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Table of Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Welcome to the NCLEX-RN (R) Exam Cram . . . . . . . . . . . . . . . . . . . . 1

Taking the Computerized Adaptive Test . . . . . . . . . . . . . . . . . . . . . . 2

The Cost of the Exam. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

How to Prepare for the Exam. . . . . . . . . . . . . . . . . . . . . . . . . 2

How to Use This Book. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Contact the Nursing Board in Your Area . . . . . . . . . . . . . . . . . . . . . 3

About the Book. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Contact the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Self-Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Testing Your Exam Readiness . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Chapter 1: Preparing for the National Council Exam for Registered Nurses . . . . . . . . . . . . . 7

Preparing for the Exam. . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

The CAT Exam. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Testing Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Read the Question Carefully. . . . . . . . . . . . . . . . . . . . . . . . . . 10

Look for Keywords . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Watch for Specific Details. . . . . . . . . . . . . . . . . . . . . . . . 10

Eliminate Options That Are Clearly Wrong or Incorrect. . . . . . . . . . . . 11

Look for Similar Options . . . . . . . . . . . . . . . . . . . . . . . . 11

Look for Opposite Answers. . . . . . . . . . . . . . . . . . . . . . . . 12

Remember Legalities. . . . . . . . . . . . . . . . . . . . . . . . . . 12

Remember Infection Control . . . . . . . . . . . . . . . . . . . . . . . 12

Exam Prep Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Answer Rationales . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Chapter 2: Pharmacology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Three Areas of Pharmacology. . . . . . . . . . . . . . . . . . . . . . . . . 18

How Nurses Work with Pharmacology . . . . . . . . . . . . . . . . . . . . . 19

Time-Released Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Administering Medications . . . . . . . . . . . . . . . . . . . . . . . . . . 21

The Rights of Administering Medication . . . . . . . . . . . . . . . . . . 21

Understanding and Identifying the Various Drugs . . . . . . . . . . . . . . . . . 22

Angiotensin-Converting Enzyme Inhibitors . . . . . . . . . . . . . . . . . 22

Beta Adrenergic Blockers . . . . . . . . . . . . . . . . . . . . . . . . 23

Anti-Infectives (Aminoglycosides) . . . . . . . . . . . . . . . . . . . . . 25

Benzodiazepines (Anticonvulsants/Antianxiety). . . . . . . . . . . . . . . . 26

Phenothiazines (Antipsychotic/Antiemetic). . . . . . . . . . . . . . . . . . 28

Glucocorticoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Antivirals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Cholesterol-Lowering Agents . . . . . . . . . . . . . . . . . . . . . . . 32

Angiotensin Receptor Blockers . . . . . . . . . . . . . . . . . . . . . . 33

Histamine 2 Antagonists . . . . . . . . . . . . . . . . . . . . . . . . . 34

Proton Pump Inhibitors . . . . . . . . . . . . . . . . . . . . . . . . . 36

Anticoagulants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

More Drug Identification Helpers . . . . . . . . . . . . . . . . . . . . . 38

Herbals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Drug Schedules. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Pregnancy Categories for Drugs . . . . . . . . . . . . . . . . . . . . . . . . 40

Exam Prep Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Answer Rationales . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Chapter 3: Caring for the Client with Disorders of the Respiratory System . . . . . . . . . . . . . 45

Chronic Obstructive Pulmonary Disease . . . . . . . . . . . . . . . . . . . . . 46

Chronic Bronchitis . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Emphysema. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Acute Respiratory Infections . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Pleurisy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Influenza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Acute Respiratory Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Acute Respiratory Distress Syndrome . . . . . . . . . . . . . . . . . . . . 51

Pulmonary Embolus . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Emerging Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Severe Acute Respiratory Syndrome . . . . . . . . . . . . . . . . . . . . 53

Legionnaire's Disease . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Diagnostic Tests for Review . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Pharmacology Categories for Review . . . . . . . . . . . . . . . . . . . . . . 55

Exam Prep Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Answer Rationales . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Suggested Reading and Resources. . . . . . . . . . . . . . . . . . . . . . . . 60

