1001 NCLEX-RN Questions!
Congratulations on completing your initial nursing education. You are so close to becoming a registered nurse. As you know, it was a tough road. There may have been days where you were exhausted, overwhelmed, and unsure if you’d ever get this far. You persevered and you did it! Now it's time to complete the next step which is preparing for the NCLEX-RN Exam. Don’t worry, you’ve got this. You already know this stuff. Think of how many tests you have already passed. You know more than you think you do, and after completing this course, you will do just fine. This course is going to make passing the exam more comfortable. We will cover all of the areas you will be tested on. We highlight Key Takeaways which are critical points throughout the program. Some graduate nurses feel overwhelmed thinking about taking their boards. You don't have to. By the time you complete this course you will be confident in your abilities to take, and pass, the exam with flying colors. This course is specially designed and balanced so you can identify areas you need to concentrate your attention on. It contains the same proportions of topic questions as the NCLEX-RN exam. After completing this course, you will be well prepared and know what to expect when the day comes for you take and pass your boards. Let’s take a few minutes to discuss what you will be tested on.
TABLE OF CONTENTS Introduction ............................................................................................................................ 1 Part 1 Safe and Effective Care Environment ............................................................................. 5 1.1 Standards of Nursing ............................................................................................................. 5 1.1a. Client Rights .................................................................................................................... 5 1.1b. Confidentiality ................................................................................................................ 8 1.1c. Advance Directives and Life Planning ........................................................................... 12 1.1d Organ Donation ............................................................................................................. 17 1.1e Ethics.............................................................................................................................. 19 1.1f Legal Issues, Responsibilities, and Consent ................................................................... 23 1.2 Delivery of Care ................................................................................................................... 27 1.2a The Care Team ............................................................................................................... 27 1.2b Leadership ..................................................................................................................... 32 1.2c Care Delivery Models ..................................................................................................... 38 1.2d Continuity of Care/ Case Management/ Advocacy/Referrals ....................................... 41 1.2e. Prioritizing care ............................................................................................................. 48 1.2f Documentation............................................................................................................... 59 1.2g Information technology and security ............................................................................ 60 1.2h Performance Improvement ........................................................................................... 61 1.3 Safety ................................................................................................................................... 65 1.3a Providing a Safe Environment ....................................................................................... 65 1.3b Equipment Safety .......................................................................................................... 68 1.3c Hazardous and Infectious Materials Management ....................................................... 70 1.3d Emergency Management, Response, and Security ....................................................... 71 1.3e Restraints and Safety ..................................................................................................... 73
1.3f Untoward events ............................................................................................................ 75 1.3g Ergonomics .................................................................................................................... 78 1.4 Infection Control ................................................................................................................. 81 1.4a Hygiene .......................................................................................................................... 81 1.4 b. Precautions .................................................................................................................. 85 1.4c Asepsis ........................................................................................................................... 89 1.4d Perioperative care ......................................................................................................... 93 Part 2 Health Promotion and Maintenance ........................................................................... 97 2.1 Physical assessment ............................................................................................................ 97 2.1a Vital signs ....................................................................................................................... 97 2.1b Physical Examination ..................................................................................................... 98 2.2 Growth and Development though the Lifespan ............................................................... 101 2.2a Growth and Development Theory ............................................................................... 101 2.2b Prenatal Development ................................................................................................ 103 2.2c Pregnancy .................................................................................................................... 105 2.2d Newborns .................................................................................................................... 107 2.2e Children ....................................................................................................................... 108 2.2f Adults............................................................................................................................ 110 2.2g Older Adults ................................................................................................................. 111 2.3 Health Promotion .............................................................................................................. 114 2.3a Lifestyle ........................................................................................................................ 114 2.3b Health Promotion and illness prevention/Health Screening ...................................... 115 2.3c Self Care ....................................................................................................................... 119 2.3d High-Risk Behaviors ..................................................................................................... 120 Part 3 Psychological Integrity............................................................................................... 124 3.1 Mental Health Concepts .................................................................................................... 124 3.1a. Mental Health Concepts ............................................................................................. 124
