Tests/Treatments/Procedures Monitoring Conscious Sedation Potential for Complications of Potential for Alteration in Body Systems Health Alterations Section 1: Cardiovascular Problems Section 2: Hematologic Problems Section 3: Respiratory Problems

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    viii CONTENTS Chapter 22: Test Plan Category: Physiological Integrity 735 Sub-category: Physiological Adaptation—Part 1 Topics: Alterations in Body Systems Illness Management Chapter 23: Test Plan Category: Physiological Integrity 781 Sub-category: Physiological Adaptation—Part 1 Topics: Alterations in Body Systems Chapter 24: Test Plan Category: Physiological Integrity 797 Sub-category: Physiological Adaptation—Part 1 Topics: Alterations in Body Systems Illness Management Chapter 25: Test Plan Category: Physiological Integrity 825 Sub-category: Physiological Adaptation—Part 1 Topics: Alterations in Body Systems Illness Management Chapter 26: Test Plan Category: Physiological Integrity 857 Sub-category: Physiological Adaptation—Part 1 Topics: Alterations in Body Systems Illness Management Chapter 27: Test Plan Category: Physiological Integrity 875 Sub-category: Physiological Adaptation—Part 1 Topics: Alterations in Body Systems Chapter 28: Test Plan Category: Physiological Integrity 905 Sub-category: Physiological Adaptation—Part 1 Topics: Alterations in Body Systems Chapter 29: Test Plan Category: Physiological Integrity 927 Sub-category: Physiological Adaptation—Part 1 Topics: Alterations in Body Systems Chapter 30: Test Plan Category: Physiological Integrity 945 Sub-category: Physiological Adaptation—Part 1 Topics: Alterations in Body Systems Illness Management Section 4: Neurologic Problems Illness Management Section 5: Eye and Ear Problems Section 6: Musculoskeletal Problems Section 7: Gastrointestinal Problems Section 8: Hepatic and Biliary Tract Problems Section 10: Urinary Problems Section 11: Skin Problems Illness Management Section 9: Endocrine Problems Illness Management Illness Management Section 12: Male and Female Reproductive System Problems

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    CONTENTS ix Chapter 31: Test Plan Category: Physiological Integrity 971 Sub-category: Physiological Adaptation—Part 2 Topics: Fluid and Electrolyte Imbalances Chapter 32: Test Plan Category: Physiological Integrity 1013 Sub-category: Physiological Adaptation—Part 2 Topics: Infectious Diseases Chapter 33: Test Plan Category: Physiological Integrity 1039 Sub-category: Physiological Adaptation—Part 3 Topics: Pathophysiology Hemodynamics PART III: TAKING THE TEST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1071 Chapter 34: Practice Test for NCLEX-RN 1073 Index 1267 Medical Emergencies Radiation Therapy Unexpected Response to Therapies

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    CONTRIBUTORS FEATURED EDITORS Charlotte E. Blackwell, RN, BSN, MSEd Pharmacology Instructor, Department of Nursing Wake Technical Community College Raleigh, North Carolina Judy E. White, RNC, MA, MSN Maternal-Child Health and Sample Test Question Faculty, Southern Union State Community College Opelika, Alabama CONTRIBUTORS Susan E. Abbe, PhD, RN Nursing Curriculum Specialist Connecticut Community-Technical Colleges Hartford, Connecticut Sharon A. Aronovitch, PhD, APRN, BC, CWOCN Faculty, School of Nursing Excelsior College Albany, New York Mary Sharon Boni, PhD, RN, CCRN Professor & Dean School of Nursing and Allied Health Administration Fairmont State University Fairmont, West Virginia Susan R. Bulecza, RN, MSN, CNS, APRN, BC Florida Department of Health Office of Public Health Preparedness Tallahassee, Florida Patricia D. Coyne, RNC, MSN, MPA Maternal-Newborn Instructor Cochran School of Nursing Yonkers, New York Adjunct Professor, Maternal-Newborn Nursing Rockland Community College Suffern, New York Paula M. Crawford, RN, MSN Assistant Professor Nursing Department Orange County Community College Middletown, New York Dale A. Lange Crispell, RN, BSN, MA Instructor, Department of Nursing SUNY Rockland Community College Suffern, New York Mary Rose Driggers, RN, MSN LPN-ADN Online Program Director and Nursing Instructor Health Technology Division Davidson Country Community College Lexington, North Carolina Miriam Freud, RN, MSN Director, Adult Day Care Center Friedwald Center for Rehabilitation & Nursing New City, New York Anne Hussey, BS, MSEd, RN (Retired) Education Specialist School Nurse Portsmouth Middle School Portsmouth, New Hampshire Laima M. Karosas, PhD, APRN Associate Professor of Nursing Quinnipiac University Hamden, Connecticut Dorothea Lever, RN, MS, CDE, CCRN Associate Professor and Coordinator Department of Nursing SUNY Rockland Community College Suffern, New York Lisa L. Lombard, MD Diplomat American Board of Anesthesiology Boston, Massachusetts Jana Henson Lyner, MSN, RN Faculty, Department of Nursing Pensacola Junior College Pensacola Florida M. Bridget Nettleton, PhD, RN, Dean, School of Nursing Excelsior College Albany, New York Tina Peer, MS, RN Assistant Professor of Nursing Associate Degree Nursing Program College of Southern Idaho Twin Falls, Idaho xi Copyright © 200 8 by The McGraw-Hill Companies, Inc. Click here for terms of use.