Chapter 4: Caring for the Client with Disorders of the Genitourinary System . . . . . . . . . . . . 61

Acute Glomerulonephritis. . . . . . . . . . . . . . . . . . . . . . . . . . . 62

Chronic Glomerulonephritis. . . . . . . . . . . . . . . . . . . . . . . . . . 63

End Stage Renal Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . 64

Peritoneal Dialysis. . . . . . . . . . . . . . . . . . . . . . . . . . . 64

Hemodialysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

Renal Transplantation . . . . . . . . . . . . . . . . . . . . . . . . . . 65

Nephrotic Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

Urinary Calculi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

Urinary Tract Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

Genitourinary Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

Prostatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

Benign Prostatic Hyperplasia . . . . . . . . . . . . . . . . . . . . . . . . . 68

Bladder Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

Diagnostic Tests for Review . . . . . . . . . . . . . . . . . . . . . . . . . . 70

Pharmacology Categories for Review . . . . . . . . . . . . . . . . . . . . . . 70

Exam Prep Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

Answer Rationales . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

Suggested Reading and Resources. . . . . . . . . . . . . . . . . . . . . . . . 75

Chapter 5: Caring for the Client with Disorders of the Hematopoietic System . . . . . . . . . . . . 77

Anemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

Pernicious Anemia . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

Aplastic Anemia. . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

Sickle Cell Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

Iron Deficiency Anemia . . . . . . . . . . . . . . . . . . . . . . . . . 80

Cooley's Anemia (Thalassemia Major) . . . . . . . . . . . . . . . . . . . 81

Hemophilia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Polycythemia Vera . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

Diagnostic Tests for Review . . . . . . . . . . . . . . . . . . . . . . . . . . 83

Pharmacology for Review . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

Exam Prep Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

Answer Rationales . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Suggested Reading and Resources. . . . . . . . . . . . . . . . . . . . . . . . 87

Chapter 6: Caring for the Client with Disorders of Fluid and Electrolyte Balance and Acid/Base Balance . . 89

Basic Knowledge of Fluid and Electrolyte Balance . . . . . . . . . . . . . . . . . 90

Regulation of pH and Its Effect on Fluid and Electrolytes . . . . . . . . . . . . . . 91

How the Body Regulates pH. . . . . . . . . . . . . . . . . . . . . . . 91

Metabolic Acidosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

Causes of Metabolic Acidosis . . . . . . . . . . . . . . . . . . . . . . . 91

Symptoms of Metabolic Acidosis. . . . . . . . . . . . . . . . . . . . . . 92

Care of the Client with Metabolic Acidosis. . . . . . . . . . . . . . . . . . 92

Respiratory Acidosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Causes of Respiratory Acidosis . . . . . . . . . . . . . . . . . . . . . . 93

Symptoms of Respiratory Acidosis . . . . . . . . . . . . . . . . . . . . . 94

Caring for the Client with Respiratory Acidosis . . . . . . . . . . . . . . . . 94

Metabolic Alkalosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

Causes of Metabolic Alkalosis . . . . . . . . . . . . . . . . . . . . . . . 95

Symptoms of Metabolic Alkalosis . . . . . . . . . . . . . . . . . . . . . 95

Caring for the Client with Metabolic Alkalosis . . . . . . . . . . . . . . . . 96

Respiratory Alkalosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96

Symptoms of Respiratory Alkalosis . . . . . . . . . . . . . . . . . . . . . 96

Care of the Client with Respiratory Alkalosis . . . . . . . . . . . . . . . . . 97

Normal Electrolyte Values . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Changes Associated with Aging. . . . . . . . . . . . . . . . . . . . . . . . . 98

Exam Prep Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100

Answer Rationales . . . . . . . . . . . . . . . . . . . . . . . . . . . 102

Suggested Reading and Resources. . . . . . . . . . . . . . . . . . . . . . . 103

Chapter 7: Caring for the Client with Burns. . . . . . . . . . . . . . . . . . . . . . . . . . 105

