Kaplan NCLEX-RN Exam 2005-2006 with CDROM


By Kaplan

Kaplan

Copyright © 2005 Kaplan
All right reserved.

ISBN: 0743265408

Chapter One: Overview of the NCLEX-RN® Exam

LOCATION: Test Center, Anytown, USA.

CANDIDATE: You. You are talking to yourself.

GOAL: To pass the NCLEX-RN® exam.

"O.K., this is it. I've studied for six weeks. I am READY! Come on, come on. Give me the first question. Let's get started!"

A man had a permanent pacemaker implanted one year ago. He returns to the outpatient clinic because he thinks the pacemaker battery is malfunctioning. It is MOST important for the nurse to assess which of the following?

1. Abdominal pain, nausea, and vomiting.

2. Wheezing on exertion, cyanosis, and orthopnea.

3. Peripheral edema, shortness of breath, and dizziness.

4. Chest pain radiating to the right arm, headache, and diaphoresis.

"Pacemaker battery? PACEMAKER BATTERY? I've studied for six weeks, and they ask me about a PACEMAKER BATTERY? I don't remember reading about pacemaker batteries! I should have rescheduled my test! I should have studied harder. I should have bought that Kaplan book!"


Is this the way you want to begin your professional nursing career? In a panic because you think that you are going to fail the NCLEX-RN® exam? Of course not. But if the NCLEX-RN® exam strikes fear into your heart, you need to conquer that fear, and the first step in preventing panic about the NCLEX-RN® exam is to learn everything you can about the exam.

What Is the NCLEX-RN® Exam?

NCLEX-RN® Examination stands for National Council Licensure Examination, the test administered by the boards of nursing that represent each of the 50 states in the United States, the District of Columbia, and five U.S. territories: American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the Virgin Islands. These boards have a mandate to protect the public from unsafe and ineffective nursing care, and each board has been given responsibility to regulate the practice of nursing in its respective state. In fact, the NCLEX-RN® exam is often referred to as "The Boards" or "State Boards."

The NCLEX-RN® exam has only one purpose: to determine if it is safe for you to begin practice as an entry-level nurse.

Why Must You Take the NCLEX-RN® Exam?

The NCLEX-RN® exam is prepared by the National Council of State Boards of Nursing (NCSBN). Each state requires that you pass this exam to obtain a license to practice as a registered nurse. The designation registered nurse or R.N. indicates that you have proven to your state board of nursing that you can deliver safe and effective nursing care. The NCLEX-RN® exam is a test of minimum competency and is based on the knowledge and behaviors that are needed for the entry-level practice of nursing. This exam tests not only your knowledge, but also your ability to make competent nursing judgments.

What Is Entry-Level Practice of Nursing?

In order to define entry-level practice of nursing, the National Council conducts a job analysis study every three years to determine what entry-level nurses do on the job. The kinds of questions they investigate include: In which clinical settings does the beginning nurse work? What types of care do beginning nurses provide to their patients? What are their primary duties and responsibilities? Based on the results of this study, National Council adjusts the content and level of difficulty of the test to accurately reflect what is happening in the workplace.

What the NCLEX-RN® Exam Is NOT

It is not a test of achievement or intelligence. It is not designed for nurses who have years of experience. The questions do not involve high-tech clinical nursing or equipment. It is not predictive of your eventual success in the career of nursing. You will not be tested on all the content that you were taught in nursing school.

What Is a CAT?

CAT stands for Computer Adaptive Test. Each test is assembled interactively based on the accuracy of the candidate's response to the questions. This ensures that the questions you are answering are not "too hard" or "too easy" for your skill level. Your first question will be relatively easy; that is, below the level of minimum competency. If you answer that question correctly, the computer selects a slightly more difficult question. If you answer the first question incorrectly, the computer selects a slightly easier question. By continuing to do this as you answer questions, the computer is able to calculate your level of competence.

In a CAT, the questions are adapted to your ability level. The computer selects questions that represent all areas of nursing, as defined by the NCLEX-RN® test plan and by the level of item difficulty. Each question is self-contained, so that all of the information you need to answer a question is presented on the computer screen.

