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HESI Comprehensive Review for the NCLEX-RN® Examination

S I X T H E D I T I O N

Director of Live Review, Elsevier/HESI, Houston, Texas

Table of Contents

Cover image

Title page

Copyright

Contributing Authors

Preface

1. Introduction to Test-Taking Strategies and the NCLEX-RN®

Test-Taking Strategies

The NCLEX-RN

Job Analysis Studies

The NCLEX-RN Computer Adaptive Testing

Gentle Reminders of General Principles

2. Leadership and Management: Legal Aspects of Nursing

Legal Aspects of Nursing

Prescriptions and Health Care Providers

Review of Legal Aspects of Nursing

Leadership and Management

Maintaining a Safe Work Environment

Communication Skills

Review of Leadership and Management

Disaster Nursing

Ebola

Review of Disaster Nursing

3. Advanced Clinical Concepts

Respiratory Failure

Respiratory Failure in Children

Review of Respiratory Failure

Shock

Disseminated Intravascular Coagulation (DIC)

Review of Shock and DIC

Resuscitation

Management of Foreign Body Airway Obstruction (FBAO)

Review of Resuscitation

Fluid and Electrolyte Balance

Review of Fluid and Electrolyte Balance

Electrocardiogram (ECG)

Review of Electrocardiogram (ECG)

Perioperative Care

Review of Perioperative Care

HIV Infection

Pediatric HIV Infection

Review of HIV Infection

Pain: Fifth Vital Sign

Review of Pain

Death and Grief

Review of Death and Grief

4 Medical-Surgical Nursing

Communication

Health Promotion and Disease Prevention

Teaching/Learning

Spiritual Assessment

Cultural Diversity

Complementary and Alternative Interventions

Respiratory System

Review of Respiratory System

Renal System

Review of Renal System

Cardiovascular System

Review of Cardiovascular System

Gastrointestinal (GI) System

Review of Gastrointestinal System

Endocrine System

Review of Endocrine System

Musculoskeletal System

Review of Musculoskeletal System

Neurologic System

Review of Neurologic System

Hematology and Oncology

Review of Hematology and Oncology

Reproductive System

Review of Reproductive System

Burns

Review of Burns

5. Pediatric Nursing

Growth and Development

Pain Assessment and Management in the Pediatric Client

Review of Child Health Promotion

Respiratory Disorders

Review of Respiratory Disorders

Cardiovascular Disorders

Review of Cardiovascular Disorders

Neuromuscular Disorders

Review of Neuromuscular Disorders

Renal Disorders

Review of Renal Disorders

Gastrointestinal Disorders

Review of Gastrointestinal Disorders

Hematologic Disorders

Review of Hematologic Disorders

Metabolic and Endocrine Disorders

Review of Metabolic and Endocrine Disorders

Skeletal Disorders

Review of Skeletal Disorders

6. Maternity Nursing

Anatomy and Physiology of Reproduction

Antepartum Nursing Care

Review of Anatomy and Physiology of Reproduction and Antepartum Nursing Care

Fetal and Maternal Assessment Techniques

Review of Fetal and Maternal Assessment Techniques

Intrapartum Nursing Care

Review of Intrapartum Nursing Care

Normal Puerperium (Postpartum)

Review of Normal Puerperium (Postpartum)

The Normal Newborn

Review of the Normal Newborn

High-Risk Disorders

Review of High-Risk Disorders

Postpartum High-Risk Disorders

Review of Postpartum High-Risk Disorders

Newborn High-Risk Disorders

Effects on the Neonate of Substance Abuse

7. Psychiatric Nursing

Therapeutic Communication

Coping Styles (Defense Mechanisms)

Treatment Modalities

Review of Therapeutic Communication and Treatment Modalities

Anxiety and Related Disorders

Anxiety Disorders, Obsessive-Compulsive and Related Disorders, and Traumatic and Stressor Related Disorders

Review of Anxiety Disorders, Obsessive-Compulsive and Related Disorders, and

Traumatic and Stressor Related Disorders

Somatic Symptom Disorder and Related Disorders

Review of Somatic Symptom Disorder and Related Disorders

Dissociative Disorders

Review of Dissociative Disorders

Personality Disorders (DSM-5 Criteria)

Review of Personality Disorders

Eating Disorders

Review of Eating Disorders

Mood Disorders

Review of Mood Disorders

Schizophrenia Spectrum and Other Psychotic Disorders

Review of Thought Disorders

Substance Abuse Disorder

Substance Use Disorder

Review of Substance Abuse Disorder

Abuse

Review of Abuse

Neurocognitive Disorder (DSM-5)

Review of Neurocognitive Disorders

Childhood and Adolescent Disorders

Review of Childhood and Adolescent Disorders

8. Gerontologic Nursing

Theories of Aging

Neurocognitive Disorder (NCD): Dementia

Psychosocial Changes

Health Maintenance and Preventive Care

Review of Gerontologic Nursing

Answer Key to Review Questions

APPENDIX. Common Laboratory Tests

Index

Contributing Authors

Safa’a Al-Arabi, PhD, RN, MSN, MPH , Associate Professor and Master’s Track Administrator, University of Texas Medical Branch, Galveston, Texas