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    xii CONTRIBUTORS Patricia Sue Ragsdale, MSN, RN Assistant Professor of Nursing University of Arkansas at Little Rock Little Rock, Arkansas Joyce Grant Scott, MSN, BSN, ASN, CLNC, RN Associate Professor of Nursing University of Arkansas at Little Rock Little Rock, Arkansas Lovely Varghese, MSN, FNP, BC, CNOR Educator, Department of Nursing Education Columbia Presbyterian Medical Center New York, New York Susan M. Wicks, RNc, BS, MS Advanced Medical-Surgical Nursing Faculty Cochran School of Nursing St. John’s Riverside Health Care System Yonkers, New York NCLEX-RN Presenter Pace University Pleasantville, New York Denise D. Wilson, PhD, APN, FNP, ANP Associate Professor Mennonite College of Nursing Illinois State University Normal, Illinois Family Nurse Practitioner Medical Hills Internists & Pediatrics Bloomington, Illinois

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    xiii PREFACE Dear Soon-to-be Registered Nurse , The purpose of this book is to help you be successful on the NCLEX-RN® examination so that you can obtain your license as a registered nurse. You have worked long and hard to successfully complete your basic nursing program. Now the one thing between you and your license is the NCLEX- RN examination. This book is designed to guide your review study. There is a vast amount of nursing knowledge and it can be organ- ized and focused upon in different ways. This book is designed to review the content most likely to appear on the examination and approach it from the perspective of the examination. Thus, the book begins with a discussion of the test itself to direct your focus. Because time is a limited and valuable commodity for all of you as you begin life after nursing school, strategies for studying in the most effective, time-efficient manner also are discussed. A unique feature of this text is a preparatory chapter on language. Despite advanced study, you may often have a few words whose meanings were never clearly mastered. Encountering one of these words in a test question can result in a wrong answer. Hence, some of the words that are often used in nursing but are prone to being misunderstood are identified, defined, and their use illustrated in sentences reflective 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 are approaching the NCLEX-RN with the sharpest test-taking skills possible. The chapter even provides exercises to allow you to practice key skills. The next 30 chapters of the book present the review of nursing content. The title of each chapter consists of one of the major NCLEX-RN test plan categories followed by the subcategories and topics from the plan to be covered in that chapter. Precise headings found on the NCLEX-RN test plan have been used to help you think about the content in the same way that the test is organized and the questions are designed. There are separate sections in the text dealing with the child-bearing client and with gerontology just as there are in the test plan. Care of the pediatric client is incorpo- rated throughout the text. Icons in the margin are alerts that the information applies specifically to a pediatric client or a child-bearing client. To help you recognize and learn critical points of con- tent, the following alerts, which highlight key pieces of information, have been included in the chapters: Assessment Alerts are key considerations related to assessing a particular type of client. These are factors with potential for significant impact on the client’s health status if they not recognized and usually repre- sent variations from the norm. Nursing Intervention Alerts are dos and don’ts of practice that have significant import for the client’s well being and that apply to a specific client problem not to all clients. Clinical Alerts are specific items of information unique to a health problem, treatment, or test, which if not known can lead to incorrect interpretation of a clinical situation and an incorrect nursing action. Practice Alerts are critical guidelines such as legal requirements or standards, which relate to the practice of nursing in general. In addition to the alerts, complications and client teach- ing are highlighted areas because each is a separate section on 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 are significant complications that should be known. In addition, there is a table summarizing complications related to major disorders. A section on client teaching, which lists specific information that needs to be taught to the client, is part of the presentation of virtually every health problem and major diagnostic or treatment modality. Think Smart—Test Smart boxes found throughout the book are designed to make you stop and think about the dif- ferences between similar or frequently confused words or concepts, the different ways the information could be worded, how questions could be asked in different ways to test the same content, or to identify a memory trick related to content to be learned. Also unique to this book are worksheets at the end of each chapter. These worksheets allow you to actively engage with the content; help to further “cement” content into memory; and provide a check of your understanding of basic facts and concepts. This is important because NCLEX-RN is primarily a test of application of knowledge and one cannot apply what one does not know. Copyright © 200 8 by The McGraw-Hill Companies, Inc. Click here for terms of use.