Taking the Exam

There is no time limit for each individual question. You have a maximum of five hours to complete the exam, but that includes the beginning tutorial, an optional ten-minute break after the first two hours of testing, and an optional break after an additional 90 minutes of testing. Everyone answers a minimum of 75 questions to a maximum of 265 questions. Regardless of the number of questions you answer, you are given 15 questions that are experimental. These questions, which are indistinguishable from the other questions on the test, are being tested for future use in NCLEX-RN® exams, and your answers do not count for or against you. Your test ends when one of the following occurs:

You have demonstrated minimum competency and answered the minimum number of questions (75)

You have demonstrated a lack of minimum competency and answered the minimum number of questions (75)

You have answered the maximum number of questions (265)

You have used the maximum time allowed (five hours)

Try not to be concerned with the length of your test. In fact, you should plan on testing for five hours and seeing 265 questions. You are still in the game as long as the computer continues to give you test questions, so focus on answering them to the best of your ability.

Remember, every question counts. There is no warm-up time, so it is important for you to be ready to answer questions correctly from the very beginning. Concentration is also key. You need to give your best to each question because you do not know which will put you over the top.

Content of the NCLEX-RN® Exam

The questions on the NCLEX-RN® exam involve integrated nursing content. Many nursing programs are based on the medical model. Students take separate medical, surgical, pediatric, psychiatric, and obstetric classes. On the NCLEX-RN® exam, all content is integrated.

Look at the following question.

A woman with type 1 diabetes is returned to the recovery room one hour after an uneventful delivery of a 9 lb., 8 oz., baby boy. The nurse would expect the woman's blood sugar to

1. change from 220 to 180 mg/dL

2. change from 110 to 80 mg/dL

3. change from 90 to 120 mg/dL

4. change from 100 to 140 mg/dL

Is this an obstetrical question or a medical/surgical question? In order to select the correct answer, (2), you must consider the pathophysiology of diabetes along with the principles of labor and delivery. This is an example of an integrated question.

The NCLEX-RN® Exam Blueprint

The NCLEX-RN® exam is organized according to the framework "Meeting Client Needs." There are four major categories of Client Needs and six subcategories. This information is distributed by the developers of the NCLEX-RN® exam, the National Council of State Boards of Nursing, Inc.

Client Need #1: Safe and Effective Care Environment

The first subcategory for this client need is Management of Care and accounts for 13-19 percent of the questions on the exam. Nursing actions that are covered in this subcategory include:

Advanced directives

Advocacy

Case management

Client rights

Collaboration with multidisciplinary team

Concepts of management

Confidentiality

Consultation

Continuity of care

Delegation

Establishing priorities

Ethical practice

Informed consent

Legal rights and responsibilities

Performance improvement (Quality assurance)

Referrals

Resource management

Staff education

Supervision

Here is example of a typical question from this subcategory:

Which of the following assignments, if made by the registered nurse, would be appropriate for a LPN/LVN?

1. A 34-year-old woman with low back pain scheduled for a myelogram in the afternoon.

2. A 41-year-old woman in traction with a fractured femur.

3. A newly diagnosed 43-year-old woman with type 1 diabetes mellitus.

4. A 56-year-old man with emphysema scheduled to be discharged later today.

The correct answer is (2). This patient is in stable condition and can be cared for by an LPN with supervision of a RN.

Here is another example of a Management of Care question:

After receiving report from the night nurse, which of the following patients should the nurse see FIRST?

1. A 31-year-old woman refusing Carafate before breakfast.

2. A 40-year-old man with left-sided weakness asking for assistance to the commode.

3. A 52-year-old woman complaining of chills who is scheduled for a cholecystectomy.

4. A 65-year-old man with a nasogastric tube who had a bowel resection yesterday.

The correct answer is (3). This is the least stable patient.

The second subcategory for this client need is Safety and Infection Control and accounts for 8-14 percent of the questions on the exam. Nursing actions that are covered in this subcategory include:

Accident prevention

Disaster planning

Emergency response plan

Error prevention

Handling hazardous and infectious materials

Home safety

Injury prevention

Medical and surgical asepsis

Reporting of incident/event/irregular occurrence/variance

Safe use of equipment

Security plan

Standard/transmission-based/ and other precautions

Use of restraints/safety devices

Here is an example of a question from this subcategory:

The physician orders tobramycin sulfate (Nebcin) 3 mg/kg IV every 8 hours for a 3-year-old boy. The nurse enters the patient's room to administer the medication and discovers that the boy does not have an identification bracelet. What should the nurse do?

1. Ask the parents at the child's bedside to state their child's name.

2. Ask the child to say his first and last name.

3. Have a co-worker identify the child before giving the medication.

4. Hold the medication until an identification bracelet can be obtained.

The correct answer is (1). This action will allow the nurse to correctly identify the child and enable the nurse to give the medication on time.