Burn Classifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

Burn Measurement with TBSA. . . . . . . . . . . . . . . . . . . . . . 108

Nursing Care for Burn Victims. . . . . . . . . . . . . . . . . . . . . . . . 109

The Resuscitative (Emergent) Phase . . . . . . . . . . . . . . . . . . . . 110

The Acute (Intermediate) Phase . . . . . . . . . . . . . . . . . . . . . 113

Dressings for Burns. . . . . . . . . . . . . . . . . . . . . . . . . . 114

The Rehabilitative Phase. . . . . . . . . . . . . . . . . . . . . . . . 115

Diagnostic Tests for Review . . . . . . . . . . . . . . . . . . . . . . . . . 116

Pharmacology Categories for Review . . . . . . . . . . . . . . . . . . . . . . 116

Exam Prep Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117

Answer Rationales . . . . . . . . . . . . . . . . . . . . . . . . . . . 119

Suggested Reading and Resources. . . . . . . . . . . . . . . . . . . . . . . 120

Chapter 8: Caring for the Client with Sensorineural Disorders . . . . . . . . . . . . . . . . . . 121

Disorders of the Eyes . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122

Intraocular Disorders . . . . . . . . . . . . . . . . . . . . . . . . . 122

Retinal Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . 125

Refractive Errors . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

Traumatic Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . 128

Visual Tests for Review . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

Pharmacology Categories for Review . . . . . . . . . . . . . . . . . . . . . . 129

Ear Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

Otitis Externa . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130

Otitis Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130

Meniere's Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . 130

Otosclerosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131

Presbycusis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131

Ear Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132

Assisting Clients with Hearing Loss . . . . . . . . . . . . . . . . . . . . . . 132

Diagnostic Tests for Review . . . . . . . . . . . . . . . . . . . . . . . . . 132

Pharmacology Categories for Review . . . . . . . . . . . . . . . . . . . . . . 133

Exam Prep Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134

Answer Rationales . . . . . . . . . . . . . . . . . . . . . . . . . . . 136

Suggested Reading and Resources. . . . . . . . . . . . . . . . . . . . . . . 137

Chapter 9: Caring for the Client with Cancer. . . . . . . . . . . . . . . . . . . . . . . . . 139

Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140

American Cancer Society's Seven Warning Signs of Cancer . . . . . . . . . . . 140

The Four Major Categories of Cancer . . . . . . . . . . . . . . . . . . . 140

Risk Factors for Specific Cancers . . . . . . . . . . . . . . . . . . . . . 141

Cancer Prevention. . . . . . . . . . . . . . . . . . . . . . . . . . . 143

Patient Teaching . . . . . . . . . . . . . . . . . . . . . . . . . . . 143

Management of the Client with Cancer . . . . . . . . . . . . . . . . . . . . . 143

Radiation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144

Chemotherapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . 145

Bone Marrow and Peripheral Stem Cell Transplantation (PSCT) . . . . . . . . . . . 147

Types of Transplants . . . . . . . . . . . . . . . . . . . . . . . . . . 148

Nursing Care After Transplantation . . . . . . . . . . . . . . . . . . . . 148

Hodgkin's Lymphoma. . . . . . . . . . . . . . . . . . . . . . . . . . . . 149

Diagnosis of Hodgkin's Lymphoma. . . . . . . . . . . . . . . . . . . . 150

Prognosis of Hodgkin's Lymphoma. . . . . . . . . . . . . . . . . . . . 150

Treatment of Hodgkin's Lymphoma . . . . . . . . . . . . . . . . . . . . 150

Diagnostic Tests for Review . . . . . . . . . . . . . . . . . . . . . . . . . 151

Pharmacology for Review . . . . . . . . . . . . . . . . . . . . . . . . . . 152

Exam Prep Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154

Answer Rationales . . . . . . . . . . . . . . . . . . . . . . . . . . . 156

Suggested Reading and Resources. . . . . . . . . . . . . . . . . . . . . . . 157

Chapter 10: Caring for the Client with Disorders of the Gastrointestinal System . . . . . . . . . . . 159

