ATI NURSEN TESNursing Q&A

Edited by Sally L

. Lagerqu

ist, RN

, MS

Nursing Q&A

Edited by Sally L. Lagerquist, RN, MS

Critical Thinking Exercises

With disc, includes over 1,000 NCLEX® style Review Questions!

ATI NURSEN TESBuild critical thinking skills and prepare for the NCLEX-RN® in one book!ATI Nursing Q&A: Critical Thinking Exercises is a single source for developing critical thinking through more than 1,000 case-based questions with detailed answers! Learn to think through patient problems – just like practicing nurses do – with the practical and relevant explanations provided. As a bonus, ATI Nursing Q&A provides a disc with over 300 NCLEX-RN® style questions and explanations to help ready you for the most important examination of your nursing career!

Reasons Why Students Will Love This Book:F act-filled pages offer more exercises to test your reasoning skills.Unique index grid helps locate your individual study needs.Nursing exam preparation is made easy! andE ssential concepts are covered by easy-to-remember cases.Assess your ability to apply nursing knowledge by using the coded and detailed answers.Special hints are given for test-wise guidelines to gain higher scores.Your study time will be spent in a better way, for success on exams.

Reasons Why Nursing Instructors Will Love This Book:Nursing problems/diagnoses are featured with medical problems.E xam question spin-offs from 75 case scenarios.Wide array of clinical situations enliven your teaching. andCase-management approach is a more interesting alternative to lectures.Real-life clinical nursing examples cover encounters with patients, families, and colleagues.E xercises that enhance critical-thinking skills.Adjunct to all clinical nursing textbooks.T ools to focus and structure discussion groups.Inference-making devices.Vignettes used in problem-based learning have everyday applicability.E xamples stimulate students’ curiosity about related situations; the broad content range naturally progresses into

related areas.

Where do today’s nursing students turn forcomprehensive help with specific study topics?

About the Author/Editor: Sally Lambert Lagerquist, RN, MS, is founder and president of Review for Nurses, Inc. and Review for Nurses Tapes Co. of San Francisco, California. She is the author and editor of five ATI NurseNotes titles, the ATI How to Pass Nursing Exams book, and a series of audio, DVD/CD-ROM, and video exam reviews. She has lectured nationwide at RN licensure exam review courses since 1976 and has been a faculty member at the University of California, San Francisco, School of Nursing where she also obtained her degrees. Sally is a charter member of Sigma Theta Tau.

ATI NURSEN TES

Contents vii

Contents

Preface ix

Acknowledgments xiii

Contributing Authors xiv

How to Use This Book xvii

I. How to Prepare for ExaminationsIntroduction 2

1. Preparing Yourself Intellectually 3

2. Preparing Yourself Emotionally 11

3. Preparing Yourself Physically 19

4. Coping with Exam-Related Anxiety 23

5. How to Take Tests 29

II. Case Management Scenarios with Critical-Thinking Exercises: Questions and Answers

Introduction 37

6. Typical Test Designs for Critical-Thinking Exams in

Clinical Nursing Areas 39

7. Children and Adolescents 51

Case Situations and Questions 51

Answers and Rationale 103

8. Young Adult and Reproductive Years 141

Case Situations and Questions 141

Answers and Rationale 200

viii Contents

9. Adult Health Problems 245

Case Situations and Questions 245

Answers and Rationale 299

10. Older Adult and Geriatrics 335

Case Situations and Questions 335

Answers and Rationale 351

11. Behavioral and Emotional Problems 363

Case Situations and Questions 363

Answers and Rationale 404

III. Coding Tables and Summary Grids 425Introduction 425

Reference Code Abbreviations 427

12. Coding Tables 429

Summary Grids 450

References 461

IndexesIndex to Nursing Problems/Diagnosis 469

Index to Medical Diagnosis/Case Management Scenarios 475

xiv Acknowledgments

BookReviewers

Janet Baatz Darrow, MS, RN, CPNLecturerSan Jose State UniversitySan Jose, California(Pediatrics)

Christine Hooper, RN EdDAssociate ProfessorSan Jose State UniversitySan Jose, California(Medical-Surgical)

Janice McMillin, BSN, MSN, EdDInstructor of Maternal-Child

Nursing Sacramento State UniversityClinical Coordinator of Family

Birth Center Methodist HospitalSacramento, California(Maternal-Newborn)

Mary St. John Seed, RN, PhDAssociate ProfessorDepartment of Community Mental Health School of NursingUniversity of San FranciscoSan Francisco, California(Psychiatric-Mental Health)

Kathleen E. Snider, RN, MSN, CNSProfessor of NursingLos Angeles Valley CollegeValley Glen, California(Pediatrics)

Item Writers for the Disk in This Edition

Christine Hooper, RN, EdDAssociate ProfessorSan Jose State UniversitySan Jose, California(Medical-Surgical)

Janice McMillin, BSN, MSN, EdDInstructor of Maternal-Child

Nursing Sacramento State UniversityClinical Coordinator of Family

Birth Center Methodist HospitalSacramento, California(Maternal-Newborn)

Mary St. John Seed, RN, PhDAssociate ProfessorDepartment of Community Mental

Health School of NursingUniversity of San FranciscoSan Francisco, California(Psychiatric-Mental Health)

Kathleen E. Snider, RN, MSN, CNSProfessor of NursingLos Angeles Valley CollegeValley Glen, California(Pediatrics)