Karen Alexander, PhD, RN , Program Director at University of Houston Clear Lake, Pearland, Texas

Joanna Cain, BSN, BA, RN , President and Founder, Auctorial Pursuits, Inc., Austin, Texas

Lucindra Campbell-Law, PhD, ANP, PMHNP, BC , Professor, Carol and Odis Peavy School of Nursing, University of St. Thomas, Houston, Texas

E. Tina Cuellar, PhD, WHNP, PMHCNS, BC , Director of Live Review, Elsevier/Education/HESI, Houston, Texas

Claudine Dufrene, PhD, RN-BC, GNP-BC, CNE , Assistant Professor, Carol and Odis Peavy School of Nursing, University of St Thomas, Houston, Texas

Sandra Jenkins, PhD, RN , Visiting Professor, University of Houston Clear Lake, Pearland, Texas

Shatoi King, MSN, RN , Instructor, University of Houston Clear Lake, Pearland, Texas

Necole Leland, MSN, RN, PNP, CPN , Instructor, School of Nursing, University of Nevada, Las Vegas, Las Vegas, Nevada

Katherine Ralph, EdD, RN , Nurse Manager Curriculum, Review and Testing, Elsevier/Education/HESI, Houston, Texas

Preface

Welcome to HESI Comprehensive Review for the NCLEX-RN ® Examination with online study exams by HESI.

Congratulations! This outstanding review manual with online study exams is designed to prepare nursing students for what is very likely the most important examination they will ever take the NCLEX-RN Licensing Examination. HESI Comprehensive Review for the NCLEX-RN ® Examination allows the nursing student to prepare for the NCLEX-RN licensure examination in a structured way.

• Organize previously learned basic nursing knowledge

• Review content learned during basic nursing curriculum.

• Identify deficits in content knowledge so that study effort can be focused appropriately

• Develop test-taking skills to demonstrate application of safe nursing practice.

• Reduce anxiety level by increasing predictability of ability to correctly answer NCLEX-type questions.

• Boost test-taking confidence by being well prepared and knowing what to expect

Organization AND PREPARING TO TAKE TESTS

Chapter 1 , Introduction to Test-Taking Strategies and the NCLEX-RN ® , gives an overview of the NCLEX-RN Licensing Examination history and test plan for the examination. Reviews of the nursing process, client needs, and strategies for employing clinical judgement to prioritize nursing care are also presented.

Chapter 2 , Leadership and Management, reviews the legal aspects of nursing, leadership and management, and disaster nursing.

Chapter 3 , Advanced Clinical Concepts, presents nursing assessment, analysis, and planning and intervention, using clinical judgment at the highest level of practice. Topics reviewed include respiratory failure, shock, disseminated intravascular coagulation, resuscitation, fluid and electrolyte balance, intravenous therapy, acid–base balance, electrocardiogram, perioperative care, HIV, pain, and death and grief

Chapters 4 through 8 , Medical-Surgical Nursing, Pediatric Nursing, Maternity Nursing, Psychiatric Nursing, and Gerontologic Nursing, are presented in traditional clinical areas Each clinical area is divided into physiologic components, with essential knowledge about basic anatomy, growth and development, pharmacology and medication calculation, nutrition, communication, client and family education, acute and chronic care, leadership and management, complementary and alternative interventions, cultural and spiritual diversity, and clinical decision making threaded throughout the different components.

Open-ended questions with the answers appear at the end of each chapter, which encourage the student to think in depth about the content that is presented throughout the particular chapter. When a variety of learning mechanisms are used, students have the opportunity to comprehensively prepare for the NCLEX exam; these strategies include:

• Reading the manual

• Discussing content with others

• Answering open-ended questions

• Practicing with study exams that simulate the licensure examination

These learning experiences are all different ways that students should use to prepare for the NCLEX-RN exam. The purpose of the open-ended questions appearing at the end of the chapter is not a focused practice session on managing NCLEX-style questions, but rather a learning approach that allows for more in-depth thinking about specific topics in the chapter. Practice with multiple-choice questions alone cannot provide the depth of critical thinking and analysis that is made possible by the short-answer questions at the end of the chapter In addition, the open-ended questions presented at the end of the chapter provide a summary experience that helps students focus on the main topics that were covered in the chapter. Teachers use open-ended questions to stimulate the critical-thinking process, and HESI Comprehensive Review for the NCLEX-RN ® Examination facilitates the critical-thinking process by posing the same type of questions the teacher might ask

When students need to practice multiple-choice questions, the online study exams on

Evolve offer extensive opportunities for practice and skill building to improve their testtaking abilities The online study exams include six content-specific exams (MedicalSurgical Nursing, Pharmacology, Pediatrics, Fundamentals, Maternity, and PsychiatricMental Health Nursing) and two comprehensive exams patterned after categories on the NCLEX-RN exam The online study exams on Evolve can be accessed as many times as necessary, and the questions from one study exam are not contained on another study exam. For instance, the Medical-Surgical study exam does not contain questions that are on the Pediatrics study exam. The purpose of the study exams is to provide practice and exposure to the critical thinking–style questions that students will encounter on the NCLEX-RN exam. However, the study exams should not be used to predict performance on the actual NCLEX-RN exam. Only the HESI Exit Exam, a secure, computerized exam that simulates the NCLEX-RN test plan and has evidence-based results from numerous research studies indicating a high level of accuracy in predicting NCLEX success, is offered as a true predictor exam. Students are allowed unlimited practice on each online study exam so that they can be sure to have the opportunity to review all of the rationales for the questions

Here is a plan for a student to use with the online study exams:

• Step 1: Take the RN study exam without studying for it to see where your strengths and weaknesses are

• Step 2: After going over the content that relates to the study questions in a particular clinical area (e.g., Pediatrics, Medical-Surgical, or Maternity), review that section of the manual and take the test again to determine whether you have been able to improve your scores.

• Step 3: Purposely miss every question on the exam so that you can view the rationales for every question.

• Step 4: Take the exam again under timed conditions at the pace that you would have to progress in order to complete the NCLEX-RN exam in the time allowed (approximately 1 minute per question). See if being placed under time constraints affects your performance.

• Step 5: Put the exam away for a while and continue review and remediation with other textbooks, resources, and results of any HESI secure exams that you have taken at your school. Then, take the study exams again to see if your performance improves after in-depth study and following a few weeks’ break from these questions.

Step 5 represents a good activity in preparation for the HESI Exit Exam presented in your final semester of the nursing program, especially if you have not used the online study exams for several weeks. Repeated exposure to the questions, however, will make them less useful over time because students tend to memorize the answers. For this reason, these tests are useful only for practice and not for prediction of NCLEX-RN success. The tendency to memorize the questions after viewing them multiple times falsely elevates a student’s score on the study exams.

Additional assistance for students studying for the NCLEX-RN Licensing Examination can be obtained from a variety of online products in the Elsevier family Many nursing schools have also adopted the following:

• HESI Examinations A comprehensive set of examinations designed to prepare nursing students for the NCLEX exam They include customized electronic remediation from current Elsevier textbooks and multimedia, as well as additional practice questions. Each student is given an individualized report detailing exam results and is allowed to view questions and rationales for items that were answered incorrectly. The electronic remediation, a complementary feature of the specialty and exit exams, can be filed by the student for later study.

• HESI Practice Test This is the ideal way to practice for the NCLEX exam. With more than 1200 practice questions included in this online test bank, nursing students can access practice exams 24 hours a day, 7 days a week. HESI Practice Test questions are written at the critical-thinking level so that students are tested not for memorization but for their skills in clinical application. Students select a test option (either a clinical specialty or a comprehensive exam), and HESI Practice Test automatically supplies a series of critical-thinking practice questions. NCLEX exam–style questions include multiple-choice and alternate-item formats and are accompanied by correct answers and rationales

• HESI RN Case Studies These prepare students to manage complex patient conditions and make sound clinical judgments. These online case studies cover a broad range of physiologic and psychosocial alterations, plus related management, pharmacology, and therapeutic concepts

• HESI Patient Reviews These are designed to teach and assess students’ retention of core nursing content. These online interactive reviews provide a firsthand look at safe and effective nursing care.

• HESI Live Review A live review course is presented by an expert faculty member who has additional instruction in working with students who are preparing to take the NCLEX exam. Students are presented with a workbook and practice NCLEX-style questions that are used during the course

• Evolve eBooks Online versions of all of the Mosby, Saunders, and Elsevier textbooks used in the student’s nursing curriculum are presented. Search across titles, highlight, make notes, and more all on your computer.

• Elsevier Simulations Virtual versions simulate the clinical environment These multilayered, complex, supplemental simulations enable students to experience clinical assignments without the need for actual clinical space.

• Elsevier Courses These are created by experts using instructional design principles This interactive content engages students with reading, animation, video, audio, interactive exercises, and assessments.

Next Generation NCLEX and Clinical Judgment

Starting in July of 2017, the National Council of State Boards of Nursing (NCSBN) began including a special research section to select candidates after they complete the exam. The data collected from this section is used to help determine new item types that may be included in a future version of the NCLEX, known as Next Generation NCLEX (NGN). (More information can be found at ( http://www ncsbn org/next-generationnclex.htm. ) An important piece of the NGN is the clinical judgment model. Clinical judgment is important for all nurses, and this book helps nursing students by reviewing information and skills that nurses must master to practice clinical judgment. Additionally, NCLEX practice questions on the Evolve website written at higher levels of Bloom’s taxonomy help students practice applying their clinical judgment knowledge. Finally, a Clinical Judgment Scenario with practice NGN questions is included in Chapter 4 to familiarize students with these types of questions

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