Ulcers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160

Types of Ulcers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160

Treatment of Ulcers . . . . . . . . . . . . . . . . . . . . . . . . . . 161

Inflammatory Bowel Disorders . . . . . . . . . . . . . . . . . . . . . . . . 163

Crohn's Disease (Regional Enteritis) . . . . . . . . . . . . . . . . . . . . 163

Ulcerative Colitis . . . . . . . . . . . . . . . . . . . . . . . . . . . 164

Diverticulitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165

Diagnosis of Diverticulitis. . . . . . . . . . . . . . . . . . . . . . . . 165

Treatment of Diverticulitis . . . . . . . . . . . . . . . . . . . . . . . 166

Gastroesophageal Reflux Disease (GERD) . . . . . . . . . . . . . . . . . . . . 166

Diseases Associated with the Liver . . . . . . . . . . . . . . . . . . . . . . . 167

Hepatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167

Cirrhosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172

Pancreatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174

Cholecystitis/Cholelithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . 176

Symptoms of Cholecystitis and Cholelithiasis . . . . . . . . . . . . . . . . 176

Diagnosis of Cholecystitis/Cholethiasis. . . . . . . . . . . . . . . . . . . 177

Treatment of Cholecystitis . . . . . . . . . . . . . . . . . . . . . . . 177

Treatment of Cholethiasis . . . . . . . . . . . . . . . . . . . . . . . . 177

Clostridium Difficile . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178

Food-Borne Illnesses. . . . . . . . . . . . . . . . . . . . . . . . . . . . 179

Diagnostic Tests for Review . . . . . . . . . . . . . . . . . . . . . . . . . 180

Pharmacology for Review . . . . . . . . . . . . . . . . . . . . . . . . . . 180

Exam Prep Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182

Answer Rationales . . . . . . . . . . . . . . . . . . . . . . . . . . . 184

Suggested Reading and Resources. . . . . . . . . . . . . . . . . . . . . . . 185

Chapter 11: Caring for the Client with Disorders of the Musculoskeletal System . . . . . . . . . . . 187

Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188

Treating Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . 188

Compartment Syndrome. . . . . . . . . . . . . . . . . . . . . . . . 191

Osteomyelitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192

Osteoporosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193

Treatment of Osteoporosis . . . . . . . . . . . . . . . . . . . . . . . 194

Gout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195

Treatment of the Client with Gout . . . . . . . . . . . . . . . . . . . . 195

Rheumatoid Arthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195

Treatment of Rheumatoid Arthritis. . . . . . . . . . . . . . . . . . . . 196

Musculoskeletal Surgical Procedures. . . . . . . . . . . . . . . . . . . . . . 197

Fractured Hip and Hip Replacement . . . . . . . . . . . . . . . . . . . 197

Total Knee Replacement . . . . . . . . . . . . . . . . . . . . . . . . 198

Amputations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199

Assistive Devices for Ambulation . . . . . . . . . . . . . . . . . . . . . . . 201

Crutches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201

Canes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202

Walkers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202

Diagnostic Tests for Review . . . . . . . . . . . . . . . . . . . . . . . . . 203

Pharmacology for Review . . . . . . . . . . . . . . . . . . . . . . . . . . 203

Exam Prep Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205

Answer Rationales . . . . . . . . . . . . . . . . . . . . . . . . . . . 207

Suggested Reading and Resources. . . . . . . . . . . . . . . . . . . . . . . 208

Chapter 12: Caring for the Client with Disorders of the Endocrine System . . . . . . . . . . . . . 209

The Endocrine System . . . . . . . . . . . . . . . . . . . . . . . . . . . 210

Pituitary Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210

Tumors of the Pituitary. . . . . . . . . . . . . . . . . . . . . . . . . 211

Thyroid Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213

Hypothyroidism . . . . . . . . . . . . . . . . . . . . . . . . . . . 213

Hyperthyroidism . . . . . . . . . . . . . . . . . . . . . . . . . . . 214

Parathyroid Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216

Hypoparathyroidism . . . . . . . . . . . . . . . . . . . . . . . . . . 216

Hyperparathyroidism . . . . . . . . . . . . . . . . . . . . . . . . . 217

Adrenal Gland Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . 218

Adrenocortical Insufficiency (Addison's Disease). . . . . . . . . . . . . . . 218

