NCLEX-RN®EXCEL
TestSuccessThroughUnfoldingCaseStudyReview
SecondEdition
RuthA.Wittmann-Price,PhD,RN,CNS,CNE,CHSE,ANEF,FAAN
BrendaReapThompson,MSN,RN,CNE
FrancesH.Cornelius,PhD,MSN,RN-BC,CNE
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Title:NCLEX-RNexcel:testsuccessthroughunfoldingcasestudyreview/[editedby]RuthA.WittmannPrice,BrendaReapThompson,FrancesH Cornelius
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Contents
Contributors
Reviewer
Foreword
Preface
GloriaFerraroDonnelly,PhD,RN,FAAN
ShareNCLEX-RN®EXCEL:TestSuccessThroughUnfoldingCaseStudyReview,SecondEdition
1.StrategiesforStudyingandTakingStandardizedTests
RuthA.Wittmann-Price,BrendaReapThompson,andFrancesH.Cornelius
2.Medical–SurgicalNursing
PartI:NursingCareofthePatientWithaCardiovascularDisorder
KarenK GittingsandBrendaReapThompson
PartII:NursingCareofthePatientWithaPulmonaryDisorder
NinaRussellandBrendaReapThompson
PartIII:NursingCareofthePatientWithRenalDisease
KarenK.GittingsandBrendaReapThompson
PartIV:NursingCareofthePatientWithaMusculoskeletalDisorder
NinaRussellandBrendaReapThompson
PartV:NursingCareofthePatientWithaNeurologicalDisorder
NinaRussellandBrendaReapThompson
PartVI:NursingCareofthePatientWithanEndocrineDisorder
KarenK GittingsandBrendaReapThompson
PartVII:NursingCareofthePatientWithaGastrointestinalDisorder
KarenK.Gittings,RuthA.Wittmann-Price,andBrendaReapThompson
PartVIII:NursingCareofPatientsWithInfectiousDiseases
NinaRussellandBrendaReapThompson
3 MentalHealthNursing
RoseannV ReganandRobertaWaite
4.Women’sHealthNursing
MaryFosterCoxandRuthA.Wittmann-Price
5.PediatricNursing
MaryannGodshall
6.Pharmacology
BrianJ.Fasolka
7.CommunityHealthNursing
MaryGallagherGordon
8.LeadershipandManagementinNursing
CherylPortwood
9.Men’sHealth
TracyP.George
10.GeriatricHealth
DeborahL Hopla
11.Veterans’Health
KarynE.Holt
Index
Contributors
FrancesH.Cornelius,PhD,MSN,RN-BC,CNE ClinicalProfessorandDepartmentChair AdvancedRoleMSNandComplementaryandIntegrativeHealthPrograms DrexelUniversity Philadelphia,Pennsylvania
MaryFosterCox,PhD,CPNP-PC ClinicalAssistantProfessor DepartmentofNursing UniversityofSouthCarolina Columbia,SouthCarolina
BrianJ.Fasolka,PhD,RN,CEN AssistantClinicalProfessor CollegeofNursingandHealthProfessions DrexelUniversity Philadelphia,Pennsylvania
TracyP.George,DNP,APRN-BC,CNE AssistantProfessor FrancisMarionUniversity Florence,SouthCarolina
KarenK.Gittings,DNP,RN,CNE AssociateDeanofHealthSciencesChair,NursingProgram DirectorofMSNNurseEducatorTrack AssociateProfessorofNursing FrancisMarionUniversity Florence,SouthCarolina
MaryannGodshall,PhD,CCRN,CPN,CNE AssistantClinicalProfessor CollegeofNursingandHealthProfessions DrexelUniversity Philadelphia,Pennsylvania
MaryGallagherGordon,PhD,MSN,RN,CNE ClinicalAssociateProfessor AssistantDean,StudentandTechnologyOperations CollegeofNursingandHealthProfessions DrexelUniversity Philadelphia,Pennsylvania
KarynE.Holt,PhD,CNM,NCC
AssociateClinicalProfessor DivisionofGraduateNursingAdvancedRoleMSNDepartment CollegeofNursingandHealthProfessions DrexelUniversity Philadelphia,Pennsylvania
DeborahL.Hopla,DNP,APRN-BC AssistantProfessor Director,MSN/FNPProgram FrancisMarionUniversity Florence,SouthCarolina
CherylPortwood,MSN,RN,NEA-BC,CNE AssistantClinicalProfessor CollegeofNursingandHealthProfessions DrexelUniversity Philadelphia,Pennsylvania
RoseannV.Regan,PhD,APRN,BC AssistantProfessor GwyneddMercyUniversity GwyneddValley,Pennsylvania
NinaRussell,DNP,FNP-C,APRN NursingInstructor FrancisMarionUniversity Florence,SouthCarolina
BrendaReapThompson,MSN,RN,CNE AdjunctFaculty
RN-BSNDegreeCompletionProgramCollegeofNursingandHealthProfessions DrexelUniversity Philadelphia,Pennsylvania
RobertaWaite,EdD,PMHCNS-BC,FAAN,ANEF ProfessorandAssistantDean
AcademicIntegrationandEvaluationofCommunityPrograms,DoctoralNursingDepartment CollegeofNursingandHealthProfessions DrexelUniversity Philadelphia,Pennsylvania
RuthA.Wittmann-Price,PhD,RN,CNS,CNE,CHSE,ANEF,FAAN Dean SchoolofHealthSciences
FrancisMarionUniversity Florence,SouthCarolina
Reviewer
AmandaMyrhen,RN,MSN
Instructor
FrancisMarionUniversity
Florence,SouthCarolina
Foreword
The most important test that any nurse will ever take is the National Council Licensure Examination-RN (NCLEX-RN®), validating safety to practice nursing and opening the door to professional nursing practice opportunities. Therefore, preparation for the NCLEX must begin early in the nursing program and provide a scaffold on which to hang the nursing knowledge and the skill base on which safe practice is built The authors of this review book understand the scaffolding process and its relationship to NCLEX success. They have watched nursing students strugglewithNCLEXpreparationandhavelearnedwhatworksandwhatdoesnot.
Insteadofanexhaustivelistofquestionsattachedtoasnippetofcaseinformation,thisunique review book presents a group of unfolding case studies that tell stories about real patients, clinical issues,andtheroleofthenurseinprovidinghigh-quality,safecare.Integratedintoeachunfolding case study are activities to increase comprehension, rapid response terms that highlight important information, and the pharmacological interventions required for the conditions being discussed. This book allows the student to make decisions about the cases as they unfold and encourages the student to “think like a nurse ” Practicing the role of the nurse is a novel and beneficial review methodofstudyingfortheNCLEX.
There are at least two schools of thought concerning NCLEX preparation. One asserts that passing the NCLEX is the sole responsibility of the student, the program having provided the curriculum and experiences. The second school of thought asserts that the nursing program is a collaborative partner in the student’s quest for licensure. Measures focusing on the attainment of licensure must be built into the curriculum from nursing foundations to senior seminar Every nursing faculty member who teaches undergraduate nursing students needs resource material to use in the course of teaching or to recommend to students as they prepare for the test that will launchtheircareers
Itisincumbentoneverynursingfacultymemberinvolvedinundergraduate,prelicensenursing education to know and use the resources that will enable the graduate’s successful career entry. Given the human and fiscal investment that a student makes while pursuing a nursing career, we need more effective tools to enable success on the licensure examination Ruth A WittmannPrice,BrendaReapThompson,andFrancesH.Corneliushavedevelopedacreativeandengaging approachtoNCLEXpreparationthathasthepotentialofensuringsuccessformanymorenursing schoolgraduates
GloriaFerraroDonnelly,PhD,RN,FAAN DeanandProfessor
CollegeofNursingandHealthProfessions DrexelUniversity Philadelphia,Pennsylvania
Preface
This book was designed with several purposes in mind It is foremost a review and remediation workbook for students who are about to take the National Council Licensure Examination-RN (NCLEX-RN® ; National Council of State Boards of Nursing, 2016). This book is also a unique casestudyworkbookforinstructorstoassigntostudentsthroughouttheircourseofundergraduate study for the purposes of (a) assisting faculty in delivering content in an innovative format, (b) assisting students in understanding the nature of clinical thinking, and (c) use in simulation environments.Thephilosophyofthisbookistoengagestudentsinactivelearningusingunfolding casestudies Carr(2015)states:
The use of the unfolding case study moves health care provider education from fact-based lecturing to situation-based discussion and decision making as a person ’ s condition or situation changes. Use of the unfolding case facilitates collaborative learning, covers necessary content, and assists students to think beyond the facts and use their clinical imagination Unfolding case studies require students to begin to grasp the nature of a clinicalsituationandadjustinterventionsastheclinicalsituationunfolds.(p.283)
In this way, unfolding case studies closely mimic real-life situations in nursing practice and are important situational mental models that are useful in assisting students to problem solve and to actively engage in and use critical-thinking techniques (Kaylor & Strickland, 2015). Unlike other NCLEX-RN preparation books that expect students to answer question after unrelated question, thisbookbuildscontentintothecasescenarios,therebyengagingstudentsintheprocessofhaving toconsideranevolving,andperhapsincreasinglycomplex,clinicalsituationbeforeansweringeach question
As you, the student, work and twist your mind through the unfolding case studies, you will begintoenvisionbeingapracticingregisterednursewhoisactivelyproblemsolvingand“thinking like a nurse ” Adopting this method of thinking will assist you in developing clinical-thinking skills that are important for NCLEX-RN success in assessment, planning, intervention, and evaluationofpatientcare.ThepatientcarecontentareasthatareessentialtomasterforNCLEXRN success safe and effective care, health promotion, and physiological and psychological integrity are interwoven throughout the unfolding case studies. You will find this unique format enjoyable; it will help you escape the drudgery of answering multiple-choice question after multiple-choice question, studying flashcards, medical terminology definitions, or simply wasting valuabletimeapplyingtest-takingtricks.
