Rhoda L. Sommer, RN, MSN Ed, spent 28 years in patient care before beginning a second career teaching and serving as a private tutor for nursing students preparing for the NCLEX-RN.

Patrick R. Coonan, EdD, RN, CNAA, is the former Dean of the College of Nursing and Public Health at Adelphi University.

Introduction 1

About This Book 1

Foolish Assumptions 2

Icons Used in This Book 2

Beyond the Book 3

Where to Go from Here 3

Part 1: Demystifying the Complexity of the NCLEX-RN 5

Chapter 1: Meet the NCLEX-RN: Your Ticket to Getting a License 7

The Big Deal behind the Big Exam 7

You Must Remember This: Nursing Basics to Know by Heart 8

The NCLEX-RN - Not Your Average CAT Scan! 9

Thinking the NCLEX-RN Way 10

Getting to the root of the question 10

Navigating the grand inquisition, or the integrated exam 11

Avoiding test-taking missteps 12

Finding the real question behind the long scenario 13

Keeping your cool when answering select-all-that-apply questions 13

When All Is Said and Done 14

Hey, nurse? Yeah, you! 14

So, you failed - it's not the end of the world 14

Chapter 2: Preparing for T-Day: Paperwork and Whatnot 17

How Long Should I Wait after I Graduate? Deciding When to Test 17

Applying to Take the NCLEX-RN 18

Completing the application process 18

Paying your dues 19

Hitting a bump: Potential problems with the licensure application 19

Scheduling the Time and Place 21

Planning Ahead for the Big Day 22

Help, My Car Won't Start! Rescheduling the Test 24

Chapter 3: The NCLEX-RN Blueprint 25

Considering the Four Main Categories of Client Needs 25

Client need #1: Safe and effective care environment 26

Client need #2: Health promotion and maintenance 28

Client need #3: Psychosocial integrity 28

Client need #4: Physiological integrity 30

Queuing Up Question Types 32

Putting knowledge into action: Application questions 33

Becoming an assessor: Evaluation questions 34

Slipping into Sherlock's shoes: Analysis questions 34

Getting creative: Synthesizing and creating questions 35

Exercising individuality: Alternate test questions 35

Chapter 4: Buffing Up: Study Tips and Test-Taking Strategies 43

Setting Up an NCLEX-RN Study Schedule 44

Identifying Your Weak Points and Hitting the Books 45

Remembering Dear Maslow and His Needs 47

Applying the Nursing Process in Test Questions 48

Assessing the situation 49

Analyzing the situation 51

Planning your actions 52

Implementing care 54

Evaluating your actions 55

Dissecting the Questions and Finding Keywords 57

Pinpointing the keywords 58

Putting the keywords in context 59

Developing Critical-Thinking Strategies 60

Knowing the expected outcomes 60

Finding the elusive question topic 61

Making an educated guess 62

Picking the best answer when you're completely clueless 62

Knowing how to prioritize when all the answers are right 64

Avoiding Test Question Pitfalls 67

Don't read into the question 67

Read the whole question and reword it 68

Eliminate wrong answers 68

Try not to predict answers 69

Part 2: Testing Your Knowledge of Client Needs 71

Chapter 5: Management of Care 73

First Things First: Knowing Your Patient's Rights 73

You must heed prearranged treatment options 74

All lips must remain sealed 75

Information and technology changes 76

Nothing happens without informed consent 76

Ethical decisions don't require your opinion 77

Rallying the Troops: Managing Care 78

Assuring the quality of patient care 78

Prioritizing when your hands are full: Group care 79

Tailoring care for each patient: Case management 80

Collaborating with other medical team members 81

Getting others to lend a hand: Delegation 82

Recognizing Legal Rights and Nursing Responsibilities 84

Knowing Where to Get the Support You Need 86

Keeping up with education and training 86

Expecting adequate supervision 87

Making referrals 88

Chapter 6: Safety and Infection Control 89

Preventing Accidents and Injuries 89

Using electrical equipment safely 90

Keeping clients from falling 91

Disaster Planning and Emergency Response 92

Sounding the alarm: When fires break out 93

Responding to terrorism or bioterrorism 95

Keeping Infectious Bugs at Bay 95

Maintaining medical and surgical purity 95

Differentiating among the types of infection precautions 97

Handling hazardous and infectious materials 100

Keeping Clients Down in a Way That Lifts Them Up 101