Adrenocortical Hypersecretion (Cushing's Syndrome) or Cushing's Disease. . . . . 219

Diabetes Mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219

Diagnostic Tests for Review . . . . . . . . . . . . . . . . . . . . . . . . . 223

Pharmacology Categories for Review . . . . . . . . . . . . . . . . . . . . . . 223

Exam Prep Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224

Answer Rationales . . . . . . . . . . . . . . . . . . . . . . . . . . . 226

Suggested Reading and Resources. . . . . . . . . . . . . . . . . . . . . . . 227

Chapter 13: Caring for the Client with Disorders of the Cardiovascular System . . . . . . . . . . . 229

Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230

Medications Used to Treat Hypertension . . . . . . . . . . . . . . . . . . 231

Heart Block. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231

Toxicity to Medications . . . . . . . . . . . . . . . . . . . . . . . . . 233

Malfunction of the Conduction System. . . . . . . . . . . . . . . . . . . 233

Myocardial Infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234

Diagnosis of Myocardial Infarction . . . . . . . . . . . . . . . . . . . . 235

Management of Myocardial Infarction Clients . . . . . . . . . . . . . . . . 236

Inflammatory Diseases of the Heart . . . . . . . . . . . . . . . . . . . . . . 239

Infective Endocarditis . . . . . . . . . . . . . . . . . . . . . . . . . 239

Pericarditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239

Buerger's Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240

Thrombophlebitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240

Raynaud's Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241

Aneurysms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241

Congestive Heart Failure . . . . . . . . . . . . . . . . . . . . . . . . . . 242

Diagnostic Tests for Review . . . . . . . . . . . . . . . . . . . . . . . 242

Pharmacology Categories for Review . . . . . . . . . . . . . . . . . . . . . . 243

Exam Prep Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244

Answer Rationales . . . . . . . . . . . . . . . . . . . . . . . . . . . 246

Suggested Reading and Resources. . . . . . . . . . . . . . . . . . . . . . . 247

Chapter 14: Caring for the Client with Disorders of the Neurological System . . . . . . . . . . . . 249

Seizures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250

Types of Seizures. . . . . . . . . . . . . . . . . . . . . . . . . . . 250

Treatment of Seizure Clients. . . . . . . . . . . . . . . . . . . . . . . 252

Status Epilepticus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253

Brain Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253

Epidural Hematomas. . . . . . . . . . . . . . . . . . . . . . . . . . 254

Subdural Hematoma . . . . . . . . . . . . . . . . . . . . . . . . . . 254

Treatment of Epidural and Subdural Hematomas . . . . . . . . . . . . . . . 254

Increased Intracranial Pressure . . . . . . . . . . . . . . . . . . . . . . . . 255

Treatment of ICP . . . . . . . . . . . . . . . . . . . . . . . . . . . 257

Neurological Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . 258

Cranial Nerve Assessment. . . . . . . . . . . . . . . . . . . . . . . . 258

Glasgow Coma Scale. . . . . . . . . . . . . . . . . . . . . . . . . . 259

Intracranial Pressure Monitors . . . . . . . . . . . . . . . . . . . . . . 260

Care of the Client with Intracranial Surgery (Craniotomy) . . . . . . . . . . . . . 260

Cerebrovascular Accident/Stroke . . . . . . . . . . . . . . . . . . . . . . . 262

Spinal Cord Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263

Treatment of Spinal Cord Injuries. . . . . . . . . . . . . . . . . . . . . 263

Potential Complications with SCI Clients. . . . . . . . . . . . . . . . . . 264

Guillain-Barre . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265

Treating Clients with Guillian-Barre. . . . . . . . . . . . . . . . . . . . 266

Degenerative Neurological Disorders . . . . . . . . . . . . . . . . . . . . . . 266