Contributing Authors xv

Contributing Authors to Previous Editions

Judith E. Barrett, RN, MSN, MNPFormer Associate Professor, University of San Francisco, School of Nursing, San Francisco

Irene M. Bobak, RN, PhD, FAANProfessor Emerita, Women’s Health and Maternity Nursing, San Francisco State University, San Francisco

Geraldine C. Colombraro, RN, MA, PhD Assistant Dean, Center for Continuing Education in Nursing and Health Care, Lienhard School of Nursing, Pace University, Pleasantville, New York

Jane Corbett, RN, MS, PhDProfessor Emerita, University of San Francisco, School of Nursing, San Francisco

Marlene Farrell, RN, MAFormer Professor of Nursing, California State University, Los Angeles

Sandra Faux, RN, MNFormer Faculty, University of Illinois College of Nursing, Chicago

Lois A. Fenner Giles, RN, MSFormer Faculty, University of Maryland, School of Nursing, Baltimore, Maryland

Marilyn Brolin Hopkins, RN, MS, DNScProfessor of Nursing, California State University, Sacramento, California

Sister Mary Brian Kelber, RN, DNScAssociate Professor, University of San Francisco, School of Nursing, San Francisco

Sally Lambert Lagerquist, RN, MSPresident and Course Coordinator, Review for Nurses, Inc. and RN Tapes Company; Former Instructor of Undergraduate, Graduate, and Continuing Education in Nursing, University of California, San Francisco, School of Nursing, San Francisco

xvi Contributing Authors

Diane R. Lapkin, RN, MS, EdDFormer Dean, School of Nursing, Salem State College, Salem, Massachusetts

Sister Mary Peter McKusker, RN, MS, MA Former Instructor, Puno, Peru

Janice Majewski Rhoades, RN, MS, DNScFormer Clinical Research Nurse, Cardiac Rehabilitation, Sequoia Hospital District, Redwood City, California

Karen L. Miller, RN, MSN Wilmette, Illinois

Robyn M. Nelson, RN, DNScDepartment Chair and Professor of Nursing, California State University, Sacramento, California

Agnes F. Padernal, RN, MSFormer Assistant Clinical Professor, University of California, Los Angeles, School of Nursing, Los Angeles

Kathy Rose, RN, MSFormer Assistant Professor, University of Illinois School of Nursing, Chicago

Williamina Rose, RN, MSFormer Education Director and Associate Professor, Montana State University, Butte Extended Campus, Butte, Montana

Patricia Sparacino, RN, MSVice Chairperson, Family Health Care Nursing, University of California School of Nursing, San Francisco

Janice Horman Stecchi, RN, EdDDean Emerita, College of Health Professions, University of Massachusetts Lowell, Lowell, Massachusetts

Janet Jordan Veatch, RN, MNClinical Nurse Specialist, Pediatric Oncology, University of California, San Francisco, Department of Nursing, San Francisco

Kathleen Hickel Viger, RN, MSDirector of Nursing, River Ridge Brain Injury Rehabilitation Center, Kennebunk, Maine

Adult Health Problems 245

9. Adult Health Problems

Case Management Scenarios and Critical-Thinking Exercises

Medical Diagnosis: Diabetic ketoacidosis.n NursingProblems/Diagnosis:

Electrolyte imbalance: hypokalemia.

Fluid volume deficit.

Altered nutrition.

n ChiefComplaint:

Dennis Rose, who is 18-years old and a high school basketball star, was admitted to the hospital for treatment of polyuria, polydipsia, and dry cough.

n HistoryofPresentIllness:

The patient was well until 10 days prior to admission, when he developed gastroenteritis followed by bronchitis. He had diarrhea, abdominal pain, intermittent vomiting, and dry cough.

n PastHistory:

Measles at age 7. No allergies.

n FamilyHistory:

Hyperthyroidism in maternal grandmother. Adult-onset diabetes mellitus in maternal uncle.

n ReviewofSymptoms:

10 pound weight loss over the past 6 days.

n PhysicalExam:

Head and neck: Eyes sunken. Tongue dry. Fruity breath odor.

Lungs: Clear on auscultation.

Abdomen: Benign.

Extremities: Skin dry with decreased turgor.

Vital signs: BP: 110/70. Temperature: 100.6°F. P: 110. R: 40.

246 II. Case Management Scenarios with Critical Thinking Exercises: Questions and Answers

n LaboratoryData:

Na+: 138.

K+: 3.2.

CO2: 6.

Cl-: 102.

Glucose: 860.

WBC: 17,000/mL.

Hgb: 18.1g.

Hct: 54%.

Urinalysis: 4 + glucose; ketones—large.

1. The nurse knows that the condition that does not precipitate diabetic ketoacidosis in the client is:

A. Diarrhea.

B. Intermittent vomiting.

C. Bronchitis.

D. Dehydration.

2. The nurse knows that Dennis will require insulin injections. Which statement best explains the rationale for insulin therapy?

A. The person with diabetes, type 1 requires insulin to supplement circulating insulin.

B. The person with diabetes, type 1 is insulin-dependent.

C. The injections are temporary until the pancreas increases insulin production.

D. All people who have diabetes must receive insulin.

3. Which admitting symptom indicates the incomplete lipid metabolism that occurs in diabetes?

A. Polyuria.

B. Polydipsia.

C. Fruity breath.

D. Weight loss.

4. The nurse knows that the presence of hypokalemia (after treatment with insulin) increases the risk of the client developing:

A. Cardiac irritability.

B. Renal failure.

C. Cardiac depression.

D. Respiratory failure.