3.1b Therapeutic Communication ....................................................................................... 126 3.1c Stress Management ..................................................................................................... 128 3.1d Family Dynamics: ......................................................................................................... 130 3.1e Diversity and Cultural Awareness................................................................................ 132 3.1f Support systems ........................................................................................................... 134 3.1g Religion and Spirituality ............................................................................................... 136 3.1h Sensory Alterations ..................................................................................................... 138 3.1i Crisis Intervention......................................................................................................... 140 3.1j Crisis Intervention......................................................................................................... 142 3.1k Abuse and Neglect ....................................................................................................... 144 3.1l Behavioral Interventions .............................................................................................. 146 3.1m Addictions ................................................................................................................... 147 3.1n End of Life Care............................................................................................................ 149 3.1o Grief and Loss .............................................................................................................. 151 Part 4 Physiological Integrity ............................................................................................... 155 4.1 Basic Care and Comfort ..................................................................................................... 155 4.1a Mobility/ Immobility .................................................................................................... 155 4.8b Assistive Devices .......................................................................................................... 158 4.8c Elimination ................................................................................................................... 161 4.8d Non-Pharmacological Pain Interventions .................................................................... 165 4.8e Nutrition ...................................................................................................................... 168 4.8f Oral Fluids ..................................................................................................................... 178 4.8g Rest and Sleep ............................................................................................................. 180 4.2 Pharmacological and Parenteral Therapies ...................................................................... 182 4.2a Medication Administration.......................................................................................... 182 4.2b Outcomes and Actions of Medication ......................................................................... 192 4.2c Adverse Reactions and Side Effects ............................................................................. 201
4.2d Dosage Calculation ...................................................................................................... 208 4.2e Pharmacological Pain Management ............................................................................ 214 4.2f Parenteral Therapies .................................................................................................... 217 4.2g Central Venous Access Devices ................................................................................... 222 4.2h Total Parenteral Nutrition ........................................................................................... 223 4.2i Blood and Blood products ............................................................................................ 224 4.3 Reduction of Risk Potential ............................................................................................... 227 4.3a Alterations in Health .................................................................................................... 227 4.3b Potential Alterations in Systems/ Abnormal Vital signs .............................................. 232 4.3c Diagnostic Tests/Potential Complications and Adverse Reactions to Tests and Treatments .................................................................................................................. 235 4.3d Laboratory Values........................................................................................................ 239 4.3e Therapeutic Procedures/Enteral Nutrition/Oxygen Therapy...................................... 242 4.3f Potential Complications from Surgery ......................................................................... 248 4.4 Physiological Adaptation ................................................................................................... 252 4.4a Hemodynamics ............................................................................................................ 252 4.4b Altered Fluid Balance................................................................................................... 254 4.4d integumentary system................................................................................................. 256 4.4e Respiratory System ...................................................................................................... 258 4.4f Cardiovascular System ................................................................................................. 261 4.4g Nervous System/Mental Health .................................................................................. 265 4.4h Gastrointestinal System .............................................................................................. 268 4.4i Hepatic System ............................................................................................................. 272 4.4j Renal System ................................................................................................................ 273 4.4k Musculoskeletal System .............................................................................................. 275 4.4l Endocrine System ......................................................................................................... 277 4.4m Male Reproductive System ........................................................................................ 279 4.4n Female Reproductive System ...................................................................................... 280
4.4o Immune system ........................................................................................................... 283 4.4p Hematological System and Oncology .......................................................................... 286 4.4q Illness Management .................................................................................................... 288 4.4r Unexpected Response to Treatment ........................................................................... 290 4.4s Medical Emergencies ................................................................................................... 292 Part Five Mixed Review ....................................................................................................... 298
INTRODUCTION Content of the NCLEX-R The entire test is based on client needs. There are four key areas. •
Safe and Effective Care Environment
•
Health Promotion and Maintenance
•
Psychosocial Integrity
•
Physiological Integrity
Some of these areas are broken down into multiple focus topics. Here is the actual percentage of questions you can expect during this review course and when you take the NCLEX-RN exam. Safe and Effective Care Environment •
Management of Care 17-23%
•
Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12% Psychosocial Integrity 6-12% Physiological Integrity •
Basic Care and Comfort 6-12%
•
Pharmacological and Parenteral Therapies 12-18%
•
Reduction of Risk Potential 9-15%
•
Physiological Adaptation 11-17% (National Council of State Boards of Nursing., 2016)
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Here is what we will be covering in the course. There are a total of 1001 review questions. We’ve got you covered so that there won’t be any surprises during your exam. The following are the topics covered in the NCLEX-RN exam: Topics: Management of Care Infection Control and Safety Health Promotion and Maintenance Psychosocial Basic Care and Comfort Pharmacological and Parenteral Therapies Risk Reduction Physiological Adaption Your supplement shows how much of each topic is covered by approximate percentage in the exam. It also lists the number of questions to expect in this course for each area. These areas will be covered as we review professional standards, fundamentals, the human lifespan, and body systems. We will initially address key areas and then incorporate them throughout the course. This will prepare you well for your exam. The NCLEX-RN integrates topics randomly during the test. Here’s an example of what I am saying: When we are reviewing the unit on cardiac health, there will be questions about management of cardiac patient care. These may include ethical dilemmas, case management, or continuity of care in relation to the care being provided to a patient with a cardiac problem. We may address the safe use of AEDs and post-operative angioplasty care as part of infection control and safety.
