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NCLEX-RN Notes: Core Review and Exam Prep (2007)

Prepare for success with NCLEX-RN Notes: Core Review and Exam Prep (2007), a comprehensive guide to your certification test.

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    Bonus CD-ROM Includes— • 1000  plus NCLEX-style questions • Rationales for correct and incorrect responses • Alternate format questions • Strategic tips for successfully answering questions All questions coded for— • Client Need • Content Area • Cognitive Domain • Difficulty Level All combined to promote success on NCLEX examinations

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    Minimum System Requirements PC CPU:Pentium III or higher 64 MB Ram; 128 MB Ram preferred 800 x 600 monitor with thousands of colors OS: Windows/2000/XP 8x CD-ROM drive 135 MB hard disk space LICENSE AGREEMENT 1. F . A. Davis (“FAD”) grants the recipient of the NCLEX-RN ® Notes: Core Review & Exam Prep , limited license for the program on the enclosed CD- ROM (“Software”). FAD retains complete copyright to the Software and associated content. 2. Licensee has nonexclusive right to use this copy of the Software on one computer on one screen at one location. Any other use is forbidden. 3. Licensee may physically transfer the Software from one computer to another, provided that it is used on only one computer at any one time. Except for the initial loading of the Software on a hard disk or for archival or backup purposes, Licensee may not copy, electronically transfer, or otherwise distribute copies. 4. This License Agreement automatically terminates if Licensee fails to comply with any term of this Agreement. 5. SOFTWARE UPDATES. Updated versions of the Software may be created or issued by FAD from time to time. At its sole option, FAD may make such updates available to the Licensee or authorized transferees who have returned the registration card, paid the update fee, and returned the original CD-ROM to FAD.

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    LIMITED WARRANTY AND DISCLAIMER FAD warrants that the CD-ROM on which the Software is furnished will be free from defects of sixty (60) days from the date of delivery to you by FAD or FAD’s authorized representative or distributor. Your receipt shall be evidence of the date of delivery. The Software and accompanying materials are provided “as is” without warranty of any kind. The complete risk as to quality and performance of a nonwarranted program is with you. FAD makes no warranty that the Software will meet your requirements or that Software operation will be uninterrupted or error free or that Software defects are correctable. No oral or written information or advice given by FAD, its dealers, distributors, agents, or employees shall create warranty or in any way increase the scope of this limited warranty. REMEDIES. FAD’s entire liability and your exclusive remedy shall be limited to replacing the defective media if returned to FAD (at your expense) accompanied by dated proof of purchase satisfactory to FAD not later than one week after the end of the warranty period, provided you have first received a Return Authorization by calling or writing FAD in advance. The maximum liability of FAD and its licensors shall be the purchase price of the Software. In no event shall FAD and its licensors be liable to you or any other person for any direct, indirect, incidental, consequential, special, exemplary, or punitive damages for tort, contract, strict liability, or other theory arising out of the use of, or inability to use, the Software. ENTIRE AGREEMENT. This Agreement contains the entire understanding of the parties hereto relating to the subject matter hereof and supersedes all prior representations or agreements. GOVERNING LAW. This Agreement and Limited Warranty are governed by the laws of the Commonwealth of Pennsylvania. All warranty matters should be addressed to F .A. Davis, Publishers, 1915 Arch Street, Philadelphia, PA 19103. INSTALLATION INSTRUCTIONS Windows Step 1. Insert CD into your CD-ROM drive. Step 2. After a few moments, the CD-ROM menu will automatically open. Step 3. Select the item to install If the CD-ROM Menu does not automatically open, from the START Menu, select RUN and enter X:\SETUP .EXE (where “X” is the letter of your CD-ROM drive) and select OK For Technical Support, e-mail: support@fadavis.com

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    NCLEX-RN® Notes Purchase additional copies of this book at your health science bookstore or directly from F . A. Davis by shopping online at www.fadavis.com or by calling 800-323- 3555 (US) or 800-665-1148 (CAN) A Davis’s Notes Book Barbara A. Vitale, RN, MA NCLEX-RN® Notes Core Review & Exam Prep Core Review & Exam Prep

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    F . A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2007 by F . A. Davis Company All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in China by Imago Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Publisher, Nursing: Robert G. Martone Project Editor: Padraic Maroney Manager of Art and Design: Carolyn O’Brien Content Development Manager: Darlene Pedersen Contributing Author: Mary Ann Hellmer-Saul, RN, AAS, BS, MS, PhD, ANP Consultants: Paula A. Olesen, RN, MSN; Daryl Boucher, MSN, RN, CCEMTP; Golden Tradewell, PhD, RN; Kathy Whitley, RN, MSN, FNP; Leesa A. McBroom, MSN, APRN, FNP-C; Lindsey L. Carlson, MSN, RN; Eileen Kaslatas, MSN, RN; Joanne Vitale, RPA- C, BA; William Hendricks, RPh; Jean Prochilo, RN, BS; Nina Goldsztejn, RN, BC, BSN, MSN, NP As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F .A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.10 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 803 6–1570/07 0  $.10.

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    Look for our other Davis’s Notes titles Available Now! RNotes ® : Nurse’s Clinical Pocket Guide ISBN: 0-8036-1335-0 LPN Notes: Nurse’s Clinical Pocket Guide ISBN: 0-8036-1132-3 MedNotes: Nurse’s Pharmacology Pocket Guide ISBN: 0-8036-1109-9 MedSurg Notes: Nurse’s Clinical Pocket Guide ISBN: 0-8036-1115-3 NutriNotes: Nutrition & Diet Therapy Pocket Guide ISBN: 0-8036-1114-5 IV Therapy Notes: Nurse’s Clinical Pocket Guide ISBN: 0-8036-1288-5 PsychNotes: Clinical Pocket Guide ISBN: 0-8036-1286-9 LabNotes: Pocket Guide to Lab & Diagnostic Tests ISBN: 0-8036-1265-6

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    Contacts • Phone/E-Mail Name: Ph: e-mail: Name: Ph: e-mail: Name: Ph: e-mail: Name: Ph: e-mail: Name: Ph: e-mail: Name: Ph: e-mail: Name: Ph: e-mail: Name: Ph: e-mail: Name: Ph: e-mail: Name: Ph: e-mail: Name: Ph: e-mail: Name: Ph: e-mail: Name: Ph: e-mail:

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    1 NCLEX-RN ® ■ The National Council Licensure Examination for registered nurses (NCLEX-RN®) measures the knowledge and abilities necessary for entry- level nurses. ■ It is administered by Computer Adaptive Testing (CAT), which individualizes tests to match the unique competencies of each test taker. ■ Each exam adheres to the NCLEX-RN® Test Plan, which describes the content and scope of RN competencies. ■ Practices basic to nursing (e.g., nursing process, caring, teaching, learning, communication, documentation) are integrated throughout, and most questions require application and analysis of information. NCLEX-RN ® Test Plan—Distribution of Content Patient Needs and % of Items Safe and Effective Care Environment ■ Management of Care ■ Safety/Infection Control Health Promotion and Maintenance Psychosocial Integrity Physiological Integrity ■ Basic Care/Comfort ■ Pharmacological/Parenteral gfd Therapies ■ Reduction of Risk Potential ■ Physiological Adaptation Taking the NCLEX-RN® Test on a Computer ■ First: You will receive general information about the exam and the testing center. Your time spent on this will not count. ■ Second: You will take a tutorial on how to use the computer to answer the questions on NCLEX-RN®. Your answers will not count toward your score, but the time you take will be subtracted from the total 6 hours you have for the exam. ■ Third: You will then be presented with real NCLEX-RN® items; there will be between 75 and 265 items. The test ends when it is 95% certain your ability is ↑ or ↓ the passing standard. TIPS 13%–19% 8%–14% 6%–12% 6%–12% 6%–12% 13%–19% 13%–19% 11%–17%

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    2 ■ Answers may be selected or deleted several times if desired before confirming a final answer. You must answer every question. You cannot return to a previous question. ■ A time-remaining clock is in the screen’s upper right-hand corner. ■ A calculator on the computer is available for calculations. Go to www.NCSBN.org to access an NCLEX tutorial to practice multiple choice and alternate format items on the computer. Critical Thinking Definition, Influences, and Uses of Critical Thinking ■ Definition of critical thinking: Cognitive technique by which you reflect on and analyze your thoughts, actions, decisions ■ Intellectual standards that influence critical thinking: Focused, methodical, clear, deliberate, logical, relevant, accurate, precise ■ Processes that require critical thinking: Test taking, nursing process, problem solving, decision making, diagnostic reasoning Maximize Your Critical Thinking Abilities Action Benefit Be positive: Be optimistic ■ Maintain positive mental attitude: Replace negative thoughts with positive ones Be calm: Control anxious feelings ■ Use relaxation techniques: Practice breathing exercises and guided imagery Be inquisitive: Question and investigate ■ Ask the questions how, why, what: e.g., How does Colace promote a bowel movement? Why does BP drop with hemorrhage? Be persistent: Follow a course of action ■ Develop self-discipline: Be logical and organized TIPS ■ ↑ Positive thinking and ↓ negative thinking that can interfere with learning ■ ↓ Anxiety ■ ↑ Control in relation to intellectual tasks ■ ↑ Ability to determine significance of information ■ ↑ Understanding/retention of information ■ ↑ Ability to apply information ■ ↑ Control over variables associated with thinking

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    3 Maximize Your Critical Thinking Abilities (Continued) Action Benefit ■ Develop perseverance: Adhere to a preset study schedule; remain determined ■ Maintain motivation: Set short and long-term goals; divide tasks into steps; reward self Be creative: Be innovative and resourceful ■ Develop open-mindedness: Compartmentalize identified beliefs, opinions, biases, stereotypes, prejudices ■ Develop comfort with ambiguity: Recognize that there is more than 1 way to perform a task/achieve a goal ■ Develop independent thought: Consider all possibilities and arrive at an autonomous conclusion ■ Take risks: Implement unique interventions within the definition of nursing practice and safety guidelines Be reflective: Thoughtfully explore and assess ■ Develop courage: Confront difficult tasks (e.g., reviewing mistakes) with a non-judgmental attitude ■ Develop humility: Admit your limitations—defensive thinking promotes negativity, which closes the mind ■ Use retrospective reviews: Recall information/event to rediscover/ explore its meaning; conduct internally or with others TIPS ■ ↓ Procrastination; ↑ enthusiasm ■ ↑ Efficiency of time management ■ ↓ Stress of making purposeful daily study decisions: inspires action ■ ↑ Goal-directed behavior ■ ↑ Openness to different perspectives; ↓ egocentric thinking; ↑ nonjudgmental thinking/practice ■ ↑ Comprehension, synthesis, interpretation, analysis of information: promotes practice based on principles; innovation ■ ↑ Ability to synthesize, summarize, conceptualize: promotes practice based on principles; ↑ innovation ■ Removes negative emotions from the task; ↑ positive thinking ■ Allows an open mind to explore and acquire information; permits nonjudgmental review of mistakes ■ Identifies strengths, weaknesses, and gaps in knowledge; ↑ understanding of relationships between information and its application; ↓ future mistakes

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    4 General Study Skills ■ Set goals ■ Take class notes ■ Manage your time ■ Control internal and external distractions ■ Establish a routine ■ Simulate a school environment ■ Prepare for class ■ Balance sacrifices and rewards Use Techniques Appropriate for Learning Domains Action Benefit Cognitive domain (thinking): Knowing, comprehending, applying, analyzing, synthesizing, evaluating ■ Use all your senses ■ Use memorization techniques ■ Put information into own words ■ Apply information in new situations Affective domain (feeling): Receiving, valuing, organizing, characterizing ■ Observe role models ■ Explore feelings, beliefs, values ■ Integrate values into philosophy of life Psychomotor domain (doing): Imitating, manipulating, developing precision, articulating, naturalizing ■ Observe others performing a skill ■ Manipulate equipment while doing procedures ■ Include speed/timing when practicing skills ■ Practice skills repeatedly TIPS ■ ↑ Reception of information ■ ↑ Retention of basic information ■ ↑ Understanding ■ Encourages correct use of information ■ ↑ Sensitivity ■ ↑ Self-disclosure/growth ■ ↑ Consistency in actions; allows for self-actualization ■ Identifies steps of a skill ■ Transfers information from head to hands ■ Promotes proficiency through repetition ■ Perfects the skill; naturalization occurs when skill becomes automatic

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    5 Specific Study Skills How to Remember/Recall Information: Commit Facts to Memory Action Benefit Example Memorization: Repeatedly reciting out loud, reviewing in your mind, writing it down Alphabet cues: Combination of significant letters Acronyms: Word formed from the first letters of a series of facts Mnemonics: A phrase, motto, verse TIPS ■ Repetition ↑ retention of information ■ Each letter prompts recall of specific information ■ Each letter jolts retrieval of specific information ■ Prompts recall of specific information ■ Lists on index cards: Steps of a procedure; signs of a specific electrolyte imbalance ■ Flash cards: Drug classification on one side and action on reverse side; medical terminology on one side and definition on reverse side ■ The 3 Ps: Cardinal signs of diabetes mellitus: ■ P olyuria: Increased secretion/ excretion of urine ■ P olydipsia: Excessive thirst ■ P olyphagia: Eating excessive amounts of food ■ RACE: Procedure for a fire in a health care facility ■ R escue people in immediate danger ■ A ctivate the fire alarm ■ C onfine the fire ■ E vacuate people to a safe area ■ “There are 15 grains of sugar in 1 graham (gram) cracker. ” This sentence should help you remember that 15 grains are equivalent to 1 gram.

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    6 How to Understand Information: Translate, Interpret, and Determine Implications of Information Action Benefit Example Explore how or why information is relevant and valuable Study in small groups How to Manipulate Information: Apply, Solve, Modify, and Use Information Action Benefit Example Relate new information to prior learning Recognize commonalities TIPS ■ Significant information is more likely remembered ■ Sharing/listening ↑ understanding and corrects misinformation ■ Placing information within a personal frame of reference makes informa- tion more meaningful ■ Application of information to similar situations ↑ learning ■ Elevation of an extremity reduces peripheral edema ■ How: Hand held above elbow/shoulder ↑ venous return via gravity, which ↓ edema ■ Discussing differences between hyper- and hypoglycemia ■ Debating the pros and cons of breastfeeding ■ Identify more correct things the nurse should do in addition to the correct answer presented in a test question ■ Pathophysiology of diabetes should build on normal physiology of the pancreas ■ Placing a pt in a left side–lying position after a liver biopsy should build on the fact that pressure compresses blood vessels, which supports hemostasis preventing hemorrhage ■ Actions that use the principle of gravity: Enema instillation, elevation of extremity to limit edema, high Fowler’s position to promote respirations

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    7 How to Analyze Information: Examine the Organization, Structure, and Interrelationships of Information Action Benefit Example Recognize differences Practice test taking Review rationales for all options Modify test questions Analyze your performance TIPS ■ ↑ Ability to analyze and discriminate significance of information ■ Reinforces learning, builds endurance, ↑ test-taking and time-management skills, ↑ testing comfort ■ Reinforces concepts and principles, ↑ new learning, strengthens critical thinking, corrects misinformation ■ Identify commonalities and differences, ↑ opportunities for exploring content ■ Analysis identifies areas of strength, gaps in knowledge, information-processing errors, effectiveness of educated guesses, plans for future study ■ Variety of causes that can ↑ BP: Hypervolemia, rigid arterial walls, emotional stress ■ Answer questions at the end of a chapter ■ Take a simulated test in a NCLEX prep book ■ Take a simulated NCLEX test on a computer ■ Review why the correct answer is correct ■ Review why the incorrect options are incorrect; look up additional information in textbooks ■ Change a key word in a stem to change the focus: “Identify the pt adaptation associated with acute pain. ” Change the word acute to chronic and then identify if any options apply ■ Identify number of questions answered correctly/incorrectly ■ Group questions answered incorrectly by Knowledge Deficits and Information Processing Errors (see Tab 8) ■ Identify Personal Performance Trends (see Tab 8) ■ Design a plan for future test success

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    8 Test-Taking and Study Tips See enclosed disk for 160 examples of questions demonstrating the 15 test- taking tips and alternate format questions. Identify positive polarity in a stem ■ Correct answer is in accord with a truth, fact, principle, or action that should be done; it attempts to determine if you can understand, apply, or differentiate correct information. ✔ Study Tip: Review content being tested; identify additional things the nurse should do. Identify negative polarity in a stem ■ Correct answer reflects something that is false; the words except, not, contraindicated, unacceptable, least, avoid, violate, untrue, side effect, and exception indicate negative polarity. If 3 answers appear correct, you may have missed the negative word in the stem. ✔ Study Tip: Change negative word to a positive word and then answer the question. Identify words that set a priority ■ Correct answer is what should be done first ; the words initial, main, primary, initially, greatest, best, first, most, and priority require ranking of options from most to least desirable. If unable to identify correct answer, eliminate least desirable option and repeat again until left with a final option. ✔ Study Tip: After selecting correct answer, select what action should be done next. Identify opposites in options ■ When 2 options reflect extremes on a continuum, frequently 1 of them is the correct answer; opposites may be obvious or obscure. ✔ Study Tip: Examples of opposites: hypo- vs. hyper-; increase vs. decrease; brady- vs. tachy-; identify what is associated with the incorrect opposite (e.g., tachycardia is associated with hyperthyroidism vs. bradycardia being associated with hypothyroidism). Identify key words in a stem ■ Identify important word or phrase that modifies another word (e.g., early vs. late sign of shock). ✔ Study Tip: Change key words in stem; this changes focus of question and ↑ opportunities for learning. TIPS

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    9 Identify patient-centered options ■ Correct answers testing principles in the affective domain focus on feelings, choices, empowerment, and preferences. ✔ Study Tip: Examples of pt-centered options: Acknowledging: “Losing your independence must be difficult?” Offering a choice: “Would you like your bath at 7 or 10 today?” Empowering: Encourage pt to write down questions for the physician. Determining preferences: “What foods do you like to eat?” Identify equally plausible options ■ When 2 options are similar and 1 is not better than the other, generally both are incorrect. ✔ Study Tip: Identify other equally plausible facts related to either the 3 incorrect options or the correct answer. Identify options with “absolute” terms ■ The words all, just, none, only, never, every, and always have no exceptions; 1 of these before a statement that is true generally makes it an incorrect option. Options with absolute terms are more often incorrect. ✔ Study Tip: Examples of options to be eliminated: Always position an infant prone and just prescription drugs can cause interactions; exceptions include: Always maintaining an airway and focusing on the pt. Identify the global option ■ A global option is a broad general statement, whereas the 3 other options are specific and inherently are included under the mantel of the global option. ✔ Study Tip: What else can be included under the global option? Identify options that deny a patient’s feelings, needs, concerns ■ Options that deny feelings, give false reassurance, focus on nurse, encourage cheerfulness, or change the subject cut off communication and should be eliminated. ✔ Study Tip: Examples of options to be eliminated: Denies feelings: “Don’t cry. It is not so bad. ” False reassurance: “You’ll feel better tomorrow. ” Focuses on the nurse: “The thought of dying would frighten me. ” Cheerfulness: “Cheer up. You are getting better. ” Identify the unique option ■ When 3 options are similar in some way and 1 is different, the unique option often is the correct answer (e.g., 3 options promote a bowel movement and correct answer causes diarrhea). TIPS

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    10 ✔ Study Tip: Identify additional similar or different examples of correct and incorrect options. Identify clues in a stem ■ A word(s) in the stem that is identical, similar, paraphrased, or closely related to a word(s) in an option is called a clang ; a clang can be obvious or obscure. Generally, an option with a clang is the correct answer. ✔ Study Tip: Identify a similar word(s) that relates to an important word in the stem (e.g., to the word movement in a stem consider similar words such as activity and mobility that may be found in an option). Identify duplicate facts in options ■ If 2 or more facts are in each option and identical or similar facts are in at least 2 of the 4 options, and you can identify at least 1 fact that is correct or incorrect, you can eliminate at least 2 options. ✔ Study Tip: Identify additional facts that may be correct. Use Maslow to identify correct option ■ Answer the question in light of Maslow’s hierarchy of needs; basic physiologic needs are 1st-level needs that are a priority and are followed by needs associated with safety and security (2nd), love and belonging (3rd), self-esteem (4th), and self-actualization (5th). ✔ Study Tip: Identify an intervention associated with each level of Maslow’s hierarchy of needs in relation to the question. Use multiple test-taking tips ■ First analyze the stem for 1 or more test-taking tips. Then analyze the options for 1 or more test-taking tips. When you focus on what the stem is asking and eliminate options from consideration, you maximize the ability to select the correct answer. ✔ Study Tip: Practice answering questions at the end of a chapter or in test-taking books using the presented test-taking tips. Alternate Format Questions and Test-Taking Tips Alternate format questions evaluate certain knowledge more effectively than the typical multiple-choice question. They supplement multiple-choice questions, which remain the majority of questions. Any format, including the standard multiple-choice question, may include a chart, table, or graphic image. Alternate format questions are scored as either right or wrong, and partial credit is not given. TIPS

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    11 Ordered response (drag and drop) question ■ Presents a scenario or makes a statement and then lists a variety of actions or factors that must be placed in sequence or in order of priority. The sequence chosen must be identical to the correct sequence to receive credit. ✔ Test-Taking Tip: Identify the action/factor you believe should be first. Identify the action/factor you believe should be last. Evaluate the remaining 2 actions/factors and make a final determination as to which one goes second. The remaining action/factor is placed third. Fill-in-the-blank (calculation) question ■ Requires manipulation, interpretations, or solving a problem based on presented information. It requires an intellectual skill such as computing a drug dosage, calculating an I&O, or determining the amount of IV solution to be given. The recorded answer must be identical to the correct answer to receive credit. You do not have to type in the unit of measurement. ✔ Test-Taking Tip: Before attempting to answer the question, recall information related to the question (e.g., memorized equivalents, formulas); this taps your knowledge first and limits confusion. Multiple-response question ■ Asks a question and then lists several responses. You must identify the 1 or more responses that are correct. All correct responses must be selected to receive credit. ✔ Test-Taking Tip: Before looking at presented options, quickly review information you know about the topic. This taps your knowledge first and limits confusion after looking at presented options. Compare your list to presented options. Some of your recalled information should match. Then review the remaining presented options and determine if they are applicable. If you look at the presented options first, eliminate at least 1 or 2 you believe are wrong. Then identify at least 1 or 2 you believe are correct. Finally, evaluate the remaining options and make a determination if they are correct or not. Hot-spot question ■ Asks a question in relation to a graphic image, picture, chart, or table. You must identify a location or analyze information on the illustration to answer the question. Your answer must mirror the correct answer exactly to receive credit. ✔ Test-Taking Tip: Read the question carefully to identify exactly what the question is asking. This limits misinterpretation and confusion. When questions reflect anatomy and physiology, close your eyes, visualize the area, briefly recall the significant structures and functions, and then look TIPS

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    12 at the picture. When questions involve graphs or tables, first break them into segments for analysis and then review them as a whole. Chart/exhibit question ■ Presents a problem and then provides a chart/exhibit that has several tabs. Each tab has to be clicked to retrieve information contained within the tab. The data must be analyzed and the significant information gleaned from the material presented to answer the question or eliminate incorrect options. These questions require the highest level of critical thinking (analysis and synthesis). ✔ Test-Taking Tip: First identify what the question is asking, then click each tab to collect data. Dissect, analyze, and compare and contrast the information collected in light of what the question is asking. Extensive information must be recalled from your body of knowledge and compared to the information in context of the situation presented in the question. TIPS

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    13 BASICS Child:  1year–adolescent Tap and ask, “Are you OK?” Carotid or femoral Center of chest, between nipples 1 hand: Heel of 1 hand 2 hands: Heel of 1 hand and heel of second hand on top Witnessed collapse with no response; unwitnessed event after 5 cycles of CPR Place on hard surface; head tilt-chin lift (lift-jaw thrust with spinal trauma); look, listen, feel for air; if not breathing, give 2 breaths; cover nose and mouth of infant when rescue breathing Infant:  1yr No response to verbal or tactile stimuli Brachial or femoral Center of chest below nipples 1 rescuer: 2 fingers 2 rescuers: 2 thumb-encircling hands Rate: Approximately 100/min Depth: Approximately 1 / 3 to 1 / 2 depth of chest 1 rescuer— 30:2; 2 rescuers— 15:2 Sudden collapse: ASAP All others: After 5 cycles of CPR No recommendation for infants  1yr Pulse with no breaths:  60/min: 12 to 20 breaths/min;  60/min: continue CPR Cardiopulmonary Resuscitation (CPR)—Child and Infant Maneuver Assess for response Activate 911 1 rescuer Airway breaths Pulse check Compression landmarks Compression method: “Hard and fast” with chest recoil Compression rate and depth Comp/vent ratio Defibrillation Rescue breathing

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    14 Ethical and Legal Foundations Basis of Ethical Decision Making ■ Autonomy: Support personal freedom and decision making ■ Beneficence: Promote good ■ Fidelity: Keep promises and commitments ■ Justice: Treat people fairly and equally ■ Nonmaleficence: Do no harm ■ Paternalism: Make or allow a person to make a decision for another ■ Respect: Acknowledge rights of others ■ Veracity: Tell the truth Legal Terms ■ Advance directive: Written document that addresses treatment desires in the future if unable to make decisions ■ Living will: Specifically identifies treatment desires ■ Health care proxy (durable power of attorney): Assigns decision making to another ■ Do not resuscitate: Order stating that a patient should not be revived; at request of patient when able; health care proxy, family member, or legal guardian when patient is unable to give consent ■ Assault: Threat of unlawful touching of another ■ Battery: Unlawful touching of another without consent (e.g., procedures performed without consent) ■ False imprisonment: Restriction/retention of patient without consent; use restraints in compliance with policy and procedure; have patient sign release if desiring to leave facility against medical advice ■ Good Samaritan Law: Legal protection for those who render care in an emergency without expectation of remuneration ■ Libel: Written statement causing harm to patient BASICS

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    15 ■ Malpractice: Professional negligence; occurs when the nurse owed a duty to the patient, the nurse did not carry out that duty, and it resulted in injury to the patient ■ Negligence: Failing to perform an act that a reasonable prudent nurse would do under similar circumstances; may be an act of omission or commission. Examples: Failure to ensure patient safety (falls); improper performance of a treatment (burns from warm soak); med errors; inappropriate use of equipment (excessive IVF via pump); and failure to monitor, report, or document patient’s status ■ Organ donation: Donor card, living will, or family consent if patient is unable to participate in decision is necessary to donate organs ■ Respondeat superior: Latin term meaning “let the master answer”; employer is responsible for acts of employee causing harm during employment activities ■ Slander: Oral statement resulting in damage to patient; nurse incorrectly tells others that patient has AIDS and it affects patient’s business ■ Uniform Determination of Death Act: ■ Cardiopulmonary criteria: Irreversible cessation of circulatory and respiratory function ■ Whole-brain criteria: Irreversible cessation of all functions of the entire brain and brain stem (organs may be healthy for donation even though meeting whole-brain criteria) Disease and Treatment Mnemonics CAUTION: EARLY SIGNS OF CANCER INFECT: S&S OF INFECTION C hange in bowel or bladder habits A sore throat that doesn’t heal U nusual bleeding or discharge T hickening or lump I ndigestion; dysphagia O bvious change in a wart or mole N agging cough ot hoarseness RICE: TREATMENT FOR ACUTE INJURY R est; ↓ stress/strain on injury I ce; vasoconstriction ↓ edema and pain C ompression; external pressure E levate: gravity ↓ edema BASICS I ncreased pulse, respirations, WBCs N odes are enlarged F unction is impaired E rythema, Edema, Exudate C omplains of discomfort/pain T emperature – local or systemic

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    16 Therapeutic Nurse-Patient Relationship Phases of Interaction Phase Nurse Patient Preinteraction: Begins before contact with patient Orientation (introductory): Begins at first meeting of nurse/patient Working: Begins when patient identifies problems to be worked on Resolution (termination): Begins when problems are resolved; ends when relationship is terminated BASICS Explore personal feelings, values, attitudes Collect data about patient Plan for 1st interaction Listen; be empathetic Identify boundaries of relationship (termination begins here) Clarify expectations Establish rapport Assist with exploration of issues Support healthy problem solving Assist with strategy development Identify own reactions to client based on own needs, conflicts, relationships ( counter transference ) Review objectives/goals achieved Reinforce adaptive behaviors Share feelings about termination Avoid discussing previous issues Encourage independence; focus on future Promote positive family interactions Refer to community resources Patient has no role in this phase Recognize need for help Commit to a therapeutic relationship Begin to test relationship Develop trust in nurse Examine personal issues Develop strategies to resolve issues May superimpose feelings from another relationship onto the nurse/patient relationship ( transference ) Share feelings about termination (anger, rejection, regression; negative feelings may be expressed to deal with loss) May attempt to discuss previous issues Assume responsibility for use of community resources

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    17 BASICS Interviewing Interviewing Skills ■ Active listening: Absorbs content/feelings; uses all senses; includes verbal/nonverbal attending, appropriate gestures (head nodding), eye contact, sitting, open posture, vocal cues (“mmm”). ■ Clarification: Asks for more information. Checks accuracy. ↓ Ambiguity: “I am not sure I know what you mean by that. ” ■ Confrontation: Presents reality, identifies inconsistencies. ↑ Self- awareness. Use gently after trust is developed. Pt: “I never have any visitors. ” Nurse: “I was here yesterday when you had 3 visitors. ” ■ Direct: Collects specific information quickly: “Where is your pain?” ■ Focusing: Let patient finish thoughts. Centers on key elements to ↓ rambling. “When talking about your house, you mentioned scatter rugs. Let’s talk more about being safe in your home. ” ■ Nonverbal: Promotes verbalization. Techniques include leaning forward, nodding head, smiling, gestures. ■ Open-ended: Invites elaboration, nonthreatening. Avoids yes/no answer: “Tell me about what a typical day is like for you. ” ■ Paraphrasing: Restates message in same/similar words. Focuses on content; encourages discussion. Pt: “I may not make it through the surgery. ” Nurse: “You think you are going to die?” ■ Reflection: Describes/interprets feelings/mood: “You sound upset. ” ■ Silence: Allows for reflection, processing a response. Prompts talking. Useful when patient is sad/grieving or remaining quiet. ■ Summarizing: Reviews key elements; brings closure. Clarifies expectations: “Today we talked about . . . ” ■ Touch: Conveys caring, is reassuring. May invade personal space; avoid with suspicious or angry patients. Hold patient’s hand, patting gently on patient’s shoulder. ■ Validation: Confirms what the nurse heard or observed: “I understand that you just said . . . ” Barriers to Communication ■ Pain ■ Failing to listen ■ Overly optimistic statements (false reassurance) ■ Advising ■ Changing topic ■ Judgmental or minimizing comments

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    18 ■ Challenging, defensive, or disapproving responses ■ Direct probing and “how” and “why” questions ■ Interruptions, environmental noise, or extremes in temperature ■ Trite, common expressions (clichés) Leadership Leadership and Management Terms ■ Accountability: Answerable for actions/judgments regarding care ■ Autonomy: Nurse can make independent decision to decide/act ■ Case management: Coordination of interdisciplinary care for pt ■ Decentralized management: Staff participate in decision making ■ Performance appraisal: Evaluation of a nurse’s compliance (quality & quantity) with standards and roles within job description ■ Professional standards: Actions consistent with minimum safe professional conduct. Description of responsibilities. ANA, JCAHO, agency policy and procedure ■ Quality improvement: Activities to ↑ achievement of ideal care ■ Responsibility: Duties and activities that nurse is hired to perform Leadership Styles ■ Autocratic: Complete control over decisions, goals, plan, and evaluation of outcomes; firm, insistent; often used in emergencies or when staff is inexperienced or new ■ Democratic: Participative; shares responsibilities; uses role to motivate staff to achieve communal goals ( shared governance ), encourages intercommunication and contributions; used to help staff grow in abilities; ↑ motivation, ↑ staff satisfaction ■ Laissez-faire: Nondirective; relinquishes control & direction to staff; best used with experienced, expert, mature staff who know roles Tasks That May Not Be Delegated to Unlicensed Nursing Personnel ■ Assessing, analyzing, and interpreting data ■ Identifying nursing diagnoses ■ Formulating a plan of care ■ Evaluating pt responses to nursing care and extent of outcome achievement ■ Screening and classifying pts to determine priority to receive intervention (triage) BASICS

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    19 ■ Giving/monitoring parenteral medications ■ Performing patient teaching ■ Performing professional procedures (e.g., sterile irrigations, insertion of urinary catheter, colostomy irrigation, tracheal suctioning) Leader and/or Manager Qualities Effective leaders and managers need to: ■ Understand human behavior Have insight into its relationship to beliefs, values, feelings; be sensitive to others’ feelings and problems ■ Use effective communication skills Be clear, concise, avoid ambiguity; use appropriate format (verbal, written, formal, informal); be aware of own nonverbal behavior; support staff in growth of skills ■ Use power appropriately Power attained through place in table of organization (positional); power attained through knowledge and experience or perceived by staff (professional); do not abuse ■ Respond to staff needs Listen attentively, attend to needs, provide positive feedback, avoid favoritism, set realistic expectations, avoid mixed messages, and treat staff with respect: Counsel privately; keep promises; avoid threats, superior attitude, criticism, or aggressive confrontation ■ Delegate appropriately Right person (competent subordinate), right task (is within scope of practice), right situation (nursing assistant should not perform a routine task on an acutely ill patient), right communication (clear instructions, validate understanding of instructions), right supervision (monitor actions, evaluate outcomes, review with subordinate); leader retains accountability ■ Provide opportunities for personal growth Aid less experienced nurse to ↑ knowledge, experience, responsibility (e.g., mentor/preceptor, continuing education, staff education) ■ Use critical thinking and problem solving Process requires effective communication, assessment, planning, and participation of staff and evaluation of outcomes ■ Recognize conditions that are conducive to change Need is recognized by all staff and all have a stake in outcome; include all creatively in the process; focus on benefits; provide positive feedback; offer incentives ■ Process follows problem-solving process BASICS

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    20 ■ Change is planned and introduced gradually ■ Change is initiated in a calm rather than chaotic atmosphere; best after a prior successful change ■ Resistance is recognized and addressed; causes of resistance: change is threatening; lack of understanding; disagreeing with purpose/approach, beliefs, and values; ↑ in responsibility; habit; fear of failure Levels of Management ■ First-level: Supervises nonmanagerial staff; oversees day-to-day activities of a group (e.g., Team Leader, Charge Nurse) ■ Middle-level: Supervises a group of first-level managers (e.g., Supervisor, Coordinator, Head Nurse) ■ Upper-level: Organizational executives; sets goals and strategic planning (e.g., VP for Nursing, Associate Director of Nursing) Staff Nurse Role ■ Function as role model regarding professional conduct ■ Receive report from nurse previously responsible for patient ■ Make rounds on all pts immediately after receiving report ■ Set priorities regarding pt needs: Immediate threat to survival (problems with breathing, VS, ↓ LOC), requests for help (pain, toileting), urgent but not immediate needs (teaching) ■ Coordinate and/or perform care for assigned pts; use time-management skills; complete all care assigned ■ Delegate care to subordinates that is within their job description ■ Monitor care delegated; establish clear expectations; encourage communication; evaluate patient outcomes related to delegated tasks (nurse retains accountability for delegated tasks) ■ Give report to next nurse responsible for patient ■ Engage in quality improvement (QI) activities ■ Participate in intradepartmental and interdepartmental meetings Nurse Manager Role ■ Function as a role model regarding professional conduct ■ Set standards of performance; establish goals for the unit with the staff; mobilize staff and agency resources to attain goals ■ Support mutual trust; treat staff with respect; counsel privately ■ Empower staff: Support innovation, seek staff members’ opinions, promote professional environment and growth, reward growth ■ Perform pt rounds with multidisciplinary team BASICS

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    21 ■ Monitor nursing practice and achievement of standards ■ Design and implement a quality improvement (QI) program for the unit; engage staff in QI activities ■ Assist in staff development plan and orientation of new employees ■ Schedule staffing for the unit ■ Conduct regular staff meetings with all shifts ■ Evaluate performance of subordinates (performance appraisal) ■ Participate in intradepartmental and interdepartmental meetings Community Nursing ■ Community health nursing (public health nursing): Nursing care for a specific population living in the same geographic area, or groups having similar values, interests, and needs. Aims to develop a healthy environment in which to live ■ Public health functions: Community assessment, policy development, and facilitating access to resources. Cohesiveness is promoted by engaging community members in the problem-solving process and promoting empowerment through education, opportunities, and resources. Successful public health programs are congruent with that of the interests and goals of the community ■ Assessment of a community: ■ Structure (milieu): Geographical area, environment, housing, economy, water, and sanitation ■ Population: Age and sex distribution, density, growth trends, educational level, cultures and subcultures, religious groups ■ Social systems: Education, communication, transportation, wel- fare, and health care delivery systems; government and volunteer agencies ■ Community-based nursing: Nursing care delivered in the community while focused on a specific individual’s or family’s health care needs. The individual is viewed within the larger systems of family, community, culture, and society ■ Vulnerable populations: People at risk for illness (e.g., homeless, living in poverty, migrant workers, living in rural communities, pregnant adolescents, suicidal individuals, frail older adults) ■ Stigmatized groups: People viewed with disdain/disgrace (e.g., pts with dx of HIV positive, substance abuse, mental illness) ■ Settings in which nurses work: Homes, community health centers, clinics, industry, rehabilitation centers, schools, crisis intervention centers (phone lines), shelters, halfway houses, sheltered workshops, day care centers, forensic settings BASICS

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    22 ■ Roles of nurses: Discharge planner, case manager, counselor, and epidemiologist, health promoter, case finder, caregiver, educator, researcher, consultant, advocate, role model, change agent ■ Hospice care: Palliative (relieve or ↓ discomfort) and supportive care for dying persons and their caregivers. Experts in pain and symptom management. Focuses on preserving dignity and quality over quantity of life. Supports bereavement; usually during last 6mo of life ■ Respite care: Temporary care for homebound so that caregivers have relief from day-to-day responsibilities Patient Education Learning Domains Cognitive domain: Thinking, acquiring, comprehending, synthesizing, evaluating, storing, and recalling information. ■ Build on what pt knows. Present essential information first. Add information as pt asks questions. ■ Teaching strategies: Lecture, discussion, audiovisuals, printed material, computer-assisted and Web-based instruction. ■ Evaluation: Assess knowledge by verbal/written means. Affective domain: Addresses attitudes, feelings, beliefs, values. Takes time to internalize need-to-change behavior. ■ Understand own value system. Respect uniqueness of each pt. Help pt explore feelings. ■ Teaching strategies: Discussion, play, role modeling, panel discussion, groups, role-playing. ■ Evaluation: Evidence of behavior incorporated into lifestyle. Psychomotor domain: Addresses physical/motor skills. Requires dexterity and coordination to manipulate equipment. Ultimately performs a task with skill. ■ Achieve mastery of each step before moving on to next step. ■ Teaching strategies: Audiovisuals, pictures, demonstrations, models. ■ Evaluation: observation of performance of skill (return demonstration). Teaching and Learning—General Concepts ■ Education can prevent illness, promote or restore health, ↓ complications, ↑ independence and coping, ↑ individual and family growth. Incorporate throughout health care delivery. ■ Environment should be conducive to learning: Private, quiet, well lit, comfortable, and lack distractions (close door/curtain, shut off TV). ■ Teaching process should follow format of Nursing Process. BASICS

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