NCLEX-PN Exam Cram

Wilda Rinehart Gardner received an Associate Degree in Nursing from Northeast Mississippi Community College in Booneville, Mississippi. After working as a staff nurse and charge  nurse, she became a public health nurse and served in that capacity for a number of years. In 1975, she received her nurse practitioner certification in the area of obstetrics-gynecology from the University of Mississippi Medical Center in Jackson, Mississippi. In 1979, she completed her Bachelor of Science degree in Nursing from Mississippi University for Women. In 1980, she completed her Master of Science degree in Nursing from the same university and accepted a faculty position at Northeast Mississippi Community College, where she taught medical-surgical nursing and maternal-newborn nursing. In 1982, she founded Rinehart and Associates Nursing Consultants. For the past 26 years, she and her associates have worked with nursing graduates and schools of nursing to assist graduates to pass the National Council Licensure Exam for Nursing. She has also worked as a curriculum consultant with faculty to improve test construction. Ms. Rinehart has served as a convention speaker throughout the southeastern United States and as a reviewer of medical-surgical and obstetric texts. She has co-authored materials used in seminars presented by Rinehart and Associates Nursing Review.   Dr. Diann Sloan received an Associate Degree in Nursing from Northeast Mississippi Community College, a Bachelor of Science degree in Nursing from the University of Mississippi, and a Master of Science degree in Nursing from Mississippi University for Women. In addition to her nursing degrees, she holds a Master of Science in Counseling Psychology from Georgia State University and a Doctor of Philosophy in Counselor Education, with minors in both Psychology and Educational Psychology, from Mississippi State University. She has completed additional graduate studies in healthcare administration at Western New England College and the University of Mississippi. Dr. Sloan has taught pediatric nursing, psychiatric mental health nursing, and medical-surgical nursing in both associate degree and baccalaureate nursing programs. As a member of Rinehart and Associates Nursing Review, Dr. Sloan has conducted test construction workshops for faculty and nursing review seminars for both registered and practical nurse graduates. She has co-authored materials used in the item-writing workshops for nursing faculty and Rinehart and Associates Nursing Review. She is a member of Sigma Theta Tau nursing honor society.   Clara Hurd received an Associate Degree in Nursing from Northeast Mississippi Community College in Booneville, Mississippi (1975). Her experiences in nursing are clinically based, having served as a staff nurse in medical-surgical nursing. She has worked as an oncology, intensive care, orthopedic, neurological, and pediatric nurse. She received her Bachelor of Science degree in Nursing from the University of North Alabama in Florence, Alabama, and her Master of Science degree in Nursing from the Mississippi University for Women in Columbus, Mississippi. Ms. Hurd is a certified nurse educator. She currently serves as a nurse educator consultant and an independent contractor. Ms. Hurd has taught in both associate degree and baccalaureate degree nursing programs. She was a faculty member of Mississippi University for Women; Austin Peay State University in Clarksville, Tennessee; Tennessee State University in Nashville, Tennessee; and Northeast Mississippi Community College. Ms. Hurd joined Rinehart and Associates in 1993. She has worked with students in preparing for the National Council Licensure Exam and with faculty as a consultant in writing test items. Ms. Hurd has also been a presenter at nursing conventions on various topics, including itemwriting  for nursing faculty. Her primary professional goal is to prepare the student and graduatefor excellence in the delivery of healthcare.

Introduction ...................................................................................................xxi

Welcome to the NCLEX-PN® Exam Cram ................................................................xxi

Taking the Computerized Adaptive Test.......................................................................xxii

The Cost of the Exam....................................................................................................xxii

How to Prepare for the Exam......................................................................................xxiii

How to Use This Book.................................................................................................xxiii

Self-Assessment................................................................................................1

Testing Your Exam Readiness............................................................................................2

Chapter 1 Preparing for the National Council Exam for Licensed Practical Nurses ................3

Preparing for the Exam.....................................................................................................4

 The Computer Adaptive Test ..................................................................................4

 Testing Strategies......................................................................................................5

 Reading the Question Carefully ..............................................................................6

 Look for Keywords...................................................................................................6

 Watch for Specific Details........................................................................................6

Exam Prep Questions ........................................................................................................9

 Answer Rationales...................................................................................................11