Diagnostic Tests for Review . . . . . . . . . . . . . . . . . . . . . . . . . 267

Pharmacology for Review . . . . . . . . . . . . . . . . . . . . . . . . . . 267

Exam Prep Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269

Answer Rationales . . . . . . . . . . . . . . . . . . . . . . . . . . . 271

Suggested Reading and Resources. . . . . . . . . . . . . . . . . . . . . . . 272

Chapter 15: Caring for the Client with Psychiatric Disorders . . . . . . . . . . . . . . . . . . . 273

Anxiety Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 274

Generalized Anxiety Disorder . . . . . . . . . . . . . . . . . . . . . . 275

Panic Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275

Specific Phobia . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275

Obsessive-Compulsive Disorder . . . . . . . . . . . . . . . . . . . . . 276

Trauma Related Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . 276

Posttraumatic Stress Disorder . . . . . . . . . . . . . . . . . . . . . . 276

Dissociative Disorders. . . . . . . . . . . . . . . . . . . . . . . . . 277

Dissociative Identity Disorder. . . . . . . . . . . . . . . . . . . . . . 277

Somatic Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . 278

Personality Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278

Managing Clients with Personality Disorders . . . . . . . . . . . . . . . . 281

Psychotic Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282

Schizophrenia . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282

Bipolar Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . 284

Substance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286

Alcoholism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286

Other Commonly Abused Substances . . . . . . . . . . . . . . . . . . . 288

Disorders of Childhood and Adolescence . . . . . . . . . . . . . . . . . . . . 291

Disruptive, Control, and Conduct Disorders . . . . . . . . . . . . . . . . 291

Neurodevelopmental Disorders. . . . . . . . . . . . . . . . . . . . . . 291

Eating Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . 293

Diagnostic Tests for Review . . . . . . . . . . . . . . . . . . . . . . . . . 294

Pharmacology Categories for Review . . . . . . . . . . . . . . . . . . . . . . 294

Exam Prep Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295

Answer Rationales . . . . . . . . . . . . . . . . . . . . . . . . . . . 297

Suggested Reading and Resources. . . . . . . . . . . . . . . . . . . . . . . 298

Chapter 16: Caring for the Maternal/Infant Client. . . . . . . . . . . . . . . . . . . . . . . . 299

Signs of Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300

Presumptive Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . 300

Probable Signs. . . . . . . . . . . . . . . . . . . . . . . . . . . . 300

Positive Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301

Prenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301

Prenatal Diet and Weight Maintenance . . . . . . . . . . . . . . . . . . 301

Alpha-Fetoprotein Screening . . . . . . . . . . . . . . . . . . . . . . 301

Other Prenatal Diagnostic Tests . . . . . . . . . . . . . . . . . . . . . 302

Assessing Fetal Heart Tones . . . . . . . . . . . . . . . . . . . . . . . 303

Ultrasonography . . . . . . . . . . . . . . . . . . . . . . . . . . . 303

Signs of Complications of Pregnancy . . . . . . . . . . . . . . . . . . . . . . 303

Types of Abortions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304

Complications Affecting Pregnancy . . . . . . . . . . . . . . . . . . . . . . 305

Diabetes in Pregnancy. . . . . . . . . . . . . . . . . . . . . . . . . 305

Preeclampsia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306

Disseminated Intravascular Coagulation . . . . . . . . . . . . . . . . . . 307

Cord Prolapse . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307

Abruptio Placenta . . . . . . . . . . . . . . . . . . . . . . . . . . . 308

Placenta Previa . . . . . . . . . . . . . . . . . . . . . . . . . . . . 308

Maternal Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 308

Preterm Labor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311

Intrapartal Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311

Stages of Labor . . . . . . . . . . . . . . . . . . . . . . . . . . . . 312

Phases of Labor. . . . . . . . . . . . . . . . . . . . . . . . . . . . 312

Important Terms You Should Know . . . . . . . . . . . . . . . . . . . . 312

Prelabor Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313

Fetal Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314

Pharmacologic Management of Labor . . . . . . . . . . . . . . . . . . . . . 316

Postpartum Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317

Terms Associated with the Normal Newborn . . . . . . . . . . . . . . . . . . . 317

Rh Incompatibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318

Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319

Diagnostic Tests for Review . . . . . . . . . . . . . . . . . . . . . . . . . 320

Pharmacology Categories for Review . . . . . . . . . . . . . . . . . . . . . . 321

Exam Prep Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 322

Answer Rationales . . . . . . . . . . . . . . . . . . . . . . . . . . . 324

Suggested Reading and Resources. . . . . . . . . . . . . . . . . . . . . . . 325

Chapter 17: Caring for the Pediatric Client . . . . . . . . . . . . . . . . . . . . . . . . . . 327

Growth and Development. . . . . . . . . . . . . . . . . . . . . . . . . . 328

Infant (28 Days to 1 Year) . . . . . . . . . . . . . . . . . . . . . . . . 328

Toddler (1-3 Years) . . . . . . . . . . . . . . . . . . . . . . . . . . 330

About the Author

Wilda Rinehart Gardner received an Associate Degree in Nursing in 1973 from Northeast Mississippi Community College in Booneville, Mississippi. After working as a staff nurse and charge nurse, she became a public health nurse and served in that capacity for a number of years. In 1975, she received her certification as a family planning nurse practitioner from the midwifery program at the University of Mississippi Medical Center in Jackson, Mississippi. She completed her BSN in 1979 and MSN in 1980 from Mississippi University for Women. She retired after 26 years as nursing instructor at Northeast Mississippi Community College where she taught medical-surgical nursing and maternal newborn nursing. From 1982 to 2012, she operated Rinehart and Associates Nursing Review to assist graduate nurses to pass the National Council of Licensure Exam. She also worked as a curriculum consultant with nursing faculty in the improvement of test construction. Ms. Rinehart has served as a convention speaker in several states in the southeast and has been a reviewer of medical-surgical and obstetric texts.

Dr. Diann Sloan received an Associate Degree in Nursing from Northeast Mississippi Community College, a Bachelor of Science degree in Nursing from the University of Mississippi, and a Master of Science degree in Nursing from Mississippi University for Women. In addition to her nursing degrees, she holds a Master of Science in Counseling Psychology from Georgia State University and a Doctor of Philosophy in Counselor Education, with minors in both Psychology and Educational Psychology, from Mississippi State University. She has completed additional graduate studies in healthcare administration at Western New England College and the University of Mississippi. Dr. Sloan has taught pediatric nursing, psychiatric mental health nursing, and medicalsurgical nursing in both associate degree and baccalaureate nursing programs. Dr. Sloan has conducted test construction workshops for both RN and PN faculty and is coauthor of the Pearson Online Review.

Clara Hurd received an Associate Degree in Nursing from Northeast Mississippi Community College in Booneville, Mississippi (1975). Her experiences in nursing are clinically based, having served as a staff nurse in medical-surgical nursing. She has worked as an oncology, intensive care, orthopedic, neurological, and pediatric nurse. She received her Bachelor of Science degree in Nursing from the University of North Alabama in Florence, Alabama, and her Master of Science degree in Nursing from the Mississippi University for Women in Columbus, Mississippi. Ms. Hurd is a certified nurse educator. She currently serves as a nurse educator consultant and an independent contractor. Ms. Hurd has taught in both associate degree and baccalaureate degree nursing programs. She was a faculty member of Mississippi University for Women; Austin Peay State University in Clarksville, Tennessee; Tennessee State University in Nashville, Tennessee; and Northeast Mississippi Community College. Ms. Hurd joined Rinehart and Associates in 1993. She has worked with students in preparing for the National Council Licensure Exam and with faculty as a consultant in writing test items. Ms. Hurd has also been a presenter at nursing conventions on various topics, including item-writing for nursing faculty. Her primary professional goal is to prepare the student and graduate for excellence in the delivery of healthcare.

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