Let’s face it: The NCLEX-RN is a content-driven test. The unfolding case studies presented inthisstudy guidedeliverthecontentintermingledwithactivelearningstrategies Manydifferent evaluative forms are used in this book to help you assess your own learning. The question styles used include all those used on the NCLEX-RN licensing examination, including multiple-choice questions, select all that apply, hot spots, matching, true or false, prioritizing, and calculations ThisbookalsohasRapidResponseTipsthathelpstudentsmakeeasycognitiveconnectionsabout content, includes pharmacology principles of each nursing specialty, and has a chapter devoted completely to the review of medication administration principles The authors have heard and listened to the recommendations of nursing students that continuously ask for a pharmacology reviewthatisappliedtoclinicalsituations.
The correct responses to each question related to the case studies are easily accessible at the end of each chapter. The authors suggest that you work through each chapter, then go back and evaluate yourself, paying close attention to the content areas that might require remedial work beforetakingtheNCLEX-RNexamination.
The authors are committed to making this the best review book ever to break the endless review cycle of question after question and to support students’ ability to walk into the NCLEXRN examination with confidence. This book was written and compiled by practicing clinicians: nurses who work at the bedside and know how to multitask, prioritize, and lead novice nurses to success Please provide us with feedback on your experience using this book at cs@springerpub.com. We look forward to hearing from you and to you soon becoming one of our colleaguesinnursing.
RuthA Wittmann-Price BrendaReapThompson FrancesH.Cornelius
Resources
Carr, K. C. (2015). Using the unfolding case study in midwifery education. Journal of Midwifery&Women’s Health,60(3),283–290.doi:10.1111/jmwh.12293
Kaylor, S K, & Strickland, H P (2015) Unfolding case studies as a formative teaching methodology for novice nursing students JournalofNursingEducation,54(2), 106–110 doi:103928/01484834–2015012006 NationalCouncilofStateBoardsofNursing.(2016).Homepage.Retrievedfromncsbn.org
StrategiesforStudyingandTakingStandardizedTests
RuthA Wittmann-Price,BrendaReapThompson,andFrancesH Cornelius
Always bear in mind that your own resolution to succeed is more important than anyonething AbrahamLincoln
Many factors contribute to success in studying and test taking Once you learn about these, your life becomes much easier because you are “in the know.” This chapter briefly, but effectively, reviews key points that are important for all students who are about to embark on a “high-stakes” test
Motivation
Themostimportantaspectoftesttakingisstudying,andthemostimportantaspectofstudyingis motivation Donotworryifyouarenotalwaysmotivatedtositandstudy Motivationcomesfrom both internal and external sources and is not always consistent or stable for any one person. External factors that motivate are those that arise from the environment around you. Many different things, people, and issues can be the source of an external motivator, such as grades, parents,andcareergoals.Internalfactorsthatmotivateyoutostudyarethoseaspectsthatarepart ofyouanddriveyou;theyarepartofyourpersonalitymakeup.Positivethinkingcanincreaseyour motivation, as can the task of creating a study schedule and following it seriously so that it becomes part of your routine. The good news is that overall motivation can be improved through the introduction of such strategies. Successful time management, study, and test-taking skills will helpyoutoimproveyourmotivation
TimeManagement
Time management is a key strategy that we hear much about these days, probably because everyone ’ s day is so full. You cannot manage time; it just moves forward. But you can manage what you do with your time. Here are some hints that help successful test takers. Use a weekly calendar to schedule study sessions by outlining time frames for all of your other activities: home, school, and appointments. Then find the “unscheduled time” in your calendar. Make these times your study periods, and make them very visible by using color to highlight them either on your paper calendar or in your electronic timekeeper Make these “study times” priorities Another strategy is to investigate your learning style to optimize the time you devote to study by applying methodsthatmeshwithyourpersonallearningstyle(Thompson,2009).Youcanusethe3-month calendartemplateinTable11
TABLE1.1Three-MonthStudyCalendar
LearningStyles
Differentstudentslearndifferently.Tomaximizeyourlearningpotential,itishelpfultodetermine whattypeoflearneryouare.Quitesimply,alearningstyleisanapproachtolearning;youwantto usethestylethatworksbestforyou Mostlearnersmayhaveapredominantlearningstyle,butitis possible to have more than one style The four most common learning styles are defined by the acronymVARK,describedbyFleming(2001);VARKstandsfor:
Visual(V)
Auditory(A)
Read/write(R)
Kinesthetic(K)
The visual (spatial) learner learns best by what he or she sees, such as pictures, diagrams, flowcharts, timelines, maps, and demonstrations. A good way to learn a topic for a visual learner maybebyconceptmappingortheuseofcomputergraphics
If you are an aural/auditory learner, you prefer information that is heard or spoken You may learn best from lectures, tapes, tutorials, group discussion, speaking, web chats, e-mails, mobile phones,andreadingaloudthecontentyouarestudying Byreadingaloud,youmaybeabletosort thingsoutandgainunderstanding(Brancato,2007;Fleming,2001)
A read/write learner prefers information offered in the form of written words. This type of learner likes text-based input and output in all of its forms Students who prefer this method like PowerPoint presentations, the Internet, lists, dictionaries, thesauri, quotations, and anything with writtenwords(Fleming,2001).
The fourth type of learner is characterized as kinesthetic and uses the body and sense of touch
to enhance learning. This type of learner likes to think out issues while working out or exercising. Kinesthetic learners prefer learning content through gaming or acting. This type of learner (Fleming, 2001) appreciates simulation or a real-life experience Felder and Solomon (1998) refer totheselearnersasactivelearners.
It is not hard to find out what type of learning style will work best for you. You can easily use the Internet to search “learning styles,” and a variety of self-administered tests are available for self-assessment. Having this insight about yourself is just one more way of becoming a more successfultesttaker!
SuccessfulStudying
Other studying tips are also helpful for many students First, eliminate external sources of distraction (TV, radio, phone) while studying Even though many people feel that they study better with music, there is no evidence to support this notion. Eliminate your internal sources of distraction, such as hunger, thirst, or thoughts about problems that cannot be worked out at that moment If there is an interpersonal relationship issue bothering you with a family member, friend, or partner try to talk it out and clear it up before your scheduled “study time.” In addition, do not forget to treat yourself well and take breaks. Take a 10-minute break after each hour of study During your break, get up and stretch, have a glass of water, or get yourself a snack (Thompson,2009).
Create a conducive study environment Get comfortable but not so comfortable that you fall asleep! Use a clean, clear, attractive workspace Have all the materials that you need assembled so thatyouwon’thavetointerruptyourselftolookforthingslikeapenorastapler.
What to study can pose another dilemma. Many nurse educators suggest that the best way to go is to concentrate on questions of the National Council Licensure Examination-RN (NCLEXRN®) type. Others propose that you should use material that reviews content. We are suggesting thatacombinationofthetwoisbest Bycompletingquestionsasyouronlystrategy,youmaymiss important information. Therefore, if you are reviewing information that truly escapes your memory, go back to a reliable source, such as a textbook, and reread that content. Let’s face it: Some of the topics learned in the beginning of your professional education may be slightly harder torecallthancontentlearnedinthefinalcourses.
OrganizingInformation
Theuseofstudyingframeworkscanbehelpfulinorganizinginformation.Oneofthebestwaysto organize information is to think of the answer in terms of the nursing process framework The nursing process was created as a logical method to solve problems of patient care Assessment is always the first step of the process, because you need to comprehend all aspects of the patient’s physical and emotional situation before making a nursing diagnosis Once you have a nursing diagnosis, you can create a nursing plan Then you can confidently carry out that plan by implementing the nursing interventions. The only way to know whether those interventions work is to evaluate the outcome; then you reassess the situation and the process then starts over again. An example of a question that can be answered by applying the nursing process framework is showninExercise1.1.
