Prioritization, Delegation, & Management of Care for the NCLEX-RN ® Exam 3313_FM_i-xii 14/03/14 5:13 PM Page i 3313_FM_i-xii 14/03/14 5:13 PM Page ii Davis’s success series Q&A Course Review and NCLEX Prep 9Thousands of NCLEX-style questions 9Alternate-item-format questions 9Rationales for correct and incorrect answers 9Test-taking tips Visit www.fadavis.com Keyword: Success Series to learn more. www.fadavis.com Davis Mobile aPPs Download today from your favorite app store! Prioritization, Delegation, & Management of Care for the NCLEX-RN ® Exam Ray A. Hargrove-Huttel, RN, PhD Kathryn Cadenhead Colgrove, RN, MS, CNS 3313_FM_i-xii 14/03/14 5:13 PM Page iii F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2014 by F. A. Davis Company Copyright © 2014 by F. A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Publisher, Nursing: Robert G. Martone Director of Content Development: Darlene D. Pedersen Project Editor: Jacalyn C. Clay Electronic Project Editor: Sandra A. Glennie Illustration and Design Manager: Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Cataloging-in-Publication Data Library of Congress Cataloging-in-Publication Data ISBN: 978-0-8036-3313-1 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 978-0-8036-3313-1/14 0 + $.25. 3313_FM_i-xii 14/03/14 5:13 PM Page iv Thank you to all the nursing students, nursing faculty, and nursing colleagues we have had the privilege to work with during our careers. We want to thank Robert Martone for his vision and support, who was there when our writing career started and has been with us every step of the way. Our thanks to computer extraordinaire Glada Norris, who fixes our mistakes, makes the questions look “pretty,” and is responsible for making this book possible. Thank you to Kathryn McAfee who codes all the questions, leaving us time to write the questions. I want to thank all my friends for love, support, and prayers as I battled ovarian cancer this last year. Thanks to aunts, uncles, and cousins, my Los Angeles friends, my Trinity Valley Community College friends, my Texas friends, my Hawaiian friends, and the Lee girls. My thanks to my sisters Gail and Debbie, my nephew Ben, and Paula who brought me home and cared for me. I thank my children Teresa and Aaron for making me want to get up every day and fight the fight. As always, I dedicate this book to my parents, T/Sgt Leo R. Hargrove and Nancy, who made me believe I can do anything. I am an ovarian cancer survivor. —RAY A. HARGROVE-HUTTEL (This was Ray’s dedication. Ray lost her battle with cancer on December 23, 2012. She is much loved and greatly missed. -Kathy Colgrove) I would like to dedicate this book to the memory of my mother, Mary Cadenhead, and grandmother, Elsie Rogers. They always told me I could accomplish anything I wanted to accomplish. I would also like to dedicate this book to my husband, Larry, children, Laurie and Todd and Larry Jr. and Mai, and grandchildren, Chris, Ashley, Justin C., Justin A., Connor, Sawyer, and Carson—without their support and patience the book would not have been possible. —KATHRYN CADENHEAD COLGROVE v 3313_FM_i-xii 14/03/14 5:13 PM Page v 3313_FM_i-xii 14/03/14 5:13 PM Page vi Reviewers Debra Bailey, RN, PhD candidate, FNP, CDE Associate Professor of Nursing, Department Head Health Sciences Colorado Mesa University Grand Junction, Colorado Patricia A. Bicknell, EdD, APRN, ACNS-BC, CNL Assistant Professor of Nursing; Track Coordinator for Clinical Nurse Leader (CNL) La Salle University Philadelphia, Pennsylvania Donna Bowles, EdD, MSN, CNE Associate Professor Indiana University Southeast New Albany, Indiana Diane Cohen, RN, MSN Professor MassBay Community College Framingham, Massachusetts Diane L. Cooper-McLean, RN, BSN, MSN Nursing Instructor Faulkner State Community College Bay Minette, Alabama Pamela DeWitt, RN, MN, CNE Residential Faculty Phoenix College Department of Nursing Phoenix, Arizona Kathleen Walsh Free, MSN, RN-C, APRN-BC Clinical Professor Indiana University Southeast New Albany, Indiana Lynn D. Kennedy, MSN, RN Assistant Professor of Nursing Francis Marion University Florence, South Carolina Maria McCormick, MSN, MS, RN Faculty Spencerian College Louisville, Kentucky Mary Ann Siciliano McLaughlin, MSN, RN Faculty, UMDNJ School of Nursing UMDNJ School of Nursing Stratford, New Jersey Elizabeth Murray, PhD, RN, CNE Assistant Professor Florida Gulf Coast University School of Nursing Fort Myers, Florida L. Jane Rosati, EdD, MSN, RN-BC Assistant Chair/Program Manager of the ADN Program Daytona State College Daytona Beach, Florida Faye Sigman, PhD Professor of Nursing Dyersburg State Dyersburg, Tennessee Thomas Worms, RN, MSN Professor of Nursing Truman College Chicago, Illinois Polly Gerber Zimmermann, RN, MS, MBA, CEN, FAEN Associate Professor Harry S Truman College Chicago, Illinois vii 3313_FM_i-xii 14/03/14 5:13 PM