Chapter 2 Simplifying Pharmacology.....................................................................13

Pharmacology...................................................................................................................14

 Three Areas of Pharmacology ...............................................................................14

How Nurses Work with Pharmacology..........................................................................15

  Time-Released Drugs.............................................................................................16

 Administering Medications ....................................................................................17

Understanding and Identifying the Various Drugs ........................................................18

 Angiotensin-Converting Enzyme Inhibitors .........................................................18

 Beta Adrenergic Blockers .......................................................................................19

 Anti-Infectives (Aminoglycosides) .........................................................................20

 Benzodiazepines (Anticonvulsants/Antianxiety) ....................................................22

 Phenothiazines (Antipsychotic/Antiemetic) ..........................................................24

 Glucocorticoids.......................................................................................................25

 Antivirals .................................................................................................................26

 Cholesterol-Lowering Agents................................................................................28

 Angiotensin Receptor Blockers..............................................................................29

 Histamine 2 Antagonists ........................................................................................30

 Proton Pump Inhibitors .........................................................................................31

 Anticoagulants ........................................................................................................32

 More Drug Identification Helpers ........................................................................33

Herbals .............................................................................................................................34

Drug Schedules ................................................................................................................35

Pregnancy Categories for Drugs.....................................................................................35

Exam Prep Questions ......................................................................................................36

 Answer Rationales...................................................................................................38

Chapter 3 Caring for the Client with Disorders of the Respiratory System.........................41

Chronic Obstructive Pulmonary Disease .......................................................................42

 Chronic Bronchitis .................................................................................................42

 Emphysema.............................................................................................................42

 Asthma ....................................................................................................................43

Acute Respiratory Infections ...........................................................................................44

 Pneumonia ..............................................................................................................44

 Pleurisy....................................................................................................................45

 Tuberculosis ............................................................................................................46

 Influenza .................................................................................................................46

Acute Respiratory Failure................................................................................................47

 Acute Respiratory Distress Syndrome ...................................................................47

 Pulmonary Embolus ...............................................................................................48

Emerging Infections ........................................................................................................50

 Severe Acute Respiratory Syndrome .....................................................................50

 Legionnaire’s Disease .............................................................................................51

Diagnostic Tests for Review............................................................................................51

Pharmacology Categories for Review.............................................................................52

Exam Prep Questions ......................................................................................................53

 Answer Rationales...................................................................................................55

Suggested Reading and Resources ..................................................................................56

Chapter 4 Caring for the Client with Disorders of the Renal and Genitourinary System.........57

Acute Glomerulonephritis ...............................................................................................58

Chronic Glomerulonephritis...........................................................................................59

End Stage Renal Disease .................................................................................................60

 Peritoneal Dialysis ..................................................................................................60

 Hemodialysis...........................................................................................................60

 Renal Transplantation ............................................................................................61

Nephrotic Syndrome .......................................................................................................61

Urinary Calculi ................................................................................................................62

Urinary Tract Infections..................................................................................................63

Genitourinary Disorders .................................................................................................63

 Prostatitis ................................................................................................................63

Benign Prostatic Hyperplasia ..........................................................................................64

Bladder Cancer ................................................................................................................66

Diagnostic Tests for Review............................................................................................67

Pharmacology Categories for Review.............................................................................67

Exam Prep Questions ......................................................................................................68

 Answer Rationales...................................................................................................70

Suggested Reading and Resources ..................................................................................71

Chapter 5 Caring for the Client with Disorders of the Hematopoietic System .....................73

Anemia..............................................................................................................................74

 Pernicious Anemia..................................................................................................74

 Aplastic Anemia ......................................................................................................75

 Sickle Cell Anemia .................................................................................................76

 Iron Deficiency Anemia .........................................................................................77

 Cooley’s Anemia (Thalassemia Major) ..................................................................77

Hemophilia ......................................................................................................................77

Polycythemia Vera ...........................................................................................................78

Diagnostic Tests for Review............................................................................................79

Pharmacology for Review................................................................................................79

Exam Prep Questions ......................................................................................................80

 Answer Rationales...................................................................................................82

Suggested Reading and Resources ..................................................................................83

Chapter 6 Caring for the Client with Disorders of Fluid and Electrolyte Balance and Acid/Base Balance ...........................................................................................85