Accidents Happen: Knowing the Next Steps and Preparing an Incident Report 103

Code Pink: Understanding the Protocol for Infant Abduction 104

Chapter 7: Health Promotion and Maintenance 107

Surveying the Stages of Growth and Development 107

For children 108

For normal pregnancy and the birth of newborns 110

For older adults 111

To Your Clients' Health! Promoting Well-Being 111

Creating and Implementing Care Plans 112

Assessing your patient's physical condition 112

Teaching patients from the moment of introduction 114

Understanding and explaining screening tests 116

Handling High-Risk Behavior and Alternate Lifestyle Choices 117

Preparing Patients to Leave Your Care 118

Helping patients take care of themselves 118

Embracing the family system 118

Chapter 8: Psychosocial Integrity 121

Looking beyond the Surface: Factors That Influence Behavior 121

Behavioral basics: Important development theories 122

The spice of life: Cultural and family diversity 123

Coping, Counseling, and Crisis Intervention 124

Dealing with defense mechanisms 125

Talking through troubles 126

Teaching stress management 128

Helping Patients through Grief and Loss 129

Caring for Patients with Abuse Issues 130

Recognizing different types of abuse 130

Identifying stages of substance abuse 131

Chapter 9: Basic Care and Comfort 133

Giving Patients First What They Need Most 133

Ensuring Adequate Nutrition and Hydration 134

Identifying the building blocks of nutrition 135

Modifying your patient's diet 135

Recognizing malnutrition 136

Administering tube feedings 138

Hydrating your patient 138

Resting Easy, Sleeping Soundly 139

Keeping 'em Clean: Personal Hygiene 140

Understanding the Process of Elimination 142

Measuring your patient's urinary health 142

Keeping bowels healthy 144

Wading through Irrigations 145

Providing Holistic Care with Alternative and Complementary Medicine 147

Decreasing Pain without Pills 148

Helping Patients Get Around (and What to Do if They Can't) 149

Training patients to use crutches, walkers, and canes 149

Avoiding complications from immobility 150

Chapter 10: Meditating on Meds: Pharmacological and Parenteral Therapies 153

Remembering the Factors You Must Verify before Giving Meds 153

Medicating Patients Safely 155

Assessing before medicating 155

Calculating dosages 156

Recognizing the effects of meds 159

Answering questions about unfamiliar meds 161

Using Medicine to Manage Pain 162

Giving Meds and More with a Stick and a Poke: Parenteral Therapy 165

Solving the puzzle of solutions 165

Providing med therapy all in vein 168

Hanging blood and blood products 169

Chapter 11: Reduction of Risk 173

Interpreting Lab Results without a Hitch 173

Separating the oozing red stuff 174

Looking closely at immunity defenders 178

Examining pee (ha-ha) 179

Recognizing the Main Diagnostic Assessments 180

The daily routine: Checking vital signs 180

Respiratory tests 181

Cardiovascular tests 183

Gastrointestinal tests 184

Musculoskeletal tests 184

Neurological tests 184

Being Ready for the Bumps: Complications with Testing and Treating 185

Taking stock of diagnostic risks 186

Preventing postsurgical complications 186

Taking a Load Off: Therapeutic Procedures and Diagnostic Tests 190

Administering Conscious Sedation Safely 193

Chapter 12: Physiological Adaptation 195

Understanding What's Normal So You Know What Isn't 195

The water of life: Accounting for fluid 196

Getting the right pH: The key to acid-base balance 198

Keeping an eye on respiratory health - the sum of water and pH 199

Monitoring hemodynamics 201

Anticipating the Results of Imbalance 202

Knowing what to do when the body systems are out of whack 202

Looking down the road to infection 204

Pathophysiology: Recognizing and Managing Illness and Disease 205

Houston, we have a problem: Focusing on microsystems 206

Doing damage control of the medical kind 208

Taking a Patient for Tests and Therapy 208

Facing an MRI, the hot potato of medical tests 209

Handling therapies, from dialysis to radiation 209

Part 3: Just What You Were Looking For: A Full-Length Practice Test 213

Chapter 13: A Story of Blood, Chills, and Pain: A Practice NCLEX-RN 215

Chapter 14: The Answers to All Your Questions (and Explanations to Boot) 257

Answers and Explanations 258

Answer Key 284

Part 4: The Part of Tens 287

Chapter 15: Ten Myths about the NCLEX-RN 289

Length Matters 289