Page vii 3313_FM_i-xii 14/03/14 5:13 PM Page viii Table of Contents 1 Introduction to Prioritization, Assignment, Delegation, and Management 1 NCSBN BLUEPRINT FOR QUESTIONS 1 GUIDELINES FOR MAKING A DECISION 2 TYPES OF QUESTIONS 4 PUTTING THE PIECES TOGETHER 5 2 Cardiovascular Management 7 QUESTIONS 7 CARDIAC CLINICAL SCENARIO 20 ANSWERS AND RATIONALES 22 CLINICAL SCENARIO ANSWERS AND RATIONALES 40 3 Peripheral Vascular Management 43 QUESTIONS 43 PERIPHERAL VASCULAR DISEASES CLINICAL SCENARIO 54 ANSWERS AND RATIONALES 56 CLINICAL SCENARIO ANSWERS AND RATIONALES 74 4 Respiratory Management 77 QUESTIONS 77 RESPIRATORY CLINICAL SCENARIO 88 ANSWERS AND RATIONALES 90 CLINICAL SCENARIO ANSWERS AND RATIONALES 107 5 Gastrointestinal Management 109 QUESTIONS 109 GASTROINTESTINAL CLINICAL SCENARIO 120 ANSWERS AND RATIONALES 122 CLINICAL SCENARIO ANSWERS AND RATIONALES 139 6 Renal and Genitourinary Management 141 QUESTIONS 141 RENAL AND GENITOURINARY CLINICAL SCENARIO 152 ANSWERS AND RATIONALES 154 CLINICAL SCENARIO ANSWERS AND RATIONALES 171 ix 3313_FM_i-xii 14/03/14 5:13 PM Page ix x TABLE OF CONTENTS 7 Neurological Management 173 QUESTIONS 173 NEUROLOGICAL CLINICAL SCENARIO 185 ANSWERS AND RATIONALES 187 CLINICAL SCENARIO ANSWERS AND RATIONALES 204 8 Endocrine Management 207 QUESTIONS 207 ENDOCRINE CLINICAL SCENARIO 220 ANSWERS AND RATIONALES 221 CLINICAL SCENARIO ANSWERS AND RATIONALES 238 9 Integumentary Management 239 QUESTIONS 239 INTEGUMENTARY CLINICAL SCENARIO 250 ANSWERS AND RATIONALES 252 CLINICAL SCENARIO ANSWERS AND RATIONALES 269 10 Hematological and Immunological Management 271 QUESTIONS 271 HEMATOLOGICAL AND IMMUNOLOGICAL CLINICAL SCENARIO 282 ANSWERS AND RATIONALES 284 CLINICAL SCENARIO ANSWERS AND RATIONALES 299 11 Women’s Health Management 301 QUESTIONS 301 MATERNAL-CHILD CLINICAL SCENARIO 312 ANSWERS AND RATIONALES 314 CLINICAL SCENARIO ANSWERS AND RATIONALES 330 12 Pediatric Health Management 333 QUESTIONS 333 PEDIATRIC CLINICAL SCENARIO 345 ANSWERS AND RATIONALES 347 CLINICAL SCENARIO ANSWERS AND RATIONALES 361 13 Mental Health Management 363 QUESTIONS 363 MENTAL HEALTH CLINICAL SCENARIO 376 ANSWERS AND RATIONALES 378 CLINICAL SCENARIO ANSWERS AND RATIONALES 394 3313_FM_i-xii 14/03/14 5:13 PM Page x TABLE OF CONTENTS xi 14 Case Studies: Care of Clients in Various Settings 397 MEDICAL NURSING CASE STUDY 397 CRITICAL CARE NURSING CASE STUDY 400 OUTPATIENT NURSING CASE STUDY 403 HOME HEALTH CASE STUDY 406 MENTAL HEALTH NURSING CASE STUDY 409 MATERNAL-CHILD CASE STUDY 412 ANSWERS TO CASE STUDIES 414 15 Comprehensive Exam 429 QUESTIONS 429 ANSWERS AND RATIONALES 446 Appendix A: Normal Laboratory Values 469 Glossary of English Words Commonly Encountered on Nursing Examinations 471 Index 475 3313_FM_i-xii 14/03/14 5:13 PM Page xi 3313_FM_i-xii 14/03/14 5:13 PM Page xii 1 Introduction to Prioritization, Assignment, Delegation, and Management 1 Each problem that I solved became a rule which served afterwards to solve other problems. —Rene Descartes This book is designed to assist the student nurse in nursing school and in taking nursing examinations, particularly the NCLEX-RN® exam for licensure as a registered nurse (RN). Prioritization, Delegation & Management of Care for the NCLEX-RN® Exam focuses on aspects of management such as setting priorities for client care, delegating and assigning nursing tasks, and managing clients and staff. It contains practice questions on these topics in a wide variety of nursing arenas, including medical, surgical, critical care, pediatric, geriatric, reha- bilitation, home health, and mental health nursing. Answers—and why each possible response is correct or incorrect—are given for all questions. Management, prioritizing, and delegation questions are some of the most difficult questions for the student and new graduate to answer because there is no reference book in which to find the correct answers. Answers to these types of questions require knowl- edge of basic scientific principles, standards of care, pathophysiology, and psychosocial behaviors, and leadership qualities and the ability to think critically. It is important to note that the test taker may not always agree with the authors’ rationale for the correct answer. It is poor test taking to read rationales for the incorrect answers; the students will remember reading the rationale but not if the rationale was for the correct or incor- rect answer. Many of the answers in this book include tips to help the test taker. Termed “Making Nursing Decisions,” these tips provide help for the student in identifying exactly what the question is asking, in analyzing the question, and in determining the correct response. A Comprehensive Examination with answers and rationales is also included for each field of nursing. Practice questions and answers and practice examinations are valuable in preparing for an examination, but the test taker should remember that there is no substitute for studying the material. (For general information on how to prepare for an examination and on the types of ques- tions used in nursing examinations, refer to Fundamentals Success: A Q&A Review Applying Critical Thinking to Test Taking by Patricia Nugent, RN, MA, MS, EdD, and Barbara Vitale, RN, MA.) NCSBN BLUEPRINT FOR QUESTIONS The National Council of State Boards of Nursing (NCSBN) provides a blueprint that assists nursing faculty in developing test questions for the NCLEX-RN®. Content included in management of care provides and directs nursing care that enhances the care delivery setting to protect clients, family/significant others, and healthcare personnel. Related content includes, but is not limited to, advance directives, advocacy, case management, client rights, collaboration with the interdisciplinary team, delegation, establishing priorities, ethical 3313_Ch01_001–006 14/03/14 4:45 PM Page 1 practice, informed consent, information technology, and performance improvement. Other topics also include legal rights and responsibilities, referrals, resource management, staff education, supervision, confidentiality/information security, and continuity of care. The questions in this book follow this blueprint. GUIDELINES FOR MAKING A DECISION Nurses* base their decisions on many different bodies of information in order to arrive at a course of action. Among the basic guidelines to apply in nursing practice—and in answering test questions—are the nursing process and Maslow’s Hierarchy of Needs. The Nursing Process One of the basic guidelines to apply in nursing practice is the nursing process, which consists of five steps—assessment, nursing diagnosis, planning, intervention, and evaluation—usually completed in a systematic order. Many questions can be answered based on “assessment.” If a priority-setting question asks the test taker which step to implement first, the test taker should look for an answer that would assess for the problem discussed in the stem of the question. EXAMPLE 2 PRIORITIZATION, DELEGATION, AND MANAGEMENT OF CARE FOR THE NCLEX-RN® EXAM In this book, the term “nurse,” unless otherwise specified, refers to a licensed registered nurse (RN). An RN can assign tasks to an LPN or delegate to unlicensed assistive personnel (UAP), which may be known under other terms such as medical assistant or nurse’s aide. An LPN can delegate tasks to UAP. Each state will have specific regulations that govern what duties/tasks can be delegated/assigned to each of these types of personnel. The term “healthcare provider,” as used in this book, refers to a client’s primary provider of medical care. It includes physicians (including osteopathic physicians), nurse practitioners (NPs), and physician assistants (PAs). Depending on state regulations, many NPs and some PAs have prescriptive authority at least for some categories of prescribed drugs. The nurse is caring for a client diagnosed with congestive heart failure who is currently com- plaining of dyspnea. Which intervention should the nurse implement first? 1. Administer furosemide (Lasix), a loop diuretic, IVP. 2. Check the client for adventitious lung sounds. 3. Ask the respiratory therapist to administer a treatment. 4. Notify the healthcare provider. Answer: 2 Checking for adventitious lung sounds is assessing the client to determine the extent of the client’s breathing difficulties causing the dyspnea. There are numerous words, such as “check,” that can be used to indicate assessment. The test taker should not discard an option because the word “assess” or “assessment” is not used. Alternatively, the test taker shouldn’t assume that an option is correct merely because the word “assess” is used. The test taker must also be aware that the assessment data must match the problem stated in the stem, regardless of terminology. The nurse must assess for the correct information. If option 2 in the above example said, “Assess uri- nary output,” it would not be a correct option even though it includes the word “assess,” since urinary output is not related to heart failure or breathing difficulties. In addition, the test taker should be aware that assessment is not always the correct answer when the question asks which should be done first. Suppose, for example, that the above question had listed option 3 as “Apply oxygen via nasal cannula at 2 LPM.” In that case, assessment does not come first. The nurse would first attempt to relieve the client’s distress and then assess. When a question asks what a nurse should do next, the test taker should determine from the information given in the question which steps in the nursing process have been completed and then choose an option that matches the next step in the nursing process. 3313_Ch01_001–006 14/03/14 4:45 PM Page 2