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International; Published by John Wiley & Sons, Limited. NCLEX® , NCLEX-RN® , and NCLEX-PN® are Registered Trademarks of the National Council of State Boards of Nursing, Inc.
International Standard Book Number: 978-0-323-42933-7
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Contributing Authors
Safa'a Al-Arabi, PhD, RN, MSN, MPH, Associate Professor and Accelerated BSN Track Administrator, School of Nursing, University of Texas Medical Branch, Galveston, Texas
Sharon L. Colley, PhD, MSN, BSN, RN, CNE, MSN Program Coordinator, Associate Professor, School of Nursing, Ferris State University, Big Rapids, Michigan
Claudine Dufrene, PhD, RN-BC, GNP-BC, CNE, Assistant Professor, Carol and Odis Peavy School of Nursing, University of St. Thomas, Houston, Texas
Tiffany Jakubowski, BSN, RN, ONC, CMSRN, Adjunct Nursing Faculty, Front Range Community College, Longmont, Colorado
Sandra R. Jemison, RN, MSN, Assistant Professor, Cox College of Nursing and Health Sciences, Springfield, Missouri
Necole Leland, MSN, RN, PNP, CPN, School of Nursing, University of Nevada, Las Vegas, Nevada
Abimbola Farinde, Pharmacist, PhD, Professor, College of Business, Columbia Southern University, Orange Beach, Alabama
Christina Flint, RN, MSN, MBA, Assistant Professor, Nursing, University of Indianapolis, Indianapolis, Indiana
Judith M. Hochberger, PhD, RN, Assistant Professor, Nursing, Roseman University, Henderson, Nevada
Lisa Tardo-Green, ABD, MSN, RN, Assistant Professor, Associate Degree Nursing, Cabarrus College of Health Sciences, Concord, North Carolina
Laura Williams, MSN, CNS, ONC, CCNS, Clinical Nurse Specialist, Center for Nursing Research and Advanced Nursing Practice, Orlando Health, Orlando, Florida
Preface
Welcome to HESI Comprehensive Review for the NCLEX-PN® Examination with online study exams by HESI.
Congratulations! This outstanding review manual with the companion Evolve site is designed to prepare nursing students for what is likely the most important examination they will ever take, the NCLEX-PN Licensing Examination. As a graduate of a PN nursing program, the student has the basic knowledge required to pass tests and perform safely and successfully in the clinical area. HESI Comprehensive Review for the NCLEX-PN® Examination with the companion Evolve site allows the nursing student to prepare for the NCLEX-PN licensure exam in a structured way
• Organize basic nursing knowledge previously learned
• Review content learned during basic nursing curriculum.
• Identify weaknesses in content knowledge so that study efforts can be focused appropriately.
• Develop test-taking skills so application of safe nursing practice from knowledge can be demonstrated
• Reduce anxiety level by increasing ability to correctly answer NCLEX-type questions.
• Boost test-taking confidence by being well prepared and knowing what to expect.
Organization
Chapter 1, Introduction to Testing and the NCLEX-PN® Examination, gives an overview of the NCLEX-PN Licensing Exam history and a test plan for the examination A review of the nursing process (updated with the latest NANDA-approved nursing diagnoses), client needs, and prioritizing nursing care is also presented.
Chapter 2, Leadership and Management, reviews the legal aspects of nursing, leadership, and management, along with disaster nursing.
Chapter 3, Advanced Clinical Concepts, presents nursing assessment (data collection), analysis (nursing diagnosis), planning, and intervention at the practical nurse level Respiratory failure, shock, disseminated intravascular coagulation (DIC), resuscitation, fluid and electrolyte balance, acid-base balance, electrocardiography (ECG), perioperative care, HIV, pain, and death and grief are reviewed.
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, but essential knowledge about basic anatomy, medications, nutrition, communication, client and family education, acute and chronic care, leadership and management, and clinical decision-making are integrated throughout the different components.
