Mosbys_Comprehensive_Review_of_Nursing_for_the_NCLEX_20th_Edition.pdf

Mosby’s Comprehensive Review of Nursing for the NCLEX-RN® Examination TWENTIETH EDITION Patricia M. Nugent, RN, EdD Nugent Books, Inc., President; Professor Emerita, Nassau Community College, Garden City, New York Judith S. Green, RN, MA Professor Emerita, Nassau Community College, Garden City,...

Mosby’s Comprehensive Review of Nursing for the NCLEX-RN® Examination TWENTIETH EDITION Patricia M. Nugent, RN, EdD Nugent Books, Inc., President; Professor Emerita, Nassau Community College, Garden City, New York Judith S. Green, RN, MA Professor Emerita, Nassau Community College, Garden City, New York Mary Ann Hellmer Saul, RNCS, PhD Professor, Nassau Community College, Garden City, New York Phyllis K. Pelikan, RN, MA President, PKP Books, Inc.; Professor Emerita, Nassau Community College, Garden City, New York Table of Contents Cover image Title page Copyright Contributing Authors Contributing Item Writers Reviewers Dedication Preface Introduction for Students Preparing for the NCLEX-RN® Examination Overview Classification of Questions General Clues for Answering Multiple-Choice Questions Alternate Item Formats Comprehensive Examinations and Focus for Study Worksheets Companion CD How to Use This Book When Studying Taking the Licensure Examination Unit 1: Foundations of Nursing Practice Chapter 1: Factors Influencing Client Needs and Nursing Care Concepts from Sociology  Hierarchy of Needs Individual Factors Affecting Health Stress Response Grieving Process Health-Illness Continuum and Rehabilitation Type of Condition Affecting Client Level of Preventive Care Chapter 2: Basics of Nursing Practice Nursing Process Ensuring Quality Health Care Communication Teaching-Learning Leadership and Management Nursing Practice and the Law Medication Administration Chapter 3: Integral Aspects of Nursing Care Pain Infection Fluid, Electrolyte, and Acid-Base Balance Perioperative Care Neoplastic Disorders Emergency Situations Chapter 4: Foundations of Nursing Practice: Review Questions with Answers and Rationales Unit 2: Medical-Surgical Nursing Chapter 5: Growth and Development of the Adult The Young Adult (Age 20 to 44 Years) The Middle-Age Adult (Age 45 to 59 Years) The Young-Older Adult (Age 60 to 74 Years)  The Middle-Older Adult (Age 75 to 84 Years) and Old-Older Adult (Age 85+ Years) Chapter 6: Nursing Care of Clients with Circulatory System (Cardiovascular, Blood, and Lymphatic Systems) Disorders Overview Major Disorders of the Circulatory System (Cardiovascular, Blood, and Lymphatic Systems) Chapter 7: Nursing Care of Clients with Respiratory System Disorders Overview Major Disorders of the Respiratory System Chapter 8: Nursing Care of Clients with Gastrointestinal System Disorders Overview Major Disorders of the Gastrointestinal System Chapter 9: Nursing Care of Clients with Endocrine System Disorders Overview Major Disorders of the Endocrine System Chapter 10: Nursing Care of Clients with Integumentary System Disorders Overview Major Disorders of the Integumentary System Chapter 11: Nursing Care of Clients with Neuromusculoskeletal System Disorders Overview Major Disorders of the Neuromusculoskeletal System Chapter 12: Nursing Care of Clients with Urinary/Reproductive System Disorders Overview Major Disorders of Urinary/Reproductive Systems Chapter 13: Nursing Care of Clients with Infectious Diseases Overview Related Procedures: Standard and Transmission-Based Precautions  Major Infectious Diseases Chapter14: Medical-Surgical Nursing: Review Questions with Answers and Rationales