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    xiv PREFACE Of course, the book also contains hundreds of practice questions. Practice questions are given at the end of each chapter as well as in the last chapter of the book, which con- sists of 198 pages of questions. Questions are in NCLEX-RN format and consist of both traditional multiple choice as well as the newer alternative style items. For all questions, the correct answer is explained; for multiple-choice questions, reasons why options are incorrect are also given. In many cases, these explanations are “mini lectures,” which serve to synthesize and or highlight an area of information. Thus the content review chapters and the final question chapter work together to present key concepts for review. I believe that this book will help you be successful on the NCLEX-RN. It is based on more than 25 years of teach- ing nursing students and giving NCLEX-RN review classes. I wish you success on the examination and hope that you find nursing a fulfilling and rewarding profession. Sincerely, Fran Monahan, PhD, RN, ANEF

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    Part I TESTING SMART Copyright © 200 8 by The McGraw-Hill Companies, Inc. Click here for terms of use.

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    3 CHAPTER 1 Preparing for NCLEX-RN ® PART 1: THE TEST Purpose of NCLEX-RN ® The purpose of this examination is to protect the safety of the public. The examination is designed to determine whether candidates for licensure as registered nurses have the minimum level of knowledge needed to practice compe- tently, knowledgeably, and safely at an entry level. In preparing for the examination, key words from the stated purpose of the examination that you should think about are minimum level, safely, and entry level. These words can help focus your preparation and ease your mind. What they tell you is that the examination questions will test general principles and commonly encountered patient care situations. The focus will not be on testing obscure pieces of knowledge applicable only rarely in practice. Neither will the test focus on situations that demand a complexity of judgment, which can be expected only with time and experience. What can be expected to be stressed are nursing assessments and actions that pro- tect patients from harm. This means that in preparing, you must give special attention to facts and procedures that promote physical safety, emotional safety, and protection from, or early identification of, disease complications or iatrogenic problems. Development of the NCLEX-RN ® Knowing the basic process by which the examination is developed will further help direct your preparation. It will reinforce the fact that the questions focus on critical information regularly used by new graduates in daily practice. NCLEX-RN ® has been developed by the National Council of State Boards of Nursing (NCSBN) and is updated on the basis of a work-study analysis of what new graduates do in the workplace. All aspects of nursing practice are observed and then classified into categories and subcate- gories. These categories and subcategories then form the basis of the test plan, which specifies the content to be cov- ered and the number of questions to be asked related to each area. Job analyses are done periodically and the test plan is changed, if required, according to the results. This ensures that the test remains accurate and consistent with current practice. Content of the examination is matched to the scope of practice. In selecting the content to be tested, there are two major considerations: the frequency with which the information is needed in day-to-day practice and the criticality of the infor- mation to the patient. The test questions are written by nurses who practice in a setting where they work with new graduates. The ques- tions are carefully edited for any type of bias. They are also reviewed 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 regional practice or opinion. The Test Plan Content The content is organized around four categories of human needs, which have been identified by the NCSBN. The four categories 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 adaptation Each of these subcategories constitutes 5–13% of the test except for Reduction of Risk Potential and Physiological Adaptation each of which accounts for 12–18% of the total questions. Copyright © 200 8 by The McGraw-Hill Companies, Inc. Click here for terms of use.