EXERCISE1.1Multiple-choice:
Thephysicianorderstheinsertionofacatheterintothepatient’sabdomenforperitonealdialysis Inpreparing apreoperativeteachingplanforthispatient,thenursewouldinitially:
A. Invitethepatient’sfamilytojointhepreoperativeteachingsession
B Askthephysicianwhatinformationwasalreadydiscussedwiththepatient
C. Assessthepatient’sknowledgeandunderstandingabouttheprocedure
D Havetheoperativepermitsignedandtheninstitutetheteachingplan
Other frameworks may include using mnemonics, and these work well for many students A familiaroneisABC (airway, breathing, and circulation). Exercise1.2 is a question that lends itself tothemnemonicprinciple.
EXERCISE1.2
Multiple-choice:
Thenurseiscaringforaclientwhohasreturnedfromsurgeryafterabelow-the-kneeamputationoftheright lowerextremity Whatwouldthenurseassessfirst?
A Temperature
B Tissueperfusion
C Pain
D. Orientation
Other mnemonics are not so familiar but often helpful, such as VEAL CHOP (see Table 1.2). ThismnemonicisfurtherexplainedinChapter4
Many other methods help learners to understand and remember what they need to know; these include visualization strategies, games, fact sheets, and tables for comparison. For example, Table 13 shows a comparison for a patient experiencing midtrimester vaginal bleeding to help a learnerremembertheprimarysymptoms.
EstablishingStudyGroups
Another strategy is to form study groups; these work well for many learners. If you choose to try workingwithastudygroup,startwithasmallonewhosemembersgetalongwell Youcanchoose a leader who can keep a list of members’ contact information and can schedule a time and place that is convenient and comfortable for everyone. Each person should be assigned a role and do some presession preparation. Everyone in the group should take the responsibility of keeping the others on task and using the time together in the most productive manner This does not mean thatthestudygroupcannottakebreaks,butbreaksshouldbeplanned(Thompson,2009).
TABLE1.2Fetal-MonitoringBasics
TABLE1.3ComparisonofThird-TrimesterBleeding
Sign PlacentaPrevia PlacentalAbruption
Pain No Yes
Bleeding Yes Notalways
Abdomen Soft Ridged
UnderstandingtheNCLEX-RNExam
TheNCLEX-RNexamwasdevelopedfromaspecifictestplan.Mostnursingstudentsknowthat there are at least 75 questions and possibly as many as 265 (National Council of State Boards of
Nursing[NCSBN],2016) EachNCLEX-RNtestalsocontains15testorpracticeitemsmixedin with the scored questions. The questions are developed by using Bloom’s revised taxonomy (Bloom,Englehart,Furst,Hill,&Drathwohl,1956)(Table14)
Table1.5providesExercises1.3to1.8,whichareexamplesofNCLEX-RNtypesofmultiplechoicequestionsateachlevelofBloom’staxonomy.
TABLE1.4Blooms’sRevisedTaxonomy
Creating Generatingnewideas,designing,constructing,planning,andproducing Evaluating Justifyingadecisionorcourseofaction,checking Analyzing Breakinginformationintopartstoexploreunderstandingsandrelationships Applying Implementing,carryingout,using,executing Understanding Explainingideasorconcepts,interpreting,summarizing,explaining Remembering Recallinginformation,recognizing,listing,describing
TABLE1.5ExampleQuestionsUsingBloom’sTaxonomy
LevelofBloom’sRevisedTaxonomy NCLEX-RN®TypeofMultiple-ChoiceQuestion
CreatingEXERCISE13
EvaluatingEXERCISE14
AnalyzingEXERCISE15
ApplyingEXERCISE16
Agroupofoutpatientswiththyroiddysfunctionarebeingtaughtabouttheirdisease Onepatientison levothyroxine(Synthroid)andstatesthathedoesnotunderstandthereason Thepatienttellsthegroup thathetakesthemedicationinconsistently Thenurseshould:
A Tellthepatienttogotohisdoctor
B Talktothepatientafterclass
C Re-adjusttheteachingtoemphasizecorrectmedicationadministration
D Telltheclassthatthisisincorrectandsuggestthatthepatienthasindividualclasssessions
Apatientwhoistakinglevothyroxine(Synthroid)tellsthenursethathefeelsveryanxiousandhas occasionalpalpitations Whichactionbythenursewouldbeappropriate?
A Checkingthepatient’slaboratoryresults
B Takingthepatient’sbloodpressure
C Palpatingthepatient’sthyroid
D Administeringthepatient’santianxietymedication
Thenurseisassessingapatientwhohasbeentakinglevothyroxine(Synthroid)for5weeks Thepatient’s heartrateis90beatsperminute,weighthasdecreased4lb,T3andT4haveincreased Whichactionby thenursewouldbeappropriate?
A Holdthemedication
B RequestarepeatT3andT4
C Assessthebloodpressure
D Administerthemedication
Apatienttakinglevothyroxine(Synthroid)tellsthenursethathefeelswellandsomedayscannot rememberwhetherhetookhismedication Thenurseshould:
A Tellthepatienttocomeoffthemedication
B Tellthepatienttotakehismedicationeveryday
C Tellthepatientthisisnotanappropriatewaytotakeanymedication
D Helpthepatienttodevelopasystemtoremembertotakethemedication
UnderstandingEXERCISE17 Thenurseprovidesdischargeinstructionsforapatientwhoistakinglevothyroxine(Synthroid) Whichof thesestatements,ifmadebythepatient,wouldindicatecorrectunderstandingofthemedication?
A “Iwilldiscontinuethemedicationwhenmysymptomsimprove”
B “Iwilltakethemedicineeachdaybeforebreakfastandatbedtime”
C “Iwillfeelmoreenergeticaftertakingthemedicationforafewweeks”
D “Iwillprobablygainsomeweightwhiletakingthismedicine”
RememberingEXERCISE18
Thenurseisadministeringlevothyroxine(Synthroid)toapatientwithhypothyroidism Thenurse recognizesthatthemedicationisprescribedto:
A Replacethethyroidhormone
B Stimulatethethyroidgland
C Blockthestimulationofthethyroidgland
D Decreasethechancesofthyrotoxicosis
Another approach that is often used to decide how to answer a question is Maslow’s theory of the hierarchy of needs, as shown in Figure 11 (Maslow, 1943) Exercise 19 is an NCLEX-RN
typeofquestionthatcanbeansweredbyapplyingMaslow’stheory.
FIGURE1.1Maslow’shierarchyofneeds
EXERCISE1.9Multiple-choice:
Thenurseiscaringforapatientwhois35weekspregnantandwasadmittedtotheemergencydepartment (ED)withplacentalabruption Whichofthefollowingactionswouldbemostappropriate?
A. Infusenormalsaline0.9%intravenous(IV)at150mL/hr
B. Administermorphine2mgIV
C Tellthepatientthatyouwillsitwithheruntilherfamilyarrives
D Askthepatientwhethershewouldlikeyoutocalltheclergy
TopasstheNCLEX-RNexam,youwillhavetoansweraminimumof60questionsattheset competency level. Some students can accomplish this in 75 questions (60 at the set competency levelplus15pretestquestions) Ifyouanswer265questions,afinalabilityestimateiscomputedto determine whether you are successful If you run out of time and have not completed all 265 questions,youcanstillpassifyouhaveansweredthelast60questionsatthesetcompetencylevel. Approximately 1.3 minutes are allocated for each question, but we all know that some questions takeashorttimetoanswer,whereasothers,includingmathquestions,maytakelonger
The NCLEX-RN exam now comprises several different types of questions, including hot spots, fill in the blank(s), drag-and-drop, order response, and select all that apply or multiplechoice questions These are referred to as alternative types of questions and have been added to better assess your critical thinking. This book offers plenty of practice with such questions. ExamplesoftheselectallthatapplytypeofquestionareshowninExercises110and111
EXERCISE110Selectallthatapply:
Thenurseisreviewingdatacollectedfromapatientwhoisbeingtreatedforhypothyroidism Which informationindicatesthatthepatienthashadapositiveoutcome?
A Sleeps8hourseachnight,wakinguptogotothebathroomonce
B Hasbowelmovementstwotimesaweekwhileonahigh-fiberdiet
C. Gained10lbsincetheinitialclinicvisit6weeksago
D. Waspromotedatworkbecauseofincreasedworkproduction
E Walks2mileswithin30minutesbeforeworkeachmorning
EXERCISE1.11Selectallthatapply:
Thehospitalisexpectingtoreceivesurvivorsofadisaster Thechargenurseisdirectedtoprovidealistof patientsforpossibledischarge Whichofthefollowingpatientswouldbeplacedonthelist?