Open-ended style questions appear at the end of each chapter, which encourage the student to think in depth about the content presented throughout the individual chapter. When a variety of learning mechanisms is used, students have the opportunity to comprehensively prepare for the NCLEX. These strategies include the following:
• Reading the review book
• 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. The purpose of the open-ended questions appearing at the end of the chapter is not a focused practice session on managing NCLEXstyle multiple-choice questions, but instead this learning approach allows for more in-depth thinking about the particular topics in the chapter. Practice with multiple-choice–style questions alone cannot provide the depth of critical thinking and analysis possible with the short-answer–style questions at the end of the chapter Additionally, the open-ended questions provide a summary experience that helps students focus on the main topics that were covered in the chapter. Teachers use open-ended–style questions to stimulate the criticalthinking process, and HESI Comprehensive Review for the NCLEX-PN®
Examination facilitates the critical-thinking process by posing the same type of questions the teacher might ask.
When students need to practice multiple-choice–style questions, the Study Exams offer extensive opportunities for practice and skill-building to improve their test-taking abilities The Study Exams contain seven content-specific exams (Medical-Surgical Nursing, Pharmacology, Pediatrics, Fundamentals, Maternity, Psychiatric-Mental Health Nursing, and Gerontology) and two comprehensive exams patterned after categories on the NCLEX. The Study Exams can be accessed as many times as necessary, and no questions are repeated For instance, the Medical-Surgical exam does not contain questions that are on the Pediatrics exam The purpose of providing these exams is to allow practice and exposure to the critical-thinking–style questions that students will encounter on the NCLEX. However, the Study Exams should not be used to predict performance on the NCLEX. Only the HESI Exit Exam a secure, computerized exam that simulates the NCLEX test plan and has evidenced-based results from numerous research studies indicating a high level of accuracy in predicting NCLEX success is offered as a true predictor of NCLEX performance. Students are allowed unlimited practice on each Study Exam so that they can have the opportunity to review all of the rationales for the questions.
Here is a plan for students to use with the companion Evolve site:
• Trial 1: Take the PN Practice Exam without studying for it to determine your areas of strengths and weaknesses.
• Trial 2: After going over the content that relates to the practice questions on a particular practice test (for instance, Pediatrics, Medical-Surgical, Maternity), review that section of the manual and take the test again to determine whether you have been able to improve your scores
• Trial 3: Purposely miss every question on the exam so that you can view rationales for every question.
• Trial 4: Take the exam again under timed conditions at the pace that you would have to progress to complete the NCLEX in the time allowed (approximately 1 minute per question) Find out whether being placed under timing constraints affects your performance.
• Trial 5: Put the exam away for a while and continue review and remediation with other textbook resources, results of any secure exams that you are taking at your school, and other study aids. Take the practice exams again after this study period to see whether your performance improves with in-depth study and a few weeks’ break from the questions
Trial 5 represents a good activity in preparation for the HESI Exit Exam presented in your final semester of the program, especially if you have not used the Evolve question site 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 are not a prediction of NCLEX-PN success. The tendency to memorize the questions after viewing them multiple times falsely elevates the student’s scores
on the study exams.
Additional assistance for students to study for the NCLEX-PN Licensing Examination can be obtained from a variety of products in the Elsevier family. Many nursing schools have also adopted the following resources:
• HESI Examinations a comprehensive set of examinations designed to prepare nursing students for the NCLEX exam. These enable customized remediation from Mosby and Saunders textbooks that saves time for faculty and students. 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 complimentary feature of the HESI specialty and exit exams, can be obtained on the subject matter in which the student did not answer a question correctly.
• HESI-PN Practice Test a test that provides an introduction to real-world client situations with critical-thinking questions. These questions cover nursing care for clients with a wide range of physiologic and psychosocial alterations and a related coordination of client care, pharmacology, and nursing concepts.
• HESI Complete PN Case Study Collection prepares students to manage complex patient conditions and make sound clinical judgments. These online case studies cover a broad range of physiologic and psychosocial alterations, in addition to related coordination of care, pharmacology, and therapeutic concepts.
• HESI Live Review a Live Review Course presented by an expert faculty member who has received training by the Manager of Review Courses for Elsevier Review and Testing. Students are presented with a workbook and practice NCLEX-style questions that are used during the course
• eBooks online versions of the all Mosby and Saunders textbooks used in the student’s Nursing Curriculum. Search across titles, highlight, make notes, and more all on your computer.