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    4 PART I: Testing Smart Integrated 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 ® Style In preparing for any examination, it is always helpful to have some idea of what to expect in terms of style. This helps prevent surprises, which can be distracting and can create anxiety. Knowing about the examination style in advance, helps free your mind to focus on the content of the questions. 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 all ages, 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 four options 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 with numerals or words rather than selecting an answer from a 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 test taker to identify a particular site by touching the correct area 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 the chest. If the test taker touches the correct area or “hot spot,” the answer is correct. —those that present a list of assessment findings or nurs- ing actions, etc., and ask the test taker to identify all those that are appropriate for a particular type of patient. Example: Which of the following are risk factors for cancer of the breast? 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 upon receipt of application and fees and verification of eligibility.) • two forms of ID—one of which must be a photograph ID and both of which must be signed NCLEX-RN ® is administered by computer. Taking the test on the computer is not complicated; it only requires use of the SPACE bar, the ENTER key, and for fill-in-the-blank answers, the keyboard. For multiple-choice and other similar questions, the cursor is moved to highlight the option selected as the answer by pressing the SPACE bar. When the option(s) selected is highlighted, the ENTER button is pressed. Then there is an opportunity to check your answer selection. If the option(s) highlighted is not the answer you want to give, you may change to another. If the answer you wish to give is highlighted, you press the ENTER key a sec- ond time to register your answer. Some very important points for you to remember about taking the examination are that • after the ENTER key is pressed a second time to register your answer, there is no returning to the question or changing the answer. • every question must be answered; you cannot skip a question. • 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 of your 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 computer selects the next question based on whether your answer to the previous question was right or wrong. If the previous answer was correct, the computer will select a slightly more difficult 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, the computer is programmed to make a decision of competent or incompetent based on the level of difficulty of questions answered correctly or incorrectly so relatively few candidates receive 265 questions. The minimum number of questions a candidate 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 Time In preparing for an examination, it is also important to know how much time you will be allowed to complete it. The total time allowed for the NCLEX-RN ® is 6 hours. If at the end of 6 hours, you have not answered enough questions for the

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    CHAPTER 1 Preparing for NCLEX-RN ® 5 computer to determine whether you are competent, you fail by default. Based on the maximum of 265 questions and the maximum time of 6 hours (360 minutes), there is slightly more 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 generally more. Nonetheless, time is not unlimited so you should not spend excessive time on any one question. Report of Pass—Fail Forty-eight hours after you take the test, the Board of Nurs- ing in the state where you are applying for licensure gets the pass/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 again in 3 months. How many times the test may be repeated depends on the State Board of Nursing. NCLEX Myths The NCLEX-RN ® is one of the most important examinations that nurses ever take. To reach the point of taking the exami- nation, much time, energy, and money have been invested and many sacrifices have been made. Because of these facts, you will hear many stories about the examination and receive much advice. This type of impromptu shared information often contributes to “myths” about the NCLEX-RN ® , which serve as sources of undue anxiety. Some of the more common myths, and the corrections to them, are presented below. The number of questions one receives indicates pass or fail. — This is not true. Candidates can answer the minimum number of questions, all of which are difficult, correctly and pass. Other candidates can answer the minimum number of questions, all of which are easy, and fail. It is not the number of items but the difficulty of the items that determines pass or fail. Extra long tests are given randomly to selected test takers. — This is not true. The number of questions is determined by the difficulty of questions you answer correctly or incorrectly. One needs to memorize everything. — This is not true. The test is looking at determining safe, entry-level practice based on the job analysis of what new graduates actually do in the work place. It is also testing generally accepted standards/methods of care. It is not testing rare, regionally variable information. How good you are with the computer determines how well you do on the examination. — The Educational Testing Service has done research on the question as to whether computer skill influences examination performance. The results show that the test-taker’s computer skill does not influ- ence the score on the examination. For more information about NCLEX, see the NCLEX Candidate Bulletin which can be accessed at the NCSBN Web site www.ncsbn.org. PART 2: STUDYING FOR THE TEST Study smart and study well! Remember, this is your future. It represents short-term sacrifice for a long-term gain. Identify Areas for Intensive Review Evaluate your own strengths and weaknesses. Often, it is a temptation to spend most of your study time reviewing material you already know quite well. This is because what you know best is most often material that you like, find easy, and are interested in (that is why you learned it well in the beginning). It is comfortable material and makes you feel good about taking the examination. Avoid this pitfall. Spend most 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 or had the least experience with—write them down. These may be broad areas of practice, for example, pediatrics or mental health/psychiatric nursing or specific topics such as acid—base balance, burns, or problems of the nervous system. If you are not a recent graduate, also identify those things that you did well in nursing school but have not had any recent experience with; these areas will need review but not as much time as those areas you did not know really well in the beginning. Be careful about assuming that since you have a lot of experience in a practice area you do not need to review. Remember NCLEX is a theory/textbook-oriented examination. The questions and answers are based on what “should be” in practice, not on the shortcuts and improvisations that “are.” Whether you are a new or a not-so-new graduate, review the list of topics in the NCLEX-RN ® test plan found in this book and judge your level of comfort with each, referring of course to the list you made as the first part of this exercise. Mark with two checks those top- ics you feel you really do not know; make one check by those that you probably do not know really well. This will serve as a guide to make sure you review the areas most important to you. Select Backup Review Materials This book, like all review books, is written in an abbreviated format that assumes basic understanding and focuses on key points. If you never mastered an area well or you encounter content in this book that you do not understand the basis of, it is important to go to a basic classroom text for clarification and additional discussion. NCLEX-RN ® utilizes selected texts as references. Lists of text books are sent to schools of nursing with directions to indicate those which are used in the curriculum and to add any that are used but do not appear on the list. Reference texts are selected based on the extent of use in schools of nursing. Questions are designed to address basic principles of practice about which all texts agree, not to test about uncommon pieces of information, which are debatable. The current list can be accessed at the NCSBN Web site.