A. Apatientwhowasadmitted3daysagowithurosepsis;whitebloodcellcountis5.4mm3/μL
B. Apatientwhowasadmitted2daysagoafteranacetaminophenoverdose;creatinineis2.1mg/dL
C Apatientwhowasadmittedwithstableanginaandhadtwostentsplacedintheleftanterior descendingcoronaryartery24hoursago
D. Apatientwhowasadmittedwithanuppergastrointestinalbleedandhadanendoscopicablation48 hoursago;hemoglobinis10.8g/dL
AnexampleofanNCLEX-RNfillintheblankquestionisprovidedinExercise1.12.
EXERCISE1.12Fillintheblanks:
Thenurseiscalculatingtheclient’stotalintakeandoutputtodeterminewhetherhehasapositiveornegative fluidbalance.Theintakeincludesthefollowing:
1,200mLintravenous(IV)D5NSS
200mLofvancomycinIV
Two8-ozglassesofjuice
One4-ozcupofbroth
One6-ozcupofwater
Onbeingemptied,theFoleybagwasfoundtocontain350mLofurine Whatwouldthenursedocument?
Draganddropquestionsarespecifictothecomputerbecausethestudentuseshisorhermouse or touch pad to place items in order A hotspot refers to moving the mouse or the touch pad to a specific point on a diagram. An example of an NCLEX-RN hot-spot question is provided in Exercise1.13.
EXERCISE1.13Hotspot:
Thenurseassessesapatientwhohasapossiblebraintumor Thepatienthasdifficultycoordinatingvoluntary musclemovementandbalance.Whichareaofthebrainisaffected?(PleaseplaceanXattheappropriate spot.)
AnexampleofanorderingNCLEX-RNquestionisfoundinExercise1.14.
EXERCISE1.14Ordering:
Thenurseisinsertinganindwellingurinarycatheterintoafemalepatient.Placethestepsinpriorityorder:
Askthepatienttobeardown
Doncleanglovesandwashtheperinealarea
Placetheclientinadorsalrecumbentposition
Advancethecatheter1.2in.(2.5–5cm)
Inflatetheballoonandpullbackgently
Retractthelabiawiththenondominanthand
Useforcepswiththedominanthandtocleansetheperinealarea
Placedrapesonthebedandovertheperinealarea
Applysterilegloves
Advancethecatheter2to3in.(5–7cm)untilurinedrains
Testballoon,lubricatecatheter,placeantisepticoncottonballs
AnexampleofanNCLEX-RNexhibit-formatquestionisprovidedinExercise115
EXERCISE1.15Exhibit-format:
A52-year-oldfemalepatientadmittedtotheemergencydepartment(ED)hashadnauseaandvomitingfor3 daysandabdominalpainthatisunrelievedaftervomiting
Skin:Pale,cool;patientshivering
Respiration:Respiratoryrate(RR):30breathsperminute,lungsclear,SaO2:90
Cardiovascular(CV)system:RRR(regularrateandrhythm)withmitralregurgitation;temperature:95°F (35°C),bloodpressure(BP):96/60mmHg,heartrate(HR):132beatsperminute(bpm)andweak
Extremities:+4pulses,noedemaoflowerextremities
Gastrointestinal(GI)system:Hyperactivebowelsounds;vomited100mLofbile-coloredfluid,positive abdominaltenderness
Genitourinary(GU)system:Foleyinserted,nourinedrained
Hemoglobin:10.6g/dL
Hematocrit:39%
Whitebloodcells:80mm3
Sodium:150mEq/L
Potassium:70mEq/L
Bloodureanitrogen:132mg/dL
Creatinine:8.2mg/dL
Serumamylase:972
Serumlipase:1,380
ArterialbloodgaspH:70
pO2:90mmHg
pCO2:39mmHg
HCO3:17mEq/L
Afterreviewingthepatient’sassessmentfindingsandlaboratoryreports,thenursedeterminesthatthepriority fortheplanofcareshouldfocuson:
A. Metabolicacidosisandoliguria
B. Respiratoryacidosisanddyspnea
C Metabolicalkalosisrelatedtovomiting
D Respiratoryalkalosisresultingfromabdominalpain
Another strategy to use in studying for the NCLEX-RN exam is to become familiar with the organization of the test. The test plan covers the four basic categories of client needs, including a safe and effective care environment, health promotion and maintenance, psychosocial integrity, and physiologic integrity The following questions are designed to test your grasp of providing a “safe and effective environment” through the way you manage patient care, which is an important aspectofyourroleandresponsibilityasalicensedRN Thisconceptappliestowhatyoushoulddo as an RN as well as the tasks you can delegate to nonlicensed personnel working with you Exercises1.16and1.17offerexamplesofquestionsbasedontheRN’sresponsibilityformanaging safeandeffectivepatientcare.
EXERCISE116
Multiple-choice:
Afterreturningfromahipreplacement,apatientwithdiabetesmellitustypeIislethargic,flushed,and feelingnauseous Vitalsignsarebloodpressure(BP):108/78mmHg,heartrate(HR):100beatsperminute (bpm),respiratoryrate(RR):24breathsperminuteanddeep.Whatisthenextactionthenurseshouldtake?
A Notifythephysician
B Checkthepatient’sglucose
C Administeranantiemetic
D. Changetheintravenous(IV)infusionrate
Exercise1.17Multiple-choice:
Thenurseisassignedtocareforapatientwithpneumonia Whichtaskcanbedelegatedtotheunlicensed assistivepersonnelbytheRN?
A. Teachingapatienthowtousetheinhaler
B Listeningtothepatient’slungs
C Checkingtheresultsofthepatient’sbloodwork
D Countingthepatient’srespiratoryrate
Yet another strategy to use in analyzing NCLEX-RN questions is to assess the negative/positive balance of the question. For a positive question, select the option that is correct; for a negative question, select the option that is incorrect Examples of NCLEX-RN questions withpositiveandnegativeanswersareshowninTable1.6.
TABLE1.6QuestionsWithPositiveandNegativeAnswers
PositiveNCLEX-RN®TypeofQuestionStem
Whichstatementbytheclientindicatesanunderstandingofthemedication sideeffects?
NegativeNCLEX-RNTypeofQuestionStem
Whichstatementbytheclientindicatesaneedforfurtherteachingaboutthe medicationsideeffects?
Therapeutic communication is one of the long-enduring basics of nursing care. As RNs, we provide therapy, not only through what we do but also through what and how we communicate with patients and families Therapeutic communication is not what you would use in everyday conversation because it is designed to be more purposeful Therapeutic communication is nonjudgmental, direct, truthful, empathetic, and informative (Potter & Perry, 2016). Communication and documentation are among the important threads integrated throughout the NCLEX-RN exam An example of an NCLEX-RN question based on therapeutic communicationisshowninExercise1.18.
EXERCISE1.18Multiple-choice:
An11-year-oldboywithacutelymphocyticleukemia(ALL)hasbeendiagnosedwithhissecondrelapse followingsuccessfulremissionsafterchemotherapyandradiation Thepatientasks,“AmIgoingtodie?” Whichresponsebythenursewouldbemosthelpfultothepatient?
A “Let’stalkaboutthisafterIspeakwithyourparents”
B. “Canyoutellmewhyyoufeelthisway?”
C. “Youwillneedtodiscussthiswiththeoncologist.”
D “Yousoundlikeyou’dliketotalkaboutit”
WhatShouldIKnowAboutNCLEX?
NCLEX is a computer adaptive test (CAT), meaning that it is customized to each candidate taking it The test will have 75 to 265 questions Fifteen pretest questions are included, which means that they do not count toward your score. The test is called adaptive because when you answeraquestioncorrectly,thefollowingquestionwillbeatahigherlevel.Therefore,acandidate who passes NCLEX-RN with 75 questions is able to answer high-level questions correctly and remainabovethepassingstandardsetbytheNCSBN(2016)forsafepractice.
If the candidate answers a question incorrectly, a question is provided that is at the same level or a lower level A candidate must stay above the passing standard to be successful The test ends whenthecandidatehasascorethatisclearlyaboveorclearlybelowthepassingstandard.