Client Need #2: Health Promotion and Maintenance

This client need accounts for 6-12 percent of the questions on the exam. Nursing actions that are covered in this subcategory include:

Aging process

Ante/intra/postpartum and newborn care

Developmental stages and transitions

Disease prevention

Expected body image changes

Family planning

Family systems

Growth and development

Health and wellness

Heath promotion programs

Health screening

High risk behaviors

Human sexuality

Immunizations

Lifestyle choices

Principles of teaching/learning

Self care

Techniques of physical assessment

It is important to understand that not everyone described in the questions will be sick or hospitalized. Some clients may be in a clinic or home-care setting. Some clients may not be sick at all. Wellness is an important concept on the NCLEX-RN® exam. It is necessary for a safe and effective nurse to know how to promote health and prevent disease.


The following is an example of a typical question from Health Promotion and Maintenance:

A 21-year-old woman in active labor is admitted to the labor suite. An hour later, the membranes rupture spontaneously. The nurse observes a glistening white cord protruding from the vagina. Which of the following actions should the nurse take FIRST?

1. Return to the nurses' station and place an emergency call to the physician.

2. Administer oxygen by mask at 10-12 liters/minute and assess the mother's vital signs.

3. Place a clean towel over the cord and wet it with sterile normal saline.

4. Apply manual pressure to the presenting part and have the mother assume a knee-chest position.

The correct answer is (4). A prolapsed cord is an emergency situation. The nurse must relieve pressure on the cord to prevent fetal anoxia.

Client Need #3: Psychosocial Integrity

This client need accounts for 6-12 percent of the questions on the exam. Nursing actions that are covered in this subcategory include:

Abuse/neglect

Behavioral interventions

Chemical dependency

Coping mechanisms

Counseling techniques

Crisis intervention

Cultural diversity

End of life

Family dynamics

Grief and loss

Mental health concepts

Psychopathology

Religious and spiritual influences on health

Sensory/perceptual alterations

Sexual abuse

Situational role changes

Stress management

Support systems

Therapeutic communications

Therapeutic environment

Unexpected body image changes

This question is an example of this subcategory:

A 50-year-old male patient comes to the nurses' station and asks the nurse if he can go to the cafeteria to get something to eat. When told that his privileges do not include visiting the cafeteria, the patient becomes verbally abusive. Which of the following approaches by the nurse would be most effective?

1. Tell the patient to lower his voice because he is disturbing the other patients.

2. Ask the patient what he wants from the cafeteria and have it delivered to his room.

3. Calmly but firmly escort the patient back to his room.

4. Assign a nursing assistant to accompany the patient to the cafeteria.

The correct answer is (3). The nurse should not reinforce abusive behavior. Patients need consistent and clearly defined expectations and limits.

Client Need #4: Physiological Integrity

The first subcategory for this client need is Basic Care and Comfort and accounts for 6-12 percent of the questions on the exam. Nursing actions that are covered in this subcategory include:

Alternative and complementary therapies

Assistive devices

Elimination

Mobility/immobility

Non-pharmacological comfort interventions

Nutrition and oral hydration

Palliative/comfort care

Personal hygiene

Rest and sleep

This question is representative of this question subcategory:

A cast is applied to a 9-month-old girl for the treatment of talipes equinovarus. Which of the following instructions is most essential for the nurse to give to the child's mother regarding her care?

1. Offer appropriate toys for her age.

2. Make frequent clinic visits for cast adjustment.

3. Provide an analgesic as needed.

4. Do circulatory checks of the casted extremity.

The correct answer is (4). A possible complication that can occur after cast application is impaired circulation. All of these answer choices might be included in family teaching, but checking the child's circulation is the highest priority.

The second subcategory for this client need is Pharmacological and Parenteral Therapies and accounts for 13-19 percent of the questions on the exam. Nursing actions that are covered in this subcategory include:

Adverse effects/contraindications

Blood and blood products

Central venous access devices

Dosage calculation

Expected effects

Intravenous therapy

Medication administration

Parenteral fluids

Pharmacological agents/actions

Pharmacological interactions

Pharmacological pain management

Total parenteral nutrition

Try this question from this subcategory:

The home health nurse is going to start an IV with 5% dextrose in water (D5W) for a 76-year-old woman. To perform the venipuncture, the nurse should start the IV with which of the following?

1. The veins of the client's wrist on the nondominant side.

2. The veins of the leg so it will not interfere with the client's ability to feed herself.

3. The dorsal veins of the client's forearm on the nondominant side.

4. The dorsal surface of the client's hand on the nondominant side.

The correct answer is (3). This is the best site for the nurse to use for the IV because of its ease of access, availability of elastic veins, and limited use by the client.