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    6 PART I: Testing Smart Develop a Realistic Schedule for Review Dividing up material into achievable goals is smart. Each time you meet a goal, you feel more positive about yourself and your ability to deal with the material and the examina- tion. This reduces stress and hence supports your ability to be successful. There are different ways to develop a realistic schedule. One way is to determine the number of days until you are scheduled to take the NCLEX-RN ® . Also, determine how many hours on how many of these days can you realis- tically study. Be sure to allow for down time. After all, no one can study without a break and everyone must eat, sleep, bathe, etc. Tally total available study times/hours. Now assign study times/hours to the topics for review. Working from the test plan topics that you have marked according to how well you feel you know them, assign hours first to the topics 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, assign study times to those topics, which you decided you probably do not know well, and then to those needing a less-detailed review. Finally, place the topics in the order you will study them. Alternate hard and easy topics and topics you like with those you do not like—this will help keep you from shortening your scheduled study time. To have enough time to study well you may need to make some temporary changes in your lifestyle. You may need to take time off from work, negotiate sharing of house- hold tasks with others in the house, delay some projects or activities, and limit your social life. Only you can determine what is the best approach to ensure the time you need for study but as you consider your options remember— cramming is not one of them. It will not work. There is way too much material. Select a Study Place That Works for You Your study place should be quiet and convenient. A place you will be undisturbed but with space for your study mate- rials. It should have good light to facilitate reading without developing eyestrain and/or a headache, a comfortable seat, and an ambient temperature that is not so warm that it makes you sleepy and not so cold that it distracts you from studying. Lying in bed or on a couch to study is not a good idea as it is at best relaxing, and at worst, sleep-inducing. A certain level of awake alertness is necessary for successful studying. Select a Study Time That Works for You Different people are most alert at different times of the day. Some people are “morning people” and concentrate best on first getting up; others are night people and concentrate best in the evening. Some people have periods of best function at two different times of the day. Analyze yourself to determine when your most productive intellectual periods are and then plan to study the most challenging material during these times. Plan to review material that needs less intense study at other times. If you have family responsibilities around which you must organize study time, involve family members in planning how to make your best study times available for working on your NCLEX-RN ® review. Make Use of All Available Time for Study You can learn a great deal, relatively painlessly, by making good use of small amounts of available time throughout the day. 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 unused time: • Review a brief set of laboratory values, the principles of a nursing procedure, or assessment parameters for a specific disease in the 5 minutes before you take a shower, then use the time in the shower to repeat them to yourself. • Write information to be learned on an index card(s) and study when standing in line at the grocery store or when waiting to pick children up at the school bus, etc. Prepare Yourself for Studying Collect your notes, books, pens, highlighters, etc. Eliminate potential distractions: Shut off the cell phone; get out 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 your teeth. 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 Effectively When you study, engage yourself with the content; mechan- ical reading of notes is useless. Research shows that the more actively you engage with the content, the better you learn. So take notes, underline or highlight, repeat content out loud; walk back and forth while you memorize; try to think what questions could be asked about the subject being reviewed. Use a sequence of study—rest/reward—review. For example, study for 50 minutes. Take a 10-minute break. Reward yourself. Have a cup of tea or take a shower. Do not get involved in a mentally demanding activity that will cause you to 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 marked areas at the beginning of your next day’s study.