The candidate will be allowed up to 6 hours to complete the test If the candidate runs out of time, the “rule of 60” applies. This means that the candidate will be successful if the competency level for the last 60 questions was above the passing standard. Some candidates have failed the NCLEX because of “rapid guessing” Therefore, it is important to take your time in reading and answeringquestions
Tosummarize,thetestiscompletewhenoneofthethreefollowingsituationshasoccurred:
1 It is determined that the candidate is above or below the passing standard with 95% confidence
2. Atotalof265questionshavebeencompleted.
3 The6hoursprovidedtocompletethetesthavepassed
The questions in the NCLEX test bank are divided into client-need categories. These categoriesreflectthepercentageseffectiveApril2016:
1 Safeandeffectivecareenvironment
Managementofcare(17%–23%)
Safetyandinfectioncontrol(9%–15%)
2. Healthpromotionandmaintenance(6%–12%)
3 Psychosocialintegrity(6%–12%)
4 Physiologicintegrity
Basiccareandcomfort(6%–12%)
Pharmacologicalandparenteraltherapy(12%–18%)
Reductionofriskpotential(9%–15%)
Physiologicadaptation(11%–17%)
Your test will be designed so that you are asked the specified percentage of questions for each category
1. Theapplicant’scredentialsaresubmittedtothestateboardofnursingforapprovaltotest.
2 Testfeesmustbepaid
3. Theapplicantisprovidedwithanauthorizationtotest(ATT)codenumber.
4. The candidate is responsible for scheduling an appointment to test. First-time candidates are given an appointment within 30 days. Schedule a time that is best for you. Do you feel morealertinthemorningorwouldalate-afternoonappointmentbebetterforyou?
BeforeTestDay
Gotothesitesoyouknowexactlywhereitisandhowlongitwilltakeyoutogetthereontime
TestDay
Arrive at the site early; you may forfeit your appointment if you are 30 minutes late. Bring valid identificationandATT.
PreparationforExamDay
‘TwastheNightBeforeTesting
As the big day approaches, you should stop studying early in the day and spend time relaxing by doing something you enjoy, such as visiting a friend, going out to eat, or watching a movie. Participating in a physical activity is a good idea because it will help you get a good night’s sleep However, before you go to bed, organize everything you need and set two alarms so that you have plenty of time in the morning and arrive at the testing site slightly early, without rushing. Most important,gotobedearly
TheDayofTesting
Startyourdayasyoualwaysdobutmakesureyoueatgood,nutritiousmeals Makesureyouknow wherethetestingsiteisandplantwodifferentroutes.Dresscomfortablyinlayerstoaccommodate variationsinroomtemperature.HaveyourIDhandyand,mostimportantly,thinkpositively!
Last-MinuteTestTips
Improveyourscoreby:
Readingthequestionandallanswerchoicesbeforemakingaselection
Makingsureyouunderstandwhatthequestionisasking
Takingyourtimetobesureyouhaveansweredallquestionsasbestasyoucan
Beinchargeofhowyouuseyourtimeby:
Pacingyourself avoidrapidguessingorspendingtoomuchtimeonanyonequestion
Doingyourbestandthenmovingon
Wearingawatchandkeepingtrackofyourtime
Wearearplugsifyoubecomedistractedeasily
Donotchangeyouranswersunlessyouareuncertainaboutyourfirstanswerchoice.
Answer every question If you do not know the answer, make the most intelligent guess you can.
Asyouanswerthequestions,eliminatechoicesthatyouknowareincorrect.
If you can eliminate two wrong answers, your chance of choosing the correct answer has
improved
Findkeywordsorphrasesinthequestionthatwillhelpyouchoosethecorrectanswer Besureyouarerespondingtothequestionthatisbeingasked. Inusingscratchpaperoraneraserboardforamathquestion,makesureyoucopytheanswer correctly.
Remember that you are not expected to know everything; standardized exams have higher levelquestionsthatwillchallengethelimitsofyourknowledge.
InternationalNursesSeekingLicensureintheUnitedStates
1. CGFNS International™ can provide information that will help you to fulfill all of the requirementsforeligibilitytotaketheNCLEX Accessthewebsiteatwwwcgfnsorg
2. CGFNS International will review your credentials, including your secondary and nursing education
3. A qualifying examination is administered that will test your general nursing knowledge. This examination is one of the requirements needed to obtain a visa to work in the United States Nurses who have the CGFNS International certification have a higher rate of successonNCLEX-RNthannurseswhohavenotbeentested.
4. The Test of English as a Foreign Language (TOEFL) is also required before taking the NCLEXtoensurethatyouhaveanadequateunderstandingoftheEnglishlanguage
5 A visa can be administered by the International Commission on Healthcare Professions (ICHP),adivisionofCGFNSInternational.Thisinformationisalsogivenonthewebsite.
StandardsofPractice
The Standards of Practice offer guidelines that encompass the knowledge, skills, and judgment required to provide safe and effective care They also discuss the need to engage in scholarship, service, and leadership. The Standards and Scope of Practice were developed by the American Nurses Association (ANA) in order to ensure competency and establish standards whereby care canbemeasured Thisprotectsthepublicandencouragesprofessionalnursestotakeresponsibility for their actions. Review the information on the website (www.nursingworld.org) to gain a better understandingofnursingasaprofessionintheUnitedStates(ANA,2015).
Thestandardsincludethefollowing:
SixStandardsofPractice
1 Assessment
2. Diagnosis
3 Outcomeidentification
4. Planning
5. Implementation
6. Evaluation
NineStandardsofProfessionalPerformance
1. Qualityofpractice
2 Education
3. Professionalpracticeevaluation
4. Collegiality
5. Collaboration
6 Ethics
7. Research
8. Resourceutilization
9 Leadership
TipsforSuccess
1 Research medical terminology used in the United States Terms such as epistaxis (nose bleed), lochia (drainage from the vagina after delivery), and erythema (redness) and many others are used in NCLEX questions. It is impossible to respond accurately without an understandingoftheterminology
2. Medications used in the United States differ from those used in other countries. Schedule timetostudymedications,aspharmacologycontentconsistsof12%to18%oftheNCLEX exam BoththegenericandbrandnamesareprovidedontheNCLEXexam
3. In the United States, the nursing process is the framework for providing care for patients. The nursing process also serves to teach students how to organize information relating to patient care and decision making; it provides a structure to help students learn how to organize their clinical thinking and care planning. Familiarize yourself with the nursing processandusethisconceptwhilestudying
4. Nurses are part of the health care team; therefore, nurses collaborate with professionals from other health care disciplines, such as physicians, respiratory therapists, physical therapists,andnutritionists
5 Nurses are expected to be assertive and to question prescriptions written by physicians or otherprimarycareprovidersifsuchprescriptionsdonotmeshwiththeguidelinesforwhat isnormallyprescribed Thisprocesshelpstosafeguardthepatient However,suchassertive behavior may not be acceptable in some countries Thus, even though it may seem uncomfortable to select an answer describing such an action, remember that such assertivenessisexpectedfromRNsintheUnitedStates.
6 Patients who are being treated for drug or alcohol abuse may be referred to group therapy sessions. During these sessions, patients talk with other patients who have similar problems In some countries, it is inappropriate to discuss this type of behavior outside of thefamily
7. In the United States, a nurse is expected to maintain eye contact in communicating with patients Eye contact indicates that you are focused on the patient and listening to him or her. This is important because it helps to build a trusting relationship between nurse and patient.
8 Technologyisusedinmanyaspectsofhealthcare Itis,therefore,importanttounderstand the use of equipment such as cardiac monitors, ventilators, wound vacuum-assisted closure (VAC), suction equipment, peritoneal dialysis, pulmonary artery pressure monitoring, intracranialpressuremonitoring,andfetalmonitoring
9. Focus your attention on information provided by the patient, such as reports of pain, weakness, edema, cough, dizziness, and nausea These may be clues that there is a complicationrelatedtothepatient’sdisease Knowtheclinicalmanifestationspointingtoa complication. It is important to recognize a complication early so that treatment can be initiatedpromptly.
10. Teaching the patient and assisting the patient to make appropriate decisions is also within thescopeofpracticeoftheRN.Itisalsotherightofthepatientstorefusecare.
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Na₂HPO₄ cubic centimeters filtrate taken.
Weight of Mg₂P₂O₇ in twenty-five cubic centimeters of the solution.
Weight of Mg₂P₂O₇ in filtrate.
(a) 25 0.1368 gram 0.0962 gram
KCl cubic centimeters filtrate taken.
P₂O₅ absorbed by 100 grams soil. Salt removed per cent.
„ 0.2589 gram
Mean 0.0963 „
Weight of K₂PtCl₆ in twenty-five cubic centimeters of solution.
Weight of K₂PtCl₆. K₂O absorbed by 100 grams soil. Salt removed per cent.
(a) 25 0.6154 gram 0.4505 gram (b) 25 0.4540 „ 0.3161 gram 26.5
K₂SO₄ cubic centimeters filtrate taken.
Mean 0.4523 „
Weight of K₂PtCl₆ in twenty-five cubic centimeters of solution.
Weight of K₂PtCl₆. K₂O absorbed by 100 grams soil. Salt removed per cent.