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We may include a question about fear and coping to address psychosocial needs. There will be additional questions focusing on the pharmacology of cardiac drugs, reducing the risk of postMI, and fluid balance in patients with congestive heart failure. By presenting problems within the realm of human needs, you will have opportunities to think about real life questions that arise as you care for your patients. How to Use this Course The beauty of this course is that you can use it anytime, anywhere. While we recommend setting aside a block of time each day to review the materials, one of the benefits of the program is you can set aside an hour to listen one day or answer just a few quick questions while waiting to pick up children from a basketball game. Listen during your commute or at the gym. Be sure to note the questions or areas that you should study more. This program is highly flexible, so use it to meet your individual needs. By now you know how you study best, so capitalize on the study skills you already possess. It’s important to remember this is information you have already learned. There are bound to be areas you are more and less confident about. Relax and view the course merely as a study tool. Be sure to take care of your mind, body, and spirit in the weeks leading up to your exam. How you approach the NCLEX-RN is as important as your knowledge base. You can relax, knowing that we are covering all areas that will be addressed on the NCLEX-RN. When you answer questions, assume you are providing acute care unless the question indicates otherwise. Assume that the patient is an adult unless otherwise stated. Base your answers on what you would do if you were in a top-notch facility with all the needed resources available. Always choose the BEST answer to the question. You will be asked a question a question followed by four multiple choice questions. Select the best one. The answers will be presented next. Mark questions that are difficult or those that remind you of other topics you want to review. The first 800 questions will be presented as topics are reviewed. The final 201 will be presented after all of the material is covered. They will be given randomly just like the NCLEX-RN. 3
For a detailed outline of the course layout, please refer to the Table of Contents in your supplement.
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PART 1 SAFE AND EFFECTIVE CARE ENVIRONMENT Part one consists of information that you need regardless of the type of nursing that you do. We will begin by covering standards. Next, we will review the delivery of care. We’ll then proceed to safety, infection control, and surgery. Let's start by reviewing standards of nursing.
1.1 STANDARDS OF NURSING 1.1A. CLIENT RIGHTS 1.
The document which acknowledges a patient/client’s right to participate in their health care and emphasizes autonomy is called the: A. B. C. D.
Client’s/Patient’s Bill of Rights Good Samaritan Law Mental Health System’s Act Health Care Portability and Accountability Act
Correct answer: A Rationale: Client’s /Patient’s Bill of Rights protects clients to participate in their health care and health care decisions. The Good Samaritan Law protects health care providers who provide emergency care while off duty. The Mental Health System’s Act protects individuals who have mental health challenges. The Health Care Portability and Accountability Notice (HIPAA) ensures the privacy of personal health information. 2.
A sixteen-year-old presents to the Emergency Department in respiratory distress. Her parents are unreachable. Which is the correct first action? A. Keep trying to notify the parents. If they aren’t reachable, call the grandparents for permission to treat. B. Provide emergency care while attempts are made to contact the parents. C. Ask the child to sign a temporary consent to treat since she is sixteen years of age.
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D. Obtain telephone consent by having two staff members listen on the telephone while verbal permission is given. Correct answer: B Rationale: Parental consent is not needed in emergency situations. The first priority is relieving the respiratory distress. Teens under the age of eighteen may only sign consents if they are emancipated minors. 3.
The Americans with Disabilities Act protects: A. B. C. D.
individuals over the age of 65 people who are infected with HIV or have disabilities only individuals who have developmental disabilities children and elders over 65
Correct answer: B Rationale: The Americans with Disabilities Act provides comprehensive protection for workers, and other individuals infected with HIV. It protects all people who have disabilities. 4.
A homeless client arrives at the emergency department with a sprained ankle. He does not have any money or insurance. What law requires that the client is treated? A. B. C. D.
the Americans with disabilities act the patient self-determination act no law requires the patient be treated the emergency medical treatment and active labor act ( EMTALA)
Correct answer: D Rationale: EMTALA, the Emergency Medical Treatment, and Active Labor Act requires that hospitals provide an evaluation of a client. The facility may not discharge or transfer the client in an emergency situation until the clients health status is stabilized. 5.
What does the mental health parity act prohibit? A. clients from being Baker acted without their consent B. children under 18 from obtaining mental health services without parental consent
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C. the arrest of clients who use medical marijuana while traveling in a state that has not legalized medical marijuana providing they have written documentation of their prescription D. insurers from placing lower limits on policy amounts for mental health benefits than other benefits Correct answer: D Rationale: The Mental Health Parity Act prohibits insurance companies from placing lower limits on policy amounts for mental health than it does for other healthcare issues. 6.
The Health Insurance Portability and Accountability Act (HIPAA): A. establishes privacy laws; and protects clients and employees B. protects clients and ensures that they will be treated promptly C. ensures portability of healthcare information and treatment regardless of financial ability D. provides financial assistance so that workers can keep their health plan after terminating employment for up to 18 months Correct answer: A Rationale: HIPAA, the Health Insurance Portability and Accountability Act, protects individuals from losing their health insurance when changing jobs. It establishes rules for privacy and confidentiality.