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    CHAPTER 1 Preparing for NCLEX-RN ® 7 To keep up your motivation, you can also do things like putting signs on your wall that say “You can do it.” or “This will be over in__days.” You can plan to go out to eat or buy a new dress if you meet your goal. Again, think about what motivational tricks work for you and use them. Know When to Stop When scheduling study, it is also important to recognize when you have studied to your capacity. Your time is valu- able and you do not want to waste it by trying to study when you are beyond your ability to concentrate. It is better to take a break or accomplish something else that needs to get done and then return to studying with refreshed con- centration. You will learn more in the end. So, again analyze yourself. You did a lot of studying in nursing school. What is the length of time you can usually concentrate? What are the telltale signs of when you are no longer learning effec- tively? Take these factors into consideration as you schedule study. WORKSHEET QUESTIONS Do you have key facts from this chapter on your NCLEX-RN ® knowledge ring? Complete the worksheet below to help you 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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    8 PART I: Testing Smart ANSWERS & RATIONALES WORKSHEET ANSWERS 1. Why is passing the NCLEX-RN ® a requirement for being licensed as a registered nurse? Answer To protect the safety of the public by limiting the practice of Registered Nursing to those individuals who have passed an examination, which documents ability to practice competently, knowledgeably, and safely. 2. At what level of practice is the NCLEX-RN ® designed to measure competence? Answer Entry-level Registered Nurse Practice. 3. What are the two major considerations in the selection of content to be tested on the NCLEX-RN ® ? Answer Frequency with which the information is needed in day-to-day practice and the criticality of the information to the patient. 4. Who are the writers of NCLEX-RN ® test questions? Answer Registered nurses who work with new graduates in their practice. 5. What is the predominant type of question found on the NCLEX-RN ® ? Answer Multiple-choice question. 6. How many questions does one have to get right in order to pass the NCLEX-RN ® ? Answer It varies because NCLEX-RN ® is a computer adaptive test and the decision on whether a test taker passes or fails is based 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 ® ? Answer 6 hours. 8. Do you need to be proficient in use of a computer in order to do well on NCLEX-RN ® ? Answer No, 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? Answer No, 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? Answer When the test stops after the minimum of 75 questions have been answered can mean one either passed or failed. The pass/fail decision is based on the difficulty of the questions answered correctly or incorrectly, not on the number.

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    CHAPTER 2 Test and Language Basics 9 To answer an examination question correctly, knowing the subject content is not enough. You have to clearly under- stand each part of the question in the context of nursing and correctly interpret the meaning of the question itself. Because nursing is a practice profession and the NCLEX- RN is measuring basic practice competencies, questions typically contain a clinical scenario followed by the ques- tion stem. In the case of multiple-choice questions, options follow. When taking an examination, it is important for you to recognize each of these question parts, so read the following definitions and look at the example carefully. • Clinical scenario : This part of the question tells you about the clinical situation. • Stem : This part of the question contains the actual prob- lem/question to be answered. • Options : These are the answer choices provided. Options are also called alternatives and in the case of traditional multiple-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 these parts 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 not correctly understood, it is difficult to select the best answer. • If the question being asked is not correctly understood, distracters, which sometimes answer a different question than the one asked in the stem or assume information not provided in the stem or in the scenario, are more likely to be perceived as the correct answer. • Most questions also contain key words. These are words that direct the answer; hence, attention to them along with clear understanding of their meaning is essential. KEY WORDS Because key words are so important in determining the cor- rect answer to a question, a list of frequently used key words is presented below for your review. Note that some of the words are negative. First Priority Next Best Most Least Appropriate Inappropriate Last Suitable Not Early Late Immediately Initial Only After Every Expected Contraindicated Partial Unexpected Independently Common Uncommon The following question illustrates the use and impor- tance of a key word: When giving medications to a client, what should the nurse do first? 1. Position the client 2. Check the client’s identity 3. Explain what he/she is going to do 4. Ask how the client is feeling In this example, all options are correct nursing actions when giving medications but which one is the correct Copyright © 200 8 by The McGraw-Hill Companies, Inc. Click here for terms of use.