The third subcategory for this client need is Reduction of Risk Potential and accounts for 13-19 percent of the questions on the exam. Nursing actions that are covered in this subcategory include:

Diagnostic tests

Laboratory values

Monitoring conscious sedation

Pathophysiology

Potential for alterations in body systems

Potential for complications from surgical procedures and health alterations

Potential for complications of diagnostic tests/treatments/procedures

System specific assessments

Therapeutic procedures

Vital signs

This is a an example of a question from this subcategory:

A 7-year-old girl with type 1 insulin dependent diabetes mellitus (IDDM) has been home sick for several days and is brought to the emergency department by her parents. If the child is experiencing ketoacidosis, the nurse would expect to see which of the following lab results?

1. Serum glucose 140 mg/dL

2. Serum creatine 5.2 mg/dL

3. Blood pH 7.28

4. Hematocrit 38%

The correct answer is (3). Normal blood pH is 7.35-7.45. This indicates diabetic ketoacidosis.


The fourth subcategory for this client need is Physiological Adaptation, which accounts for 11-17 percent of the questions on the exam. Nursing actions that are covered in this subcategory include:

Alterations in body systems

Fluid and electrolyte imbalances

Hemodynamics

Illness management

Infectious diseases

Medical emergencies

Pathophysiology

Radiation therapy

Respiratory care

Unexpected response to therapies

The following question is an example of this subcategory:

The nurse delivers external cardiac compressions to a client while performing cardiopulmonary resuscitation (CPR). Which of the following actions by the nurse is BEST?

1. Maintain a position close to the client's side with the nurse's knees apart.

2. Maintain vertical pressure on the client's chest through the heel of the nurse's hand.

3. Re-check the nurse's hand position after every 10 chest compressions.

4. Check for a return of the client's pulse after every 8 breaths by the nurse.

The correct answer is (2). The nurse's elbows should be locked, arms straight, with shoulders directly over hands. Incorrect pressure or improperly placed hands could cause injury to the client.

The Nursing Process

Several processes are integrated throughout the NCLEX-RN® exam. The most important of these is the nursing process.


The nursing process involves the assessment, analysis, planning, implementation, and evaluation of nursing care. As a graduate nurse, you are very familiar with each step of the nursing process and how to write a care plan using this process. Knowledge of the nursing process is essential to the performance of safe and effective care. It is also essential to answering questions correctly on the NCLEX-RN® exam.

Now we are going to review the steps of the nursing process and show you how each step is incorporated into test questions. The nursing process is a way of thinking. Using it will help you select correct answers.

Assessment. Assessment is the process of establishing and verifying a database about the patient. This permits you to identify actual and/or potential health problems. The nurse obtains subjective data (information given to you by the client that can't be observed or measured by others), and objective data (information that is observable and measurable by others). This data is collected by interviewing and observing the client and/or significant others, reviewing the health history, performing a physical examination, evaluating lab results, and interacting with members of the health team.

An example of an assessment test question is:

The nurse obtains a health history from a patient admitted with acute glomerulonephritis that is associated with beta hemolytic streptococcus. The nurse expects which of the following to be significant in the health history?

1. The patient had a sore throat two weeks earlier.

2. There is a family history of glomerulonephritis.

3. The patient had a renal calculus two years earlier.

4. The patient had an accident involving renal trauma several years ago.

The correct answer is (1). Glomerulonephritis is an immunologic disorder that is caused by beta hemolytic streptococcus. It occurs 21 days after a respiratory or skin infection.

Analysis. During the analysis phase of the nursing process, you examine the data that you obtained during the assessment phase. This allows you to analyze and draw conclusions about health problems. During analysis, you should compare the client's findings with what is normal. From the analysis, you establish nursing diagnoses. A nursing diagnosis is an actual or potential health problem that the nurse is licensed to manage.


Here is an analysis question:

The nurse plans care for a patient diagnosed with an acute myocardial infarction. An appropriate nursing diagnosis is decreased cardiac output secondary to which of the following?

1. Ventricular dysrhythmias.

2. Congestive heart failure.

3. Recurrent myocardial infarction.

4. Hypertensive crisis.

The correct answer is (1). Ventricular dysrhythmias are common after an MI and reduce the efficiency of the heart.

Planning. During the planning phase of the nursing process, the nursing care plan is formulated. Steps in planning include:

Assigning priorities to nursing diagnosis

Specifying goals

Identifying interventions

Specifying expected outcomes

Documenting the nursing care plan

Goals are anticipated responses and client behaviors that result from nursing care. Nursing goals are patient-centered and measurable, and they have an established time frame. Expected outcomes are the interim steps needed to reach a goal and the resolution of a nursing diagnosis. There will be multiple expected outcomes for each goal. Expected outcomes guide the nurse in planning interventions.