(a) 25 0.6113 gram 0.4426 gram (b) 25 0.4371 „ 0.3324 gram 28.0
(NH₄)₂SO₄ cubic centimeters
Mean 0.4399 „
Number cubic centimeters one-half normal acid neutralized
Half normal acid neutralized. N absorbed by 100 Salt absorbed per cent.
filtrate taken. by fifty cubic centimeters of solution. grams soil.
(a) 50 10.00 7.25 grams (b) 50 7.25 „ 0.0964 gram 27.5
Mean 7.25 „
NaNO₃ cubic centimeters filtrate taken.
Number cubic centimeters N₂O₂ afforded by ten cubic centimeters of solution at 0° and 1000 millimeters pressure. Cubic centimeter N₂O₂ at 0° and 1000 millimeters. N absorbed by 100 grams soil. Salt absorbed per cent. (a) 10 16.63 16.77 grams (b) 10 16.70 „ none 00.00
16.73 „
Upon comparing the figures it will be found that the absorption, passing from the greatest to the least, is as follows: phosphoric acid (P₂O₆), potassium sulfate, ammonium sulfate, potassium chlorid and sodium nitrate.
It will be seen that there was no absorption in the case of the nitrate, while with each of the other salts there was quite a marked absorption. It will also be noticed that the percentages of absorption are not very different, and especially is this true of the potassium and ammonium salts, the P₂O₅ being somewhat higher. Whether this fact is merely an accidental occurrence or is due to the law of combination by equivalents could hardly be predicted from the single soil experimented upon; but taking into consideration the possibility of difference in solubility of the resulting compounds in the saline solutions used, and of other varying conditions, the percentages are evidently not far enough apart to exclude the possibility of the bases uniting in equivalent proportions.
138. Preparation of Salts for Absorption.
—The salts employed in the foregoing determinations are conveniently prepared, in fractional normal strength.
In grams per liter the following quantities in grams are recommended, viz., 5.35 g NH₄Cl; 10.11 g KNO₃; 16.40 g Ca(NO₃)₂; 24.60 g MgSO₄ + 7H₂O; 23.4 g CaH₄(PO₄)₂, etc.
The ammonium chlorid, potassium nitrate and magnesium sulfate can be weighed as chemically pure salts and the standard solution be directly made up. Calcium nitrate is so hygroscopic that a stronger solution must be made up, the calcium determined and the proper volume taken and diluted to one liter.
Monocalcium phosphate is prepared as follows:
A solution of sodium phosphate is treated with glacial acetic acid and precipitated with a solution of calcium chlorid. It is then washed with water until all chlorin is removed. The fresh precipitate is saturated with pure, cold phosphoric acid of known strength. After filtering the solution is placed in a warm room and left for two or three weeks until crystallization takes place.
The crystals are pressed between blotting papers and finally dried over sulfuric acid and washed with water-free ether, and again dried. Since this salt is decomposed in strong solutions it should be used only in one hundredth normal strength, viz., 2.34 grams per liter.
POROSITY AND ITS RELATIONS TO MOISTURE.
139. Porosity.—The porosity of a soil depends upon the state of divisibility and arrangement of its particles, and upon the amount of interstitial space within the soil. If a soil be cemented together into a homogeneous mass, its porosity sinks to a minimum; if it be composed, however, of numerous fine particles, each preserving its own physical condition, the porosity of the soil will rise to a maximum. The porosity of a soil may be judged very closely by the percentage of fine particles it yields by the process of silt analysis to be described further on. In general, the more finely divided the particles of a soil, the greater its fertility. This arises from various causes; in the first place, such a soil has a high capacity for absorbing moisture and holding it; thus the dangers of excessive rain-falls are diminished, and the evil effects of prolonged drought mitigated. In the second place, a porous soil permits a freer circulation of the gases found in the soil. The influence of lime in securing the proper degree of porosity of a soil is very great, especially in alluvial deposits and other stiff soils. It prevents the impaction which will necessarily follow in a soil which is too finely divided. In general, the porosity of the soil may be said to depend on three factors, viz.: 1. Upon the state of divisibility or the number of particles per unit volume; 2. Upon the nature and arrangement of these particles; 3. Upon how much interstitial space there is in the soil.
140. Influence of Drainage.—Good underdrainage increases the porosity of a soil by removing the excess of water during wet seasons and rendering the soil more suitable to capillary attraction which will supply moisture during dry seasons. The influence of tile drainage on the production of floods has been carefully studied by Kedzie,[100] who shows that surface ditching in conjunction with deforesting may increase floods and contribute to droughts, and that
tile-draining may increase flood at the break-up in spring, when the water accumulated in the surface soil by the joint action of frost and soil capillarity during the winter, and the surface accumulations in the form of snow are suddenly set free by a rapid thaw.
He also points out that during the warm months tile-draining tends to prevent flood by enabling the soil to take up the excessive rain-fall and hold it in capillary form, keeping back the sudden flow that would pass over the surface of the soil if not absorbed by it, and it mitigates summer drought by increased capacity of the soil to hold water in capillary form and to draw upon the subsoil water supply.
141. Soil Moisture.—The capacity of a soil to absorb moisture and retain it depends on its porosity and is an important characteristic in relation to its agricultural value.
The following general principles relating to soil moisture are adapted from Stockbridge:[101]
During dry weather plants require a soil which is absorptive and retentive of atmospheric moisture. The amount of this retention is generally in direct ratio to two factors, viz., the amount of organic matter and its state of division. The capillary water of the soil is very closely related to its percolating power, since all waters in the soil are governed in their movements by what is known as capillary force. Liebenberg has shown that this movement may be either upwards or downwards, according as the atmosphere is dry or supplies soilsaturating rain. The water absorbed by the roots passes into the plant circulation, and the greater part is evaporated from the leaves. Where the supply of water is insufficient, the plant wilts, and if the evaporation long continue in excess of the supply obtained from the soil, the plant must die. The experiments of Hellriegel have shown that any soil can supply plants with all the water they need, and as fast as they need it, so long as the moisture within the soil is not reduced below one-third of the whole amount that it can hold. The quantity of water required and evaporated by different agricultural plants during the period of growth has been found to be as follows:
One acre of wheat exhales 409,832 pounds of water. „ „ „ clover „ 1,096,234 „ „ „ „ „ „ sunflowers „ 12,585,994 „ „ „ „ „ „ cabbage „ 5,049,194 „ „ „ „ „ „ grape-vines „ 730,733 „ „ „ „ „ „ hops „ 4,445,021 „ „ „
Dietrich estimates the amount of water exhaled by the foliage of plants to be from 250 to 400 times the weight of dry organic matter formed during the same time. Cultivation conserves soil moisture. It must be remembered that this water contains soil ingredients in solution. Hoffmann has estimated that the quantity of matter dissolved from the soil by water varies from 0.242 to 0.0205 per cent of the dried earth. The experiments of Humphrey and Abbott have shown that about one-sixth of the total sediment of the Mississippi river is soluble in water.
142. Determination of the Porosity of the Soil.—The porosity of the soil is fixed by the relative volume of the solid particles as compared with the interstitial space. It is most easily determined by dividing the apparent by the real specific gravity.
Let the real specific gravity of a soil be 2.5445 and the apparent specific gravity of the same soil be 1.0990.
The porosity is then calculated according to the following ratios, viz.: 2.5445 : 1.099 = 100 : X
Whence X = 43.2 = per cent volume occupied by the solid particles of the soil.
The per cent volume occupied by the interstitial space is therefore 56.8.
143. Method of Whitney.—The total volume of interstitial space within the soil, in which water and air can enter, is best determined by calculation from the specific gravity and the weight of a known volume of soil. To determine this in the soil in its natural position in the field, a sample is taken in the following way: A brass tube, about two inches in diameter and nine inches long, has a clock spring
securely soldered into one end, and this end turned off in a lathe to give a good cutting edge of steel. The area enclosed by this steel edge is accurately determined, and a mark is placed on the side of the tube exactly six inches from the cutting edge. A steel cap fits on top of the brass cylinder to receive the blows of a heavy hammer or wooden mallet. The cylinder is driven into the ground until the six-inch mark is just level with the surface. The whole is then dug out, care being taken to slip a broad piece of steel under the cylinder before it is removed, so as to prevent the soil which it contains from falling out. The cylinder is then carefully laid over on its side, and the soil is cut off flush with the cutting edge of steel. The soil is then removed from the cylinder, carried to the laboratory and properly dried and weighed. The object of the steel inserted in one end of the cylinder is to reduce the friction on the inside of the tube to a minimum, and thus prevent the soil inside the cylinder being forced down below the level of the surrounding earth. The volume of the soil removed with this sampler can readily be determined by calculation, as the area of the end of the tube is known and the sample is six inches deep. In a sampler, such as described here, this volume is about 300 cubic centimeters. From the weight of soil and the volume of the sample, the volume of interstitial space may be found by the following formula:
S is the per cent by volume of interstitial space, V is the volume of the tube in cubic centimeters, W is the weight of soil in grams, and ω is the specific gravity of the soil. The specific gravity can be determined for each soil, or the factor 2.65 can be used, which is sufficiently accurate for most work.