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A state statute that declares a competent individual with a terminal illness may legally request medication to end their life humanely: E. is called the Uniform Determination of Death Act A. is known as patient self-determination B. physician-assisted suicide statute C. is the Uniform Anatomical Gift Act Correct answer: C Rationale: Physician-assisted suicide statutes allow clients of specific states to request medication to end their own life if they are competent and diagnosed with a terminal illness. 7
Let’s move on to our next section.
1.1B. CONFIDENTIALITY 8.
Disclosure of Personal Health Information (PHI) is acceptable for all of the following except: A. B. C. D.
Health insurance reimbursement Treatment Health care operations Family information
Correct answer: D Rationale: Personal Health Information may be shared for healthcare reimbursement and benefit decisions. It may be used to provide information about health care services and operations. Personal Health Information may be shared for treatment purposes. It may not be shared with friends, employers, or family members without client permission. 9.
Which of the following describes a violation of privacy? A. Discussing a client’s care with a co-worker who is not assigned to that client. B. Attending an interdisciplinary team meeting to discuss discharge plans for a client. C. Sharing a client’s Personal Health Information with the client’s physical therapist. D. Contacting Protective Services to report suspected elder abuse of a client that you are providing care for. Correct answer: D Rationale: Personal Health Information may be shared with providers who are/or will be involved in the care of the client. Providers may only access information needed to perform their duties.
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10.
A client is diagnosed with genital warts. She states that she is no longer sexually active and does not want to tell her previous partner about her diagnosis. The nurse: A. Calls the health department B. Provides education to the client regarding the contagious disease C. Obtains the ex- partner’s contact information and calls him without the client’s consent D. Provides care to the client and refers her to social services Correct answer: B Rationale: The nurse is bound by client confidentiality. Educating the client will help her understand why it is vital she notify her former partner.
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Safeguards to ensure confidentiality and the availability of Protected Health Information are aspects of: A. The Security Rule of the Health Insurance Portability and Accountability Act (HIPAA) B. Case management C. Performance improvement D. Advance directives Correct answer: A Rationale: The Security Rule of the Health Insurance Portability and Accountability Act (HIPAA) provides safeguards to ensure confidentiality and the availability of Protected Health Information. The rule governs electronic and other forms of information.
12.
The Health Insurance Portability and Accountability Act (HIPAA) protects all of the following except: A. Handwritten medical information B. Oral medical Information C. The right to die D. Electronic medical information Correct answer: C
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Rationale: The Health Insurance Portability and Accountability Act (HIPAA) protects confidential health information regardless of whether it is oral, handwritten, or electronically stored. 13.
A woman frantically calls the emergency department to see if her sister is there. The woman’s sister is an emergency department client, but she is currently having an ultrasound. The nurse: A. Tells the caller that the sister is in the emergency department but can’t come to the telephone right now B. Asks the woman to call back in 20 minutes when the client is likely to be back from getting the ultrasound C. Reassures the woman that her sister is stable and having a test performed D. Does not confirm or deny the presence of the client Correct answer: D Rationale: Healthcare workers are prohibited from disclosing information about clients unless permission has been granted by the client.
14.
A visitor enquires about a family member’s roommate. The roommate has been moved to the intensive care unit. The nurse states that: A. B. C. D.
he cannot disclose information about clients the client has been moved to the intensive care unit the client had a severe health issue but is now stable admits that the client had a CVA, is in ICU, and not expected to survive
Correct answer: A Rationale: Healthcare workers are prohibited from disclosing information about clients unless permission has been granted by the client. 15.
The nurse is discussing a client’s health status in the hall with another staff member who is also caring for the client. A therapist from another unit overhears and says that she knows the client from previous admissions. The therapist asks for the room number that the client is in. The nurse: A. Tells the therapist the room number
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B. Realizes that she has breached the law by disclosing a client’s Personal Health Information C. Asks the therapist for input about the client D. Continues to discuss the client with the co-worker who needs information to provide care Correct answer: B Rationale: Only health care providers involved in the clients care may discuss clients. Health care workers are bound by law to avoid disclosing information intentionally or inadvertently. 16.
Who does not have the “right to know” about a client’s condition? A. B. C. D.
The billing department worker who is processing the client’s medical claim The physician from another facility who is providing consultation services A nursing student who is caring for the client’s roommate The facility’s performance improvement nurse
Correct answer: B Rationale: Direct and indirect providers have the right to know about a client’s condition. You are doing great! Let’s continue!
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Congratulations! You just completed a total of 1001 questions in preparation for your NCLEXRN. You will ace the test! All of your hard work is paying off. I will congratulate you in advance on becoming a Registered Nurse. Welcome to an amazing career!
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