Basic Knowledge of Fluid and Electrolyte Balance........................................................86

Regulation of pH and Its Effect on Fluid and Electrolytes ...........................................87

 How the Body Regulates pH.................................................................................87

Metabolic Acidosis ...........................................................................................................87

 Causes of Metabolic Acidosis.................................................................................87

 Symptoms of Metabolic Acidosis ...........................................................................88

 Care of the Client with Metabolic Acidosis ..........................................................88

Respiratory Acidosis.........................................................................................................89

 Causes of Respiratory Acidosis ..............................................................................89

 Symptoms of Respiratory Acidosis ........................................................................90

 Caring for the Client with Respiratory Acidosis...................................................90

Metabolic Alkalosis ..........................................................................................................91

 Causes of Metabolic Alkalosis ................................................................................91

 Symptoms of Metabolic Alkalosis ..........................................................................91

 Caring for the Client with Metabolic Alkalosis ....................................................92

Respiratory Alkalosis........................................................................................................92

 Symptoms of Respiratory Alkalosis........................................................................92

Care of the Client with Respiratory Alkalosis.......................................................93

Normal Electrolyte Values ..............................................................................................93

Changes Associated with Aging ......................................................................................94

Exam Prep Questions ......................................................................................................96

 Answer Rationales...................................................................................................98

Suggested Reading and Resources ..................................................................................99

Chapter 7 Caring for the Client with Burns .............................................................101

Burn Classifications .......................................................................................................102

 Burn Measurement with TBSA ...........................................................................104

Nursing Care for Burn Victims.....................................................................................105

 The Emergent Phase............................................................................................106

 The Intermediate Phase .......................................................................................110

 Dressings for Burns ..............................................................................................111

 The Rehabilitative Phase......................................................................................112

Diagnostic Tests for Review..........................................................................................112

Pharmacology Categories for Review...........................................................................112

Exam Prep Questions ....................................................................................................114

 Answer Rationales.................................................................................................116

Suggested Reading and Resources ................................................................................117

Chapter 8 Caring for the Client with Sensorineural Disorders ......................................119

Disorders of the Eyes ....................................................................................................120

 Intraocular Disorders ...........................................................................................120

 Retinal Disorders..................................................................................................123

 Refractive Errors ..................................................................................................125

 Traumatic Injuries ................................................................................................126

Visual Tests for Review..................................................................................................127

Pharmacology Categories for Review...........................................................................127

Ear Disorders .................................................................................................................127

 Otitis Externa........................................................................................................128

 Otitis Media ..........................................................................................................128

 Meniere’s Disease .................................................................................................128

 Otosclerosis...........................................................................................................129

 Presbycusis ............................................................................................................129

 Ear Trauma ...........................................................................................................130

Assisting Clients with Hearing Loss .............................................................................130

Diagnostic Tests for Review..........................................................................................130

Pharmacology Categories for Review...........................................................................131

Exam Prep Questions ....................................................................................................132

 Answer Rationales.................................................................................................134

Suggested Reading and Resources ................................................................................135

Chapter 9 Caring for the Client with Cancer ...........................................................137

Cancer ............................................................................................................................138

 American Cancer Society’s Seven Warning Signs of Cancer..............................138

 The Four Major Categories of Cancer................................................................138

 Risk Factors for Specific Cancers ........................................................................139

 Cancer Prevention................................................................................................140

 Patient Teaching ...................................................................................................141

Management of the Client with Cancer .......................................................................141

 Radiation...............................................................................................................142

 Chemotherapy ......................................................................................................143

Bone Marrow Transplantation and Peripheral Stem Cell Transplantation (PSCT)...145

 Types of Transplants.............................................................................................145

 Nursing Care After Transplantation....................................................................146

Hodgkin’s Lymphoma ...................................................................................................147

 Diagnosis of Hodgkin’s Lymphoma.....................................................................147

 Prognosis of Hodgkin’s Lymphoma.....................................................................148

 Treatment of Hodgkin’s Lymphoma....................................................................148

Diagnostic Tests for Review..........................................................................................148

Pharmacology for Review..............................................................................................149

Exam Prep Questions ....................................................................................................151

 Answer Rationales.................................................................................................153

Suggested Reading and Resources ................................................................................154

Chapter 10 Caring for the Client with Disorders of the Gastrointestinal System.................155

Ulcers .............................................................................................................................156

 Types of Ulcers .....................................................................................................156

 Treatment of Ulcers .............................................................................................157

Inflammatory Bowel Disorders .....................................................................................159

 Crohn’s Disease (Regional Enteritis) ...................................................................159

 Ulcerative Colitis..................................................................................................160

Diverticulitis...................................................................................................................161

 Diagnosis of Diverticulitis....................................................................................161

 Treatment of Diverticulitis...................................................................................161

Gastroesophageal Reflux Disease (GERD) ..................................................................162

Diseases Associated with the Liver ...............................................................................163

 Hepatitis................................................................................................................163

 Cirrhosis................................................................................................................168

 Pancreatitis............................................................................................................170

Cholecystitis/Cholelithiasis ...........................................................................................172

 Symptoms of Cholecystitis and Cholelithiasis ....................................................172

 Diagnosis of Cholecystitis/Cholethiasis ..............................................................173

 Treatment of Cholecystitis ...................................................................................173

 Treatment of Cholethiasis ....................................................................................174

Clostridium Difficile......................................................................................................175

Food-Borne Illnesses .....................................................................................................175

Diagnostic Tests for Review..........................................................................................176

Pharmacology for Review..............................................................................................177

Exam Prep Questions ....................................................................................................178

 Answer Rationales.................................................................................................180

Suggested Reading and Resources ................................................................................181

Chapter 11 Caring for the Client with Disorders of the Musculoskeletal System................183

Fractures.........................................................................................................................184

 Treating Fractures ................................................................................................184

 Compartment Syndrome......................................................................................187

 Osteomyelitis ........................................................................................................188

Osteoporosis...................................................................................................................189

 Treatment of Osteoporosis...................................................................................190

Gout ...............................................................................................................................190

 Treatment of the Client with Gout .....................................................................191

Rheumatoid Arthritis .....................................................................................................192

 Treatment of Rheumatoid Arthritis .....................................................................192

Musculoskeletal Surgical Procedures ............................................................................193

 Fractured Hip and Hip Replacement ..................................................................193

 Total Knee Replacement ......................................................................................194

 Amputations..........................................................................................................195

Assistive Devices for Ambulation..................................................................................196

 Crutches ................................................................................................................197

 Canes.....................................................................................................................197

 Walkers .................................................................................................................198

Diagnostic Tests for Review..........................................................................................198

Pharmacology for Review..............................................................................................199

Exam Prep Questions ....................................................................................................201

 Answer Rationales.................................................................................................203

Suggested Reading and Resources ................................................................................204

Chapter 12 Caring for the Client with Disorders of the Endocrine System........................205

The Endocrine System..................................................................................................206

Pituitary Disorders.........................................................................................................206

 Tumors of the Pituitary........................................................................................207

Thyroid Disorders .........................................................................................................209

 Hypothyroidism....................................................................................................209

 Hyperthyroidism ..................................................................................................210

Parathyroid Disorders ...................................................................................................212

 Hypoparathyroidism.............................................................................................212

 Hyperparathyroidism ...........................................................................................213

Adrenal Gland Disorders...............................................................................................214

 Adrenocortical Insufficiency (Addison’s Disease) ................................................214

 Adrenocortical Hypersecretion (Cushing’s Syndrome) or Cushing’s Disease....215

Diabetes Mellitus ...........................................................................................................215

Diagnostic Tests for Review..........................................................................................219

Pharmacology Categories for Review...........................................................................219

Exam Prep Questions ....................................................................................................220

 Answer Rationales.................................................................................................222

Suggested Reading and Resources ................................................................................223

Chapter 13 Caring for the Client with Disorders of the Cardiovascular System..................225

Hypertension..................................................................................................................226

 Medications Used to Treat Hypertension ...........................................................227

Heart Block ....................................................................................................................227

 Toxicity to Medications ........................................................................................229

 Malfunction of the Conduction System ..............................................................229

Myocardial Infarction ....................................................................................................230

 Diagnosis of Myocardial Infarction .....................................................................231

 Management of Myocardial Infarction Clients ...................................................232