The per cent by volume of interstitial space in the undisturbed subsoil is found to range from about thirty-five for sandy land, to sixty-five or seventy for stiff clay lands.
For the determination of the amount of water an air-dried soil will hold, if all the space within it is completely filled with water, an eight-inch straight argand lamp chimney, with a diameter of about
two inches, can be conveniently used. A mark is placed on the side of the tube, six inches from one end, and the volume of the tube up to this mark is found by covering the end with a piece of thin rubber cloth, or by pressing the chimney down firmly on a glass plate, and making a water-tight joint with paraffin or wax. Water is then poured into the tube up to the six-inch mark, and the weight or volume of water determined. The tube can then be dried, a piece of muslin tied tightly over the top and the whole then weighed. Soil is carefully poured in and the tube gently tapped on a soft support until the soil is six inches deep in the tube, and has the desired degree of compactness. The weight and volume of the soil can thus be determined, and the volume of the interstitial space from the formula already given. This can also be determined directly by introducing water from above, or by immersing the cylinder of soil up to the six-inch mark in water, and allowing the water to enter the soil from below. With such a short depth of soil, very little water will flow out when the cylinder is suspended in the air. The amount which will flow out when the cylinder is thus suspended, will depend both upon the texture and the depth of soil. It is impossible, however, by this method, to completely remove the air or to completely fill the space within the soil with water; for as the water enters the soil, a considerable amount of air becomes entangled in the capillary spaces, and this could not be removed except by boiling and vigorous stirring, which would altogether change the texture of the soil. The amount of water held by the soil, or the amount of space within the soil into which water and air can enter, will evidently depend upon the compactness of the soil, and this is best expressed in per cent by volume of space.
144. Capacity of the Fine Soil for Holding Moisture.
—The soil, as it is taken from the field, may have quite a different water coefficient from the same soil after it has been passed through a fine sieve or been dried at air temperatures or at 100° or 110°. The method of determination which depends upon adding excess of water to a given weight of fine earth, and afterwards eliminating the excess by percolation or filtration, is apt to give misleading results. If, however, the results are obtained by working on the same weight of soil, and in the same conditions, they may have value in a comparative way. The comparison between soils must be made with equal weights, in like apparatus and with the same manipulation, to
have any value. These determinations, however, cannot have the same practical value as those made in the samples in a natural condition as has just been described.
145. Method of Wolff Modified by Wahnschaffe.[102]—A cylindrical zinc tube (Fig. 17), sixteen centimeters long and four centimeters internal diameter, is used, the cubical capacity of which is 200 cubic centimeters.
The cylinder is graduated by placing the moist linen disk on the gauze and tying a piece of rubber cloth over the bottom. Water is now poured in until the level is even with the gauze bottom. Add then exactly 200 cubic centimeters of water, mark its surface on the zinc, throw out the water, and file the zinc down to the mark.
The bottom of the tube is closed with a fine nickel-wire gauze. Below this a piece of zinc tubing, of the size of the main tube, is soldered; pierced laterally with a number of holes.
Before using, the gauze bottom of the cylinder is covered with a moist, close fitting linen disk, and the whole apparatus weighed. It is then filled with the fine earth, little by little, jolting the cylinder on a soft substance after each addition of soil to secure an even filling. When filled even full the whole is weighed, the increase in weight giving the weight of soil taken.
F 17.
C F S H M . M W M W .
A large number of cylinders can be filled at once and placed in a large glass crystallizing dish containing water and covered with a bell jar (Fig. 17). The water should cover the gauze bottoms of the cylinders to the depth of five to ten millimeters. More water should be added from time to time as absorption takes place. The cylinders should be left in the water until when weighed at intervals of an hour no appreciable increase in weight takes place. The temperature and barometer reading should be noted in connection with each determination. With increasing temperature the water coefficient is diminished.
The method of Wolff, as practiced in the laboratory of the Chemical Division of the U. S. Department of Agriculture, has given very concordant results. Five determinations were made on a sample
of vegetable soil with the Wolff cylinders, which were weighed at intervals of ten, twenty, and thirty days, with the following results:
No. 1. Water absorbed after ten days 106.25 per cent
No. 1. Water absorbed after twenty days 106.44 per cent
2. „ „ „ „ „ 105.98 „ „
No. 1. Water absorbed after thirty days 108.35 per cent
The data obtained show that there was a very slight increase in the amount of moisture absorbed after the tenth day.
As will be seen, however, from the following data, the soil within the cylinder does not contain in all parts the same percentage of moisture, the lower portions of the cylinder containing notably larger proportions than the upper parts. The cylindrical soil column was divided into four equal parts and the moisture determined in each part. Beginning with the top quarter the percentages of moisture were as follows:
146. Method of Petermann.[103]—The method of Wolff as practiced by the Belgian Experiment Station, at Gembloux, is essentially the same as described above.
Petermann recommends the use of tared cylinders twenty to twenty-five centimeters long and six to eight centimeters in diameter. The cylinder is to be filled with the fine earth, little by little, with gentle tapping after each addition. The bottom of the cylinder is closed with a perforated rubber stopper on which is spread a moistened disk of linen. The cylinder, thus prepared and filled, is weighed and afterwards placed in a vessel containing distilled water, to such a depth as to secure a water level about two centimeters above the lower surface of the soil in the cylinder. The level of the water is kept constant as the contents of the cylinder are moistened by capillarity. When the earth appears to be thoroughly moistened, as can be told by the appearance of the upper surface, maintain the contact with water for about five or six hours.
The cylinder is then removed, the upper surface covered to avoid evaporation, allowed to drain for a few hours, wiped and weighed. The cylinder is again placed in water to see if any increase in weight takes place. The weight of the fine earth and of the absorbed water being known, the percentage of absorption is easily calculated.
147. Method of A. Mayer.[104]—A glass tube, one and seventenths centimeters in diameter, composed of two pieces, seventy-five centimeters and twenty-five centimeters in length, is united by a piece of rubber tubing. The lower free end of the seventy-five centimeter piece is closed with a piece of linen. The tube is filled, with gentle jolting, to the depth of one meter with fine earth, the earth column thus extending twenty-five centimeters above the point of union of the two pieces. Thus prepared, a quantity of water is poured into the upper tube sufficient to temporarily saturate the whole of the soil.
During the sinking of the water in the tube there is thus effected a moistening of the material before it is wholly filled with water. After waiting until the water poured on top has disappeared the tube is separated at the rubber tube connection and a sample of the moist soil taken at that point. This is at once weighed and then dried at 100°. The loss in weight gives the water absorbed.
The number thus obtained is calculated to the standard by volume, by use of the number representing the apparent specific gravity of the fine earth.
For sand of different degrees of fineness the following numbers were found:
The numbers thus obtained are taken to represent the absolute water capacity of a mineral substance in powder.
The full water capacity, i. e., the power of holding water when the powder is immersed in water, the excess of which is then allowed to flow away is much greater than the absolute number.
This difference is shown in the following data: Quartz, size three. Clay, size three.
In general the absolute is markedly inferior to the full water capacity. Only in the finest dust do the two numbers approach each other.
148. Volumetric Determination.—A convenient apparatus for this determination has been devised by Mr. J. L. Fuelling, of the Chemical Division, Department of Agriculture. It is shown in Fig. 18.
It consists of an ordinary percolator the diameter of which decreases slightly towards the lower end, a thick-wall rubber tube and an ordinary burette, divided in tenths. A rubber stopper is fitted to the mouth of the percolator and perforated twice—in the middle
and at the side, the former for a small tube provided with pinch-cock and the latter for the neck of a small funnel. The whole is supported on a convenient stand, the clamp holding the percolator being placed above that supporting the burette, both clamps arranged to slide on the stand-rod.
F 18.
F ’ A .
The method is as follows:
A mark is placed upon the projecting tube at the lower end of the percolator, and the tube at this point may be drawn out sufficiently to decrease the width of meniscus to one-eighth inch. Into the percolator is first introduced a small disk of wire gauze or perforated porcelain, with heavy wire pendant in the tube. Through the rubber stopper a small glass tube is passed and its lower end pressed firmly upon the wire or porcelain disk, its upper end being curved and supplied with a pinch-cock. Into the percolator is now poured one inch of fine shot (No. 20) and then one inch of fine sand which has been previously digested with hydrochloric acid and well cleaned of dust by washing.