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    10 PART I: Testing Smart Directions : Read each of the following questions. If the question contains a key word, underline it. 1. Which clinical manifestation would the nurse expect when assessing a client admitted with a diagnosis of bacterial pneumonia? 2. Which sign should alert the nurse to a potential problem in a client with a history of a CVA? 3. What is the primary goal for the hospice care of a client with lung cancer? 4. Which nursing intervention should be given priority in the plan of care for a teenager with sickle cell anemia? 5. The nurse is assessing the nutritional status of a client who is 3 months pregnant. Which information is 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 created colostomy should alert the nurse to the need for teaching regarding skin care? 8. What is the best way to assess for shortness of breath in a 3-year-old client with congenital heart disease? 9. The nurse is assessing a family’s ability to provide emotional support to a family member diagnosed with 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 when preparing to do a home assessment prior to discharge of a low birth weight newborn? 13. Why is it important to monitor pulse rate in a client on digoxin? 14. A 25-year-old woman comes to the clinic com- plaining of lower left abdominal pain. Which additional information should the nurse obtain initially? 15. Which assessment question should receive priority? FREQUENTLY MISUNDERSTOOD/MISREAD ENGLISH WORDS Almost everyone has one or more words that he/she somehow learned incorrectly and as a result misunderstands its precise meaning. These can be very common, simple words and often the person is unaware of the error. This can be a particular problem when English is a person’s second language, or is not the language of the household. Words that are similar in spelling and in pronunciation are particularly at risk of being misread, misused, or misunderstood. Because errors of this type can cause an NCLEX-RN question to be answered incor- rectly, a list of potentially misleading, common English words follows. Each word is followed by its definition and a sentence illustrating its use in nursing practice. You should read each one carefully and ask yourself if you were clear about the use of the word and its meaning. If your answer is Yes—great! If the answer is No, mark the word to be reviewed again. Accept —to agree or receive. Examples: The client accepted the diagnosis of breast cancer with surprising calm. The client accepted the nurse’s recommendation that all his 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 are consistent with a lower respiratory infection. Advice —suggestion, guidance, or counsel. Example: The client asked the nurse for advice on the best way to apply the ileostomy bag. Advise —to give a suggestion, guidance, or counsel. Example: The nurse advised the new mother to nap in the 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 an enclosed area when a car is left running is rapid and can result in fatality. Breath —air pulled into the lungs in one inhalation. answer is determined by the qualifying word “first.” The first action is to check the client’s identity. Practice identifying key words by completing the following exercise: WORKSHEET 1: IDENTIFICATION OF KEY WORDS

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    CHAPTER 2 Test and Language Basics 11 Example: Take a deep breath and hold it while I listen with the stethoscope over your lungs. Breathe —the act of inhaling and exhaling air from the lungs. Example: Breathe in slowly and deeply through your mouth. Caster —wheel on a swivel. Example: Many pieces of hospital equipment such as IV pumps and over-the-bed tables are on casters for ease of transport. Castor —oil from castor beans, used as a laxative. Example: A single dose of castor oil was ordered as part of the prep for the client’s upcoming bowel surgery. Charted (Not chartered) —entered in the client record. Example: The nurse charted the appearance of the wound 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 was the left, upper, outer thigh. Coarse (not course) —rough, uneven. Example: The skin of clients with hypofunction of the thyroid is often coarse in texture. Course —progression, order, direction. Example: The course of the disease is characterized by exacerbations and remissions. Compliment —praise. Example: The supervisor complimented the nurse on her 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 pain in the left chest. Compliant —willing to follow requirements or directions. Example: The client verbalized a desire to be compliant with the medication regimen but stated he could not be because he could not afford to buy the medications ordered. Continuous —going on without stopping. Example: The client was receiving continuous feedings via a nasogastric tube. Continually —happening at regular intervals or again and again. Example: The client continually complained of nausea while receiving the antibiotic. Defective —faulty or abnormal. Example: The neonate was diagnosed with a defective mitral valve. Deficient —lack of. Example: Genetic syndromes characterized by deficient chromosomal material are more often fatal than those characterized by excess chromosomal material. Dessert (not desert) —sweet foods served at the end of a meal. Example: The nurse advised the client to eliminate desserts as a step in controlling weight. Uninterested (not disinterested) —not caring. Example: The client appeared markedly uninterested in learning about the prescribed diet. Elicit —draw out information. Example: The nurse’s questions while obtaining the client history are designed to elicit complete, accurate information on which to base a nursing diagnosis. Illicit —illegal. Example: When obtaining a history, questions should be 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 the sign of an imminent seizure. Farther —greater distance. Example: The client should be ambulating farther than the bathroom. Further —more. Example: Before discharging the client, the physician decided further discussion with the family concerning plans for home care was necessary. Former —the first of two. (Latter refers to the second of two.) Example: Nausea and vomiting are common side effects to some medications.The former is a symptom because it 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: Clients lose central vision with macular degeneration; they lose peripheral vision with glau- coma.