This is an example of a planning question:

A client comes to the emergency room complaining of nausea, vomiting, and severe right upper quadrant pain. His temperature is 101.3° F (38.5° C) and an abdominal X-ray reveals an enlarged gall bladder. He is scheduled for surgery. Which of the following actions should the nurse take FIRST?

1. Assessing the patient's need for dietary teaching.

2. Evaluating the patient's fluid and electrolyte status.

3. Examining the patient's health history for allergies to antibiotics.

4. Determining whether the patient has signed consent for surgery.

The correct answer is (2). Hypokalemia and hypomagnesemia commonly occur after repeated vomiting.

Implementation. Implementation is the term for the actions that you take in the care of your clients. Implementation includes:

Assisting in the performance of Activities of Daily Living (ADLs)

Counseling and educating the patient and family

Giving care to patients

Supervising and evaluating the work of other members of the health team

It is important for you to remember that nursing interventions may be:

Independent actions that are within the scope of nursing practice and do not require supervision by others.

Dependent actions based on the written orders of a physician.

Interdependent actions shared with other members of the health team.

The NCLEX-RN® exam includes questions that involve all three types of nursing interventions.

Here is an example of an implementation question:

A patient is being treated in the burn unit for second- and third-degree burns over 45% of his body. The physician's orders include the application of silver sulfadiazine (Silvadene cream). The best way for the nurse to apply this medication is to use a sterile

1. 4 ¥ 4 soaked in saline.

2. tongue depressor.

3. gloved hand.

4. cotton-tipped applicator.

The correct answer is (3). A sterile, gloved hand will cause the least amount of trauma to tissues and will decrease the chances of breaking blisters.

Evaluation. Evaluation measures the patient's response to nursing interventions and indicates the patient's progress toward achieving the goals established in the care plan. You compare the observed results to expected outcomes.

This is an evaluation question:

When caring for a patient with anorexia nervosa, which of the following observations indicate to the nurse that the patient's condition is improving?

1. The patient eats all the food on her meal tray.

2. The patient asks friends to bring her special foods.

3. The patient weighs herself daily.

4. The patient's weight has increased.

The correct response is (4). The patient's weight is the most objective outcome measure in the evaluation of this client's problem.

Integrated Processes

Several other important processes are integrated throughout the NCLEX-RN® exam. They are:

Caring. As you take the NCLEX-RN® exam, remember that the test is about caring for people, not working with high-tech equipment or analyzing lab results.

Communication and Documentation. For this exam, you are required to understand and utilize therapeutic communication skills with all professional contacts, including clients, their families, and other members of the health care team. Charting or documenting your care and the client's response is both a legal requirement and an essential method of communication in nursing. On this exam you may be asked to identify appropriate documentation of a client behavior or nursing action.

Teaching/Learning Principles. Nursing frequently involves sharing information with clients and families so optimal functioning can be achieved. You may see questions concerning teaching a client about his diet and/or medications.


You might see some questions on the NCLEX-RN® exam that contain graphics (pictures). These questions may include the picture of a patient in traction or it may show the abdomen of a woman who is pregnant. These questions do count, so take them seriously. We have included a question with graphics in the practice test found in this book.

Knowledge Is Power

The more knowledgeable you are about the NCLEX-RN® exam, the more effective your study will be. As you prepare for the exam, keep the content of the test in mind. Thinking like the test maker will enhance your chance of success on the exam.

Are you still thinking about that pacemaker battery from page 3? What do you think the correct answer is?

A man had a permanent pacemaker implanted one year ago. He returns to the outpatient clinic because he thinks the pacemaker battery is malfunctioning. It is MOST important for the nurse to assess for which of the following?

1. Abdominal pain, nausea, and vomiting.

2. Wheezing on exertion, cyanosis, and orthopnea.

3. Peripheral edema, shortness of breath, and dizziness.

4. Chest pain radiating to the right arm, headache, and diaphoresis.

The correct answer is (3). These are symptoms of decreased cardiac output. These symptoms occur with pacemaker battery failure. Other symptoms include changes in pulse rate, irregular pulse, and palpitations.

GI symptoms (1) are not found with pacemaker malfunction. The items listed in (2) are not symptoms of pacemaker failure. And although chest pain may occur with decreased output (4), chest pain that radiates to the right arm is suggestive of angina. Headache and diaphoresis are not seen with pacemaker failure.

Copyright © 2005 by Kaplan, Inc.



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