Inflammatory Diseases of the Heart .............................................................................235

 Infective Endocarditis...........................................................................................235

 Pericarditis ............................................................................................................235

Buerger’s Disease ...........................................................................................................236

Thrombophlebitis ..........................................................................................................236

Raynaud’s Syndrome......................................................................................................237

Aneurysms ......................................................................................................................237

Congestive Heart Failure ..............................................................................................238

 Diagnostic Tests for Review.................................................................................238

Pharmacology Categories for Review...........................................................................239

Exam Prep Questions ....................................................................................................240

 Answer Rationales.................................................................................................242

Suggested Reading and Resources ................................................................................243

Chapter 14 Caring for the Client with Disorders of the Neurological System ....................245

Seizures...........................................................................................................................246

 Types of Seizures ..................................................................................................246

 Treatment of Seizure Clients ...............................................................................248

Status Epilepticus...........................................................................................................249

Brain Injuries..................................................................................................................249

 Epidural Hematomas............................................................................................250

 Subdural Hematoma.............................................................................................250

 Treatment of Epidural and Subdural Hematomas ..............................................250

Increased Intracranial Pressure .....................................................................................251

 Treatment of ICP .................................................................................................253

Neurological Assessment ...............................................................................................253

 Cranial Nerve Assessment....................................................................................254

 Glasgow Coma Scale ............................................................................................255

 Intracranial Pressure Monitors ............................................................................256

    Care of the Client with Intracranial Surgery (Craniotomy) ........................................256

Cerebrovascular Accident/Stroke..................................................................................257

Spinal Cord Injury .........................................................................................................258

 Treatment of Spinal Cord Injuries.......................................................................259

 Potential Complications with SCI Clients ..........................................................260

Guillain-Barré ................................................................................................................261

 Treating Clients with Guillian-Barré...................................................................261

Degenerative Neurological Disorders ..........................................................................261

Diagnostic Tests for Review..........................................................................................263

Pharmacology for Review..............................................................................................263

Exam Prep Questions ....................................................................................................265

 Answer Rationales.................................................................................................267

Suggested Reading and Resources ................................................................................268

Chapter 15 Caring for the Client with Psychiatric Disorders ........................................269

Anxiety-Related Disorders ............................................................................................270

 Generalized Anxiety Disorder..............................................................................270

 Post-traumatic Stress Disorder ............................................................................271

 Dissociative Identity Disorder .............................................................................271

 Somatoform Disorder...........................................................................................272

 Panic Disorder ......................................................................................................272

 Phobic Disorders ..................................................................................................273

 Obsessive-Compulsive Disorder ..........................................................................273

Personality Disorders ....................................................................................................274

 Cluster A...............................................................................................................274

 Cluster B...............................................................................................................275

 Cluster C...............................................................................................................276

 Managing Clients with Personality Disorders ....................................................277

Psychotic Disorders .......................................................................................................277

 Schizophrenia .......................................................................................................277

 Bipolar Disorders..................................................................................................280

Substance Abuse.............................................................................................................282

 Alcoholism ............................................................................................................282

 Other Commonly Abused Substances .................................................................285

Disorders of Childhood and Adolescence.....................................................................287

 Conduct Disorder.................................................................................................287

 Oppositional Defiant Disorder ............................................................................287

 Attention Deficit Hyperactive Disorder..............................................................288

 Autistic Disorder...................................................................................................288

 Eating Disorders...................................................................................................289

Diagnostic Tests for Review..........................................................................................289

Pharmacology Categories for Review...........................................................................290

Exam Prep Questions ....................................................................................................291

 Answer Rationales.................................................................................................293

Suggested Reading and Resources ................................................................................294

Chapter 16 Caring for the Maternal/Infant Client......................................................295

Signs of Pregnancy ........................................................................................................296

 Presumptive Signs ................................................................................................296

 Probable Signs ......................................................................................................296

 Positive Signs ........................................................................................................297

Prenatal Care .................................................................................................................297

 Prenatal Diet and Weight Maintenance ..............................................................297

 Alpha-Fetoprotein Screening...............................................................................297

 Other Prenatal Diagnostic Tests ..........................................................................298

 Assessing Fetal Heart Tones.................................................................................299