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    12 PART I: Testing Smart Loose —opposite of tight. Example: Loose bowel movements can be a problem for clients following an intestinal resection. Nauseous —inducing a feeling of nausea. Example: The nauseous smell of the drainage made the dressing difficult to change. Nauseated —experiencing nausea. Example: The client became nauseated 2 hours after the chemotherapy was administered. Past —time gone by, ago. Example: The time is past that medications could have helped; now surgery is the only option. Passed —moved along, went away, departed, succeeded on a 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 her comfortable. Patience —tolerance or understanding. Example: Patience is often needed when dealing with sick children. Peace —calmness, tranquility. Example: Helping the client achieve peace of mind is a goal of the hospice nurse. Piece —part or section. Example: The piece of the Foley catheter that inflates to hold the catheter in the urinary bladder is called the balloon. Personal —private. Example: Use of personal information about clients is governed by the HIPAA regulations. Personnel —employees. Example: Nurses are licensed health care personnel. Prescribe —order for. Example: The nurse practitioner prescribed the antibiotic Cipro for the client with a urinary tract infection. 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 strengthen the contraction of the myocardium in cases of heart failure. 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 is by convection. Proceed —go on, continue. Example: The nurse proceeded with the dressing change after the client had stopped coughing. Precede —go before. Example: Mild signs of an upper respiratory infection preceded the development of the rash. Quite —a great deal. Example: The client was quite verbal regarding his opinion of his care. Quit —leave or stop. Example: The client stated he wished he could quit smoking. Rise —get oneself up. Example: The client who had a CVA said to the nurse “I look forward to the day I can rise out of the bed in the morning without assistance.” Raise —lift or elevate an object or person. Example: During a breast examination, the client needs to raise her arms over her head so the contours of the breast can be inspected. Stationary —not moving. Example: The brake on the wheelchair should be set when the client is being moved in or out of the chair in order to keep the chair stationary and help prevent the client from falling. Stationery —paper. Example: Official letters should be written on stationery imprinted with the agency letterhead. Statute —legal restriction. Example: The statute of limitation for malpractice cases differs 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 if the 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 a procedure to be done can allay anxiety.

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    CHAPTER 2 Test and Language Basics 13 Anticipate —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 is prepared with knowledge and equipment to provide the needed care.” Avoid —keep away from. Example: Immunosuppressed clients need to avoid crowds 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 on the 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 has understood instructions; validation of understanding by repeating the instructions or by return demonstration is always 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 determine the 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 drugs because they fear the reaction of the health care provider. Determine —to come to a decision or to obtain first hand knowledge. Example: To determine the causative organism of a wound infection, a culture is done. Differentiate —discriminate or identify differences. Example: When examining the chest, it is important to differentiate between crackles and wheezes. Exacerbate —worsen. Example: Exposure to cold and damp can exacerbate the symptoms of a sinus infection. Enhance —augment. Example: Comfort measures such as clean linen, a back rub, and pleasant music can enhance the action of pain medications. Excessive —more than acceptable, exorbitant. Example: The bleeding was excessive following the surgery. Expectorate —cough up and spit out mucus. Example: To prevent spread of infection, the nurse instructed 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 warm to 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 is a 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 of laryngitis. Impinge —come into close contact. Example: The CAT scan showed that the tumor was impinging on the recurrent laryngeal nerve thus accounting for the hoarseness. Inept —not apt, unable to do well. Example: The client remained inept at handling the insulin syringe, so additional teaching was planned. Insulation —prevent transfer of electricity, heat, or sound. The insulation in the walls of hospital rooms helps clients to rest by decreasing nose heard from other areas of the unit. Intact —without injury. Example: The client’s skin remained intact despite the long period of bed rest. Isolation —loneliness, separation. Examples: Clients having intracavitary radiation treatments are at risk 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 can lead 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 channel blockers, the drugs most likely to cause allergic reactions are the antibiotics.

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    14 PART I: Testing Smart WORKSHEET 2: VOCABULARY Directions: Match the definitions in column B with the words in column A. Column A Column B 1. ____Site a. something to be left out 2. ____Coarse b. progress 3. ____Imminent c. without intending to 4. ____Deficient d. rough 5. ____Former e. create a tendency to 6. ____Enhance f. saturate 7. ____Impinge g. location 8. ____Tense h. a truth 9. ____Predispose i. at any time 10. ____Sedentary j. unable to do well 11. ____Except k. inactive 12. ____Principal l. shaky 13. ____Loose m. opposite of tight 14. ____Exacerbate n. eliminate 15. ____Profuse o. pouring forth p. easy going q. of major importance r. cause discomfort s. rigid t. worsen u. about to happen v. first of two w. misplace x. augment y. lack of z. come into close contact Liberally —freely, unchecked. Example: The client should be encouraged to use the Calamine lotion liberally to control the itch of the poison ivy. Predispose —create a tendency to. Example: Use of immunosuppressant drugs predisposes the client to infection. Permit —let. Example: Elevating a Foley catheter drainage bag above the level of the client’s pelvis permits backflow of urine into the bladder. Profuse —pouring forth. Example: Vaginal drainage was yellow, profuse, and malodorous. 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 preparation sparingly in accordance with the directions. Spasm —involuntary contracture. Example: The client complained of repeated leg spasms during 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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