The zero.—After the shot and sand have been shaken even, the burette is filled with water and raised above the level of the sand, wetting the percolator for four inches of its length. The burette is lowered and the shot and sand bed allowed to drain by opening the pinchcock of the inner tube. The burette is raised and the shot-sand flooded repeatedly until, by lowering the burette until the zero mark of the percolator tube is reached, a uniform reading on the burette is secured. Thus the shotsand bed is completely charged with water. The water level is now
made zero on the percolator stem, the burette filled to its zero mark and the apparatus is prepared for introduction of the soil.
The Determination.—From 100 to 200 grams of soil, previously dried free of moisture, are weighed, the burette raised until the water level is three inches above the sand, and the soil gently dropped through a funnel into the water. When the soil has been introduced and wetted completely the water level is raised above the soil and allowed to remain thus two hours. The burette is then lowered and the water allowed to drain from the wetted soil. Four to six hours are usually given the draining, the reading taken on the burette after establishing the zero on the percolator stem, the volume of absorbed water thus ascertained and divided by the weight of soil multiplied by 100; the result expresses the water absorbed per hundred of soil.
Example:
Water required to saturate disk, etc. 0.50 cubic centimeter.
Weight of air-dried soil taken 20.00 grams.
Moisture at 105° therein 14.25 per cent.
Weight water in soil 2.85 grams.
Reading of burette after saturation 10.75 cubic centimeters.
Less water required for disk, etc 9.25 „ „
Temperature 20°.00
Weight of 9.25 cubic centimeters H₂O at 20° 9.22 grams.
Total weight of water retained by soil 12.07 „
Per cent water retained by soil 60.35 per cent.
For general analytical work the correction for variations in the weight of water for different temperatures is of no practical importance.
149.
Accuracy
of Results.
—A sample of soil from the beet sugar station, in Nebraska, gave the following duplicate results:
First trial 45.75 per cent water. Second trial 44.85 „ „ „
Muck soils from Florida, containing varying proportions of sand, gave the following numbers:
Soil number one, 144.85 per cent, and 145.43 per cent; soil number two, 109.13 per cent, and 107.93 per cent; soil number three (very sandy), 46.86 per cent, and 46.51 per cent.
150. Method of Wollny.[105]—A zinc tube, ninety centimeters long and four centimeters internal diameter, carries at each end, at right angles to the axis, a flattened rim 1.5 centimeters broad. The lower end of the tube is closed with a strong piece of coarse linen. The soil to be examined is then filled in little by little, with gentle tamping.
On the upper end two glass tubes are placed, each ten centimeters long and four centimeters internal diameter. These tubes are furnished at each end with cemented brass cylinders which are expanded to a circular, evenly ground rim, 1.5 centimeters wide, also at right angles to the axis of the main tube. These rims are greased and placed together, one on the other, and held together by wooden clamps.
The glass tube in immediate connection with the zinc tube is also firmly filled with the soil sample, while the second tube is only partly filled, so that any settling which may take place in the soil on the addition of water may still find the first glass tube full of the sample.
The empty part of the upper glass tube is now filled with water and additional quantities of water are added from time to time until the soil is saturated. In order to be able to observe when this takes place there is a slit at the lower end of the zinc tube which is closed with a piece of glass. This slit should be about two centimeters broad and ten centimeters long. The lower end of the zinc tube is set on a glass plate to prevent evaporation.
As soon as the water shows itself at the lower end of the zinc tube, the excess of water in the upper glass tube is at once removed by a pipette and a stopper inserted through which a glass tube passes drawn out into a fine point above. The object of this is to avoid evaporation on the upper surface. The apparatus is then left at rest for thirty-six hours.
At the end of this time the clamps are removed and the column of moist earth cut with a piece of platinum foil, and the two ends of the glass tube, next to the zinc tube, covered with glass plates. It is then
weighed and the weight of moist earth determined by deducting the weight of the tube and its glass covers. The moist earth is carefully removed to a large porcelain dish and dried at 100°. Before weighing it is allowed to stand twenty-four hours in the air. The data obtained are used to calculate the water content to volume per cent.
The volume of the glass tubes should be determined by careful calibration.
151. Method of Heinrich.[106]—The soil to the depth turned by the plow is dug out and in the hole a lead vessel without bottom, twenty centimeters in diameter and forty centimeters high, is placed. The soil is then thrown back around and outside the lead vessel until the latter appears buried in the fragments.
The rest of the soil is passed into the lead vessel, through a sieve having four meshes to the centimeter, using for this purpose enough water to thoroughly moisten it. Care should be taken not to use enough water to cause any separation of the fine from the coarse particles.
By this process all coarse stones, sticks, etc., are separated. In sandy soils the flask is left for a few hours while in clay soils a much longer time is necessary. When the excess of water has disappeared the lead cylinder is removed, and a piece cut out of the center of it placed in a weighed drying flask and dried at 100°.
152. Effect of Pressure on Water Capacity.[107]—The increasing capacity of soil to hold water developed by shaking or pressure, is determined by Henrici in the following way:
Into a glass cylinder of twenty millimeters internal diameter are poured twenty cubic centimeters of water. A given quantity of soil is next added, and after standing until thoroughly saturated, the residual water is measured by pouring off, or better, by graduations on the side of the tube. The increase in the volume of the clear water is also measured, after shaking, in the same way. The data of a determination made as above described follow:
Water
Volume of saturated soil = e + w = 20.5 „ „
Water contained therein = w = 10.5 „ „
By repeated shaking the volume of e + w, the content of w therein, and the relative values of e w were found to be as follows:
If e′ represent the volume of the saturated soil then e′ = e + w, and this gives the relation to the volume of dry earth represented by the equation e′ e = 1 + w e. This indicates that the relative volume of the saturated soil is equal to unity increased by the relative content of water.
153. Coefficient of Evaporation.—At an ordinary room temperature in the shade, samples of soil, if they are subjected to experiment in tolerably thin layers have nearly an equal coefficient of evaporation. That is, the absolute quantity of water evaporated in a given time is almost entirely conditioned upon the magnitude of the surface exposed and the temperature of the surrounding air. Only when exposed in conditions as nearly as possible natural in thin layers to the action of the sunlight and shade do the soils show their peculiarities in respect of the evaporation of moisture. In order to see these peculiarities, samples of soil which have been previously examined must be subjected to examination at the same time with the soil whose properties are to be determined.
The zinc box, before described, should be protected with a well fitting cover of thick paper, and the different samples of soil which are to be tested placed therein. This should now be placed in a
wooden box, the top of which is exactly even with the top of the zinc vessel. This box containing the vessel should be exposed to the sunlight. After twenty-four hours the zinc boxes can be taken away from position and their loss in moisture determined, and these weighings, according to the condition of the atmosphere, can be continued from fourteen days to three weeks, the temperature of the air of course being carefully determined at each time. At first, all the different soils being saturated with moisture, it will be observed that the loss of moisture is proportionately the same for all. Soon, however, the rapidity of the evaporation in the samples of soil rich in humus and clay will be decreased as compared with the sandy soils, and in general, those which possess a high capillary power capable of bringing the moisture rapidly from the deeper layers to the surface. There soon comes a point when the difference in evaporation is at its greatest; and then there will be a gradual diminution until the samples lose no further moisture. This point, for the different soils, can be determined by frequent weighings of the vessel.
154. Determination of Capillary Attraction.—Long glass tubes graduated in centimeters may be used for this determination, or plain tubes so arranged as to admit of easy measurements with a rule. The tubes may be from one to two centimeters internal diameter and about one meter long. The fine earth should be evenly filled in little by little, with gentle jolting. The lower end of each tube, before filling, is closed with a piece of linen.
The tubes, after filling, are supported in an upright position by a frame AE, Fig. 19, in a vessel B containing water in which the linen covered ends D dip to the depth of two centimeters. The height of the water in the several tubes should be read or measured at stated intervals. The water contained in the supply vessel should be kept at a constant height by a Mariotte bottle.
The observations may be discontinued after one hundred and twenty hours, but even then the water will not have reached its maximum height.
It is recommended by some experimenters to cut the tubes, after the above determination is completed, into pieces ten centimeters in length, and to determine the per cent of water in each portion.
155. Statement of Results. —The following table illustrates a convenient method of tabulating the observed data as given by König.[108]
F 19.
C A S W .
156. Inverse Capillarity.—In tubes filled with fine earth, as described in paragraph 154, water is quickly poured, the same quantity into each tube of the same diameter, or such quantities in tubes of different diameters as would form a water column of the same depth over the surface of the sample. The rate at which the water column descends in each tube, the time of the disappearance of the water at the surface and the final depth to which it reaches, are the data to be entered.
157. Statement of Results.—The points to be observed in the determination of inverse capillarity are the number of hours required for the total absorption of a column of water of a given height, the depth of the moisture column at that moment, and the total depth to which the moisture column finally reaches. The data of observations with six samples with a water column four centimeters high are given by König[109] as follows:
