RN ADULT MEDICAL SURGICAL NURSING EDITION 9.0 A STERY M S T ER N I E E S T ® N O C E L U D O REVIEW M RN Adult Medical Surgical Nursing Review Module Edition 9.0 coNtRibutoRS Sheryl Sommer, PhD, RN, CNE VP Nursing Education & Strategy Janean Johnson, MSN, RN Nursing Education Strategist Karin Roberts, PhD, MSN, RN, CNE Nursing Education Coordinator Sharon R. Redding, EdD, RN, CNE Nursing Education Specialist and Content Project Coordinator Lois Churchill, MN, RN Nursing Education Specialist Brenda Ball, MEd, BSN, RN Nursing Education Specialist Norma Jean Henry, MSN/Ed, RN Nursing Education Specialist Peggy Leehy, MSN, RN Nursing Education Specialist Pamela Roland, MSN, RN Nursing Education Specialist editoRiAl ANd PubliShiNg Derek Prater Spring Lenox Michelle Renner Mandy Tallmadge Kelly Von Lunen coNSultANtS Tracey Bousquet, BSN, RN Deb Johnson-Schuh, MSN, RN, CNE Pam DeMoss, MSN, RN Terri Lemon, DNP, MSN, RN Carol J. Green, PhD, CNS, RN, CNE Tami J. Rogers, PhD(c), DVM, MSN, CNE Justina Higgins, RN, MSN, PLNC, HCE, CHC Julie Skrabal, RN, MSN Honey C. Holman, MSN, RN Virginia E. Tufano, EdD, MSN, RN RN Adult MedicAl SuRgicAl NuRSiNg i RN Adult MedicAl SuRgicAl NuRSiNg Review Module editioN 9.0 intellectual Property Notice ATI Nursing is a division of Assessment Technologies Institute®, LLC Copyright © 2013 Assessment Technologies Institute, LLC. All rights reserved. The reproduction of this work in any electronic, mechanical or other means, now known or hereafter invented, is forbidden without the written permission of Assessment Technologies Institute, LLC. 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THIS PUBLICATION IS PROVIDED AS-IS, AND THE PUBLISHER AND ITS AFFILIATES SHALL NOT BE LIABLE FOR ANY ACTUAL, INCIDENTAL, SPECIAL, CONSEQUENTIAL, PUNITIVE, OR EXEMPLARY DAMAGES RESULTING, IN WHOLE OR IN PART, FROM THE READER’S USE OF, OR RELIANCE UPON, SUCH CONTENT. ii RN Adult MedicAl SuRgicAl NuRSiNg RN Adult MedicAl SuRgicAl NuRSiNg Review Module editioN 9.0 user’s guide Welcome to the Assessment Technologies Institute® RN Adult Medical Surgical Nursing Review Module Edition 9.0. The mission of ATI’s Content Mastery Series® review modules is to provide user-friendly compendiums of nursing knowledge that will: ● Help you locate important information quickly. ● Assist in your learning efforts. ● Provide exercises for applying your nursing knowledge. ● Facilitate your entry into the nursing profession as a newly licensed RN. organization This review module is organized into units covering the foundations of nursing care (Unit 1), body systems and physiological processes (Units 2 to 13), and perioperative nursing care (Unit 14). Chapters within these units conform to one of three organizing principles for presenting the content. ● Nursing concepts ● Procedures (diagnostic and therapeutic) ● Systems disorders Nursing concepts chapters begin with an overview describing the central concept and its relevance to nursing. Subordinate themes are covered in outline form to demonstrate relationships and present the information in a clear, succinct manner. Procedures chapters include an overview describing the procedure(s) covered in the chapter. These chapters will provide you with nursing knowledge relevant to each procedure, including indications, interpretation of findings, nursing actions, and complications. System disorders chapters include an overview describing the disorder(s) and/or disease process. These chapters may provide information on health promotion and disease prevention before addressing assessments, including risk factors, subjective data, and objective data. Next, you will focus on collaborative care, including nursing care, medications, interdisciplinary care, therapeutic procedures, surgical interventions, and care after discharge. Finally, you will find complications related to the disorder, along with nursing actions in response to those complications. Application exercises Questions are provided at the end of each chapter so you can practice applying your knowledge. The Application Exercises include NCLEX-style questions, such as multiple-choice and multiple-select items, and questions that ask you to apply your knowledge in other formats, such as by using an ATI Active Learning Template. After the Application Exercises, an answer key is provided, along with rationales for the answers. RN Adult MedicAl SuRgicAl NuRSiNg iii RN Adult MedicAl SuRgicAl NuRSiNg Review Module editioN 9.0 NcleX® connections To prepare for the NCLEX-RN, it is important for you to understand how the content in this review module is connected to the NCLEX-RN test plan. You can find information on the detailed test plan at the National Council of State Boards of Nursing’s Web site: https://www.ncsbn.org/. When reviewing content in this review module, regularly ask yourself, “How does this content fit into the test plan, and what types of questions related to this content should I expect?” To help you in this process, we’ve included NCLEX Connections at the beginning of each unit and with each question in the Application Exercises Answer Keys. The NCLEX Connections at the beginning of each unit will point out areas of the detailed test plan that relate to the content within that unit. The NCLEX Connections attached to the Application Exercises Answer Keys will demonstrate how each exercise fits within the detailed content outline. These NCLEX Connections will help you understand how the detailed content outline is organized, starting with major client needs categories and subcategories and followed by related content areas and tasks. The major client needs categories are: ● Safe and Effective Care Environment ◯ Management of Care ◯ Safety and Infection Control ● Health Promotion and Maintenance ● Psychosocial Integrity ● Physiological Integrity ◯ Basic Care and Comfort ◯ Pharmacological and Parenteral Therapies ◯ Reduction of Risk Potential ◯ Physiological Adaptation An NCLEX Connection might, for example, alert you that content within a unit is related to: ● Reduction of Risk Potential ◯ Diagnostic Tests ■ Monitor the results of diagnostic testing and intervene as needed. QSeN competencies As you use the review modules, you will note the integration of the Quality and Safety Education for Nurses (QSEN) competencies throughout the chapters. These competencies are integral components of the curriculum of many nursing programs in the United States and prepare you to provide safe, high-quality care as a newly licensed RN. Icons appear to draw your attention to the six QSEN competencies: ● Safety: The minimization of risk factors that could cause injury or harm while promoting quality care and maintaining a secure environment for clients, self, and others. ● Patient-Centered Care: The provision of caring and compassionate, culturally sensitive care that addresses clients’ physiological, psychological, sociological, spiritual, and cultural needs, preferences, and values. iv RN Adult MedicAl SuRgicAl NuRSiNg RN Adult MedicAl SuRgicAl NuRSiNg Review Module editioN 9.0 ● Evidence-Based Practice: The use of current knowledge from research and other credible sources, on which to base clinical judgment and client care. ● Informatics: The use of information technology as a communication and information-gathering tool that supports clinical decision-making and scientifically based nursing practice. ● Quality Improvement: Care related and organizational processes that involve the development and implementation of a plan to improve health care services and better meet clients’ needs. ● Teamwork and Collaboration: The delivery of client care in partnership with multidisciplinary members of the health care team to achieve continuity of care and positive client outcomes. icons Icons are used throughout the review module to draw your attention to particular areas. Keep an eye out for these icons: This icon is used for NCLEX connections. This icon is used for content related to safety and is a QSEN competency. When you see this icon, take note of safety concerns or steps that nurses can take to ensure client safety and a safe environment. This icon is a QSEN competency that indicates the importance of a holistic approach to providing care. This icon, a QSEN competency, points out the integration of research into clinical practice. This icon is a QSEN competency and highlights the use of information technology to support nursing practice. This icon is used to focus on the QSEN competency of integrating planning processes to meet clients’ needs. This icon highlights the QSEN competency of care delivery using an interprofessional approach. This icon indicates that a media supplement, such as a graphic, animation, or video, is available. If you have an electronic copy of the review module, this icon will appear alongside clickable links to media supplements. If you have a hardcopy version of the review module, visit www.atitesting. com for details on how to access these features. Feedback ATI welcomes feedback regarding this review module. Please provide comments to: [email protected]. RN Adult MedicAl SuRgicAl NuRSiNg v tAble of coNteNtS UNit 1 Foundations of Nursing Care for Adult Clients NcleX® coNNectioNS ....................................................................................................................1 1 Health, Wellness, and Illness ...........................................................................................2 2 Emergency Nursing Principles and Management ...........................................................9 UNit 2 Nursing Care of Clients with Neurosensory Disorders NcleX® coNNectioNS ..................................................................................................................25 SEctioN Diagnostic and Therapeutic Procedures 3 Neurologic Diagnostic Procedures .................................................................................26 4 Pain Management ..........................................................................................................41 SEctioN Central Nervous System Disorders 5 Meningitis ......................................................................................................................53 6 Seizures and Epilepsy .....................................................................................................62 7 Parkinson’s Disease ........................................................................................................72 8 Alzheimer’s Disease ........................................................................................................82 9 Brain Tumors ..................................................................................................................91 10 Multiple Sclerosis, Amyotrophic Lateral Sclerosis, and Myasthenia Gravis ...............100 11 Headaches ....................................................................................................................113 SEctioN Sensory Disorders 12 Disorders of the Eye .....................................................................................................122 13 Middle and Inner Ear Disorders ...................................................................................135 SEctioN Neurologic Emergencies 14 Head Injury ..................................................................................................................145 15 Stroke ...........................................................................................................................155 16 Spinal Cord Injury .......................................................................................................166 vi RN Adult MedicAl SuRgicAl NuRSiNg tAble oF coNteNtS UNit 3 Nursing Care of Clients with Respiratory Disorders NcleX® coNNectioNS ................................................................................................................178 SEctioN Diagnostic and Therapeutic Procedures 17 Respiratory Diagnostic Procedures ..............................................................................179 18 Chest Tube Insertion and Monitoring .........................................................................191 19 Respiratory Management and Mechanical Ventilation ..............................................199 SEctioN Respiratory System Disorders 20 Acute Respiratory Disorders .........................................................................................215 21 Asthma .........................................................................................................................229 22 Chronic Obstructive Pulmonary Disease ....................................................................238 23 Tuberculosis .................................................................................................................249 SEctioN Respiratory Emergencies 24 Pulmonary Embolism ..................................................................................................258 25 Pneumothorax and Hemothorax ................................................................................267 26 Respiratory Failure .......................................................................................................278 UNit 4 Nursing Care of Clients with Cardiovascular Disorders NcleX® coNNectioNS ................................................................................................................293 SEctioN Diagnostic and Therapeutic Procedures 27 Cardiovascular Diagnostic and Therapeutic Procedures .............................................294 28 Electrocardiography and Dysrhythmia Monitoring....................................................312 29 Pacemakers ...................................................................................................................322 30 Invasive Cardiovascular Procedures ............................................................................331 SEctioN Cardiac Disorders 31 Angina and Myocardial Infarction ..............................................................................349 32 Heart Failure and Pulmonary Edema...........................................................................361 33 Valvular Heart Disease .................................................................................................376 34 Inflammatory Disorders ...............................................................................................385 RN Adult MedicAl SuRgicAl NuRSiNg vii tAble oF coNteNtS SEctioN Vascular Disorders 35 Peripheral Vascular Diseases ........................................................................................394 36 Hypertension ...............................................................................................................409 37 Hemodynamic Shock ...................................................................................................420 38 Aneurysms ...................................................................................................................434 UNit 5 Nursing Care of Clients with Hematologic Disorders NcleX® coNNectioNS ................................................................................................................442 SEctioN Diagnostic and Therapeutic Procedures 39 Hematologic Diagnostic Procedures ............................................................................443 40 Blood and Blood Product Transfusions .......................................................................450 SEctioN Hematologic Disorders 41 Anemias .......................................................................................................................458 42 Coagulation Disorders .................................................................................................467 UNit 6 Nursing Care of Clients with Fluid/Electrolyte/Acid-Base Imbalances NcleX® coNNectioNS ................................................................................................................472 43 Fluid Imbalances ..........................................................................................................473 44 Electrolyte Imbalances .................................................................................................483 45 Acid-Base Imbalances ...................................................................................................500 UNit 7 Nursing Care of Clients with Gastrointestinal Disorders NcleX® coNNectioNS ................................................................................................................510 SEctioN Diagnostic and Therapeutic Procedures 46 Gastrointestinal Diagnostic Procedures .......................................................................511 47 Gastrointestinal Therapeutic Procedures .....................................................................523 SEctioN Upper Gastrointestinal Disorders 48 Esophageal Disorders ...................................................................................................538 49 Peptic Ulcer Disease .....................................................................................................549 50 Acute and Chronic Gastritis ........................................................................................559 viii RN Adult MedicAl SuRgicAl NuRSiNg tAble oF coNteNtS SEctioN Lower Gastrointestinal Disorders 51 Noninflammatory Bowel Disorders .............................................................................569 52 Inflammatory Bowel Disease .......................................................................................580 SEctioN Gallbladder and Pancreas Disorders 53 Cholecystitis and Cholelithiasis ..................................................................................593 54 Pancreatitis ...................................................................................................................601 SEctioN Liver Disorders 55 Hepatitis and Cirrhosis ................................................................................................610 UNit 8 Nursing Care of Clients with Renal Disorders NcleX® coNNectioNS ................................................................................................................628 SEctioN Diagnostic and Therapeutic Procedures 56 Renal Diagnostic Procedures .......................................................................................629 57 Hemodialysis and Peritoneal Dialysis ..........................................................................640 58 Kidney Transplant ........................................................................................................653 SEctioN Renal System Disorders 59 Acute and Chronic Glomerulonephritis .....................................................................664 60 Acute Kidney Injury and Chronic Kidney Disease ......................................................674 61 Infections of the Renal and Urinary System ...............................................................686 62 Renal Calculi ................................................................................................................699 UNit 9 Nursing Care of Clients with Reproductive Disorders NcleX® coNNectioNS ................................................................................................................708 SEctioN Female Reproductive Disorders 63 Diagnostic and Therapeutic Procedures for Female Reproductive Disorders .............709 64 Menstrual Disorders and Menopause ..........................................................................722 65 Disorders of Female Reproductive Tissue ....................................................................731 SEctioN Male Reproductive Disorders 66 Diagnostic Procedures for Male Reproductive Disorders ............................................739 67 Disorders of the Male Reproductive System ................................................................743 RN Adult MedicAl SuRgicAl NuRSiNg ix