• Elsevier Simulations using virtual clinical cases, standardized simulation scenarios, and electronic documentation software, Elsevier Simulations allow students to practice and apply skills in a controlled, monitored environment
• Evolve Courses created by experts using instructional design principles, this interactive content engages students with reading, animation, video, audio, interactive exercises, and assessments.
Introduction to Testing and the NCLEX-PN® Examination
The NCLEX-PN Licensing Examination
A. The main purpose of a licensing examination such as the NCLEX-PN is to protect the public.
B The NCLEX-PN is:
1 Developed by the National Council of State Boards of Nursing
2. Administered by the State Board of Nursing.
3. Designed to test the candidate’s capability for safe and effective nursing practice by measuring current, entry-level practical nursing behavior.
Job Analysis Studies
A. “Essential” knowledge on the NCLEX-PN test is determined by practice analysis studies.
B. Practical nurses (PNs or vocational nurses [VNs]) submit statements about the frequency of nursing activities and the related impact on client safety
HESI Hint
The 2015 LPN/VN Practice Analysis: Linking the NCLEX-PN Examination to Practice (Vol. 58) determines how frequently new practical nurses perform more than 150 types of nursing care activities From the analysis, the 2017 NCLEX-PN Test Plan (effective April 1, 2017) identifies four major client needs categories, and two of those categories are further divided into a total of six subcategories and five fundamental nursing processes. They provide a basis for establishing a minimum level of knowledge and skills for PNs to use with a diverse patient population, in any setting, and within the laws and rules of each state (Table 1.1, Client Needs, and Table 1.2, Practical/Vocational Nursing Processes).
HESI Hint
For more information on the NCLEX-PN Test Plan and content related to each category, go to www.ncsbn.org.
The Nursing Process and Nursing Diagnoses
A. PN role in the nursing process: Practical nurses use the nursing process to critically think and problem solve (see Table 1.2).
B Practical nurses assist the health care team to gather and organize data and recognize client needs and problems regardless of the client’s developmental stage or the health care setting. They also assist the RN in formulating nursing
diagnoses and developing plans of care
C. The National Conference of the North American Nursing Diagnosis Association (NANDA) guides nurses in the selection of nursing interventions for the purpose of achieving specific outcomes; outcomes and interventions are associated with specific diagnoses (Table 1 3, Components of a Nursing Diagnosis, and Appendix A, NANDA-Approved Nursing Diagnoses).
HESI Hint
A nursing diagnosis is not a medical diagnosis because a nursing diagnosis: Is subject to nursing management. May or may not come from a medical diagnosis. Is formulated and written by nurses. Is implemented from nursing orders (care plan and nursing interventions).
Prioritizing Nursing Care on NCLEX-PN
A. Many NCLEX-PN test items are designed to test your ability to set priorities.
B. Some examples include:
1. Identify the MOST IMPORTANT client needs.
2. Identify the MOST IMPORTANT nursing intervention.
3 Which nursing action should be done FIRST?
4. Which client should be cared for FIRST?
Examination Item Formats
A. Several different item types (alternate item formats) are presented on the NCLEX-PN examination.
TABLE 1.1
Client Needs with Threaded Integrated Processes: Caring, Clinical Problem Solving, Culture & Spirituality, Communication & Documentation, and Teaching & Learning
Based on the results of the 2014 LPN/VN Practice Analysis: Linking the NCLEX-PN Examination to Practice (Vol 58) The percentages indicate the amount of questions written for each client need category in the 2015 NCLEX-PN Test Plan
Adapted from National Council of State Boards of Nursing, Inc NCLEX-PN Examination: Test Plan for the National Council Licensure Examination for Licensure Practical/Vocational Nurses, 2015, Chicago, IL www ncsbn org
1. The majority of the questions are multiple-choice items with four choices (answers) from which to choose one correct answer
2. Multiple-response items require the candidate to select one or more responses from five to seven choices. The item instructs the candidate to choose all that apply.
3. Fill-in-the-blank questions require the candidate to calculate the answer and type in the numbers
4 Hot-spot items require the candidate to identify an area on a picture or graph and click on the area.
5. Chart/exhibit format presents a chart or exhibit that the candidate needs to read to be able to answer the problem.
1.2
TABLE 1 3
Components of a Nursing Diagnosis
6. Ordered response items require a candidate to rank order or move options to provide the correct order of actions or events
7. Graphic format items require the candidate to choose the correct graphic in response to the question.
8. Audio format items require the candidate to listen to an audio clip using headphones and then select the correct option that applies to the audio clip
B. There is no set percentage of alternate items on the NCLEX-PN examination. All examination items are scored either right or wrong. There is no partial credit in scoring any examination questions.
Administration of the NCLEX-PN
A. The NCLEX-PN Computer Adaptive Testing (CAT) is administered at Pearson Professional Centers in the United States, selected by the National Council of State Boards of Nursing (NCSBN)
B Pearson VUE is responsible for adapting the NCLEX-PN examination to the CAT format, processing candidate applications, and transmitting test results to its data center for scoring.
C. The NCSBN generates the NCLEX-PN test items.
Understanding CAT
A. NCLEX-PN consists of 85 to 205 multiple-choice or alternative format items.
B. The candidate is presented with a test item.
1. If the question is answered correctly, a slightly more difficult item follows, and the level of difficulty increases with each item until an item is missed
2 If the question is answered incorrectly, a slightly less difficult item follows, and the level of difficulty decreases with each item until the candidate answers an item correctly.
C. The process continues until the candidate has achieved a definite “pass” or “fail” score. A message indicating that the candidate has completed the examination appears on the screen
D. The item number the candidate is currently answering appears in the upper right side of the screen.
E. The greatest number of items appearing on your examination is 205.
Taking the Test
A. A test administrator provides each candidate with an erasable note board that may be replaced as needed while testing. A candidate may not bring his or her own note boards, scratch paper, or writing instruments to the examination.
B. You must answer each question before proceeding to the next one. Returning to a question or skipping a question is not allowed during testing You will not be able to change an answer once you proceed to the next question; this works in your favor.
C. When taking the examination, read carefully and maintain a reasonable pace.
Time Frame and Breaks
A The candidate receives up to 5 hours to complete the examination The 5 hours include a tutorial, sample questions, breaks, and completion of the examination.
B. Two programmed optional breaks are given, one after 2 hours of testing and another after 3½ hours of testing. A candidate may take an unscheduled break at any time All breaks count against testing time
C. When candidates take a break, they must leave the testing room and will be required to provide a fingerprint before and after the break.
Results and Scoring
A When the candidate answers the minimum number of items (85) and has performed with 95% certainty above or below the passing standard, the computer test stops and calculates whether the candidate has passed or failed.
B. If a candidate has answered the maximum number of items (205) and is not at the end of the 5-hour limit, the candidate’s ability estimate is precise. So if the ability estimate is at or above the passing standard, the candidate passes, and if the ability estimate is at or below the passing standard, the candidate fails.
C. If a candidate has run out of time (5-hour limit) and has not answered the maximum number of items (205) but shows a consistent pattern above the passing standard, then the candidate will pass even if he or she has run out of time
D. A specific passing score is recommended by the NCSBN. All states require the same score to pass, so if you pass in one state, you are eligible to practice nursing in any other state.
HESI Hint
Results are not given at the testing centers. Results are mailed to the candidate by the boards of nursing about 1 month after taking the examination. The testing center staff does not have access to test results. The NCSBN does not want the testing center to be in a position of managing candidates’ reactions to scores, nor does it want those waiting to take their examinations to be influenced by such reactions.
Item Strategy
A. Every question must be answered to move to the next question, so make your best guess if you are not sure of the answer.
B One or more choices are likely to be very wrong Quickly eliminate those choices that do not answer the question.
C. Decide between two choices by:
1. Rereading the question for qualifiers or other words that specify what the question is asking.
2 Rereading the choices and deciding what makes them different from one another.
3. Examining the choice; it may contain correct information but not answer the question.
4. Using information from Maslow’s Hierarchy of Needs (Table 1.4) or Erikson’s Stages of Development (Table 1 5) to choose the correct response
D Trust your instincts The first response you have is a gut instinct and is an
educated guess. Do not second-guess yourself.
TABLE 1.4
Maslow’s Hierarchy of Needs
TABLE 1.5
Stages of Development and Associated Physical Characteristics