 Ultrasonography ...................................................................................................299

Signs of Complications of Pregnancy ...........................................................................299

Types of Abortions.........................................................................................................300

Complications Affecting Pregnancy..............................................................................301

 Diabetes in Pregnancy..........................................................................................301

 Preeclampsia .........................................................................................................302

 Disseminated Intravascular Coagulation .............................................................303

 Cord Prolapse .......................................................................................................303

 Abruptio Placenta .................................................................................................303

 Placenta Previa......................................................................................................303

Maternal Infections........................................................................................................304

Preterm Labor ...............................................................................................................306

Intrapartal Care..............................................................................................................307

 Stages of Labor .....................................................................................................307

 Phases of Labor ....................................................................................................308

 Important Terms You Should Know....................................................................308

Prelabor Testing.............................................................................................................309

Fetal Monitoring............................................................................................................310

Pharmacologic Management of Labor .........................................................................312

Postpartum Care............................................................................................................313

Terms Associated with the Normal Newborn ..............................................................313

Rh Incompatibility.........................................................................................................314

Contraception ................................................................................................................315

Diagnostic Tests for Review..........................................................................................316

Pharmacology Categories for Review...........................................................................317

Exam Prep Questions ....................................................................................................318

 Answer Rationales.................................................................................................320

Suggested Reading and Resources ................................................................................321

Chapter 17 Caring for the Pediatric Client .............................................................323

Growth and Development.............................................................................................324

 Infant (28 Days to 1 Year) ....................................................................................324

 Toddler (1–3 Years)...............................................................................................326

  Preschooler (3–5 Years) ........................................................................................327

 School Age (6–12 Years) .......................................................................................328

 Adolescence (12–18 Years)....................................................................................329

Congenital Anomalies....................................................................................................329

 Anomalies of the Gastrointestinal System...........................................................330

 Anomalies of the Musculoskeltal System.............................................................334

 Anomalies of the Cardiovascular System.............................................................336

 Inborn Errors of Metabolism...............................................................................339

Respiratory Disorders....................................................................................................340

 Acute Otitis Media ...............................................................................................341

 Tonsillitis...............................................................................................................342

 Laryngotracheobronchitis ....................................................................................343

 Acute Epiglottitis..................................................................................................343

 Bronchiolitis..........................................................................................................344

 Cystic Fibrosis (Mucoviscidosis) ..........................................................................345

Gastrointestinal Disorders.............................................................................................345

 Gastroenteritis ......................................................................................................346

 Pyloric Stenosis.....................................................................................................346

 Intussusception .....................................................................................................346

 Celiac (Gluten-Induced Enteropathy, Celiac Sprue) ..........................................347

Cardiovascular Disorders ..............................................................................................347

 Rheumatic Fever...................................................................................................347

 Kawasaki’s Disease (Mucocutaneous Lymph Node Syndrome) .........................348

Musculoskeletal Disorders.............................................................................................350

 Scoliosis.................................................................................................................350

 Legg-Calve-Perthes Disease (Coxa Plana) ..........................................................351

 Muscular Dystrophies...........................................................................................351

Childhood Cancer .........................................................................................................352

 Wilms Tumor (Nephroblastoma) ........................................................................352

 Leukemia...............................................................................................................352

 Osteogenic Sarcoma (Osteosarcoma) ..................................................................352

Ingestion of Hazardous Substances...............................................................................353

 Salicylate Overdose...............................................................................................353

 Acetaminophen (Tylenol) Overdose ....................................................................353

 Lead (Plumbism) ..................................................................................................353

 Iron Poisoning ......................................................................................................354

Diagnostic Tests for Review..........................................................................................354

Pharmacology Categories for Review...........................................................................355

Exam Prep Questions ....................................................................................................356

 Answer Rationales.................................................................................................358

Suggested Reading and Resources ................................................................................359

Practice Exam 1 .............................................................................................361

Answers to Practice Exam 1 ...............................................................................405

Practice Exam 2 .............................................................................................427

Answers to Practice Exam 2 ...............................................................................469

Appendix A Things You Forgot............................................................................491

Appendix B Need to Know More? ........................................................................499

Appendix C Calculations...................................................................................507

Glossary ......................................................................................................511

TOC, 9780789753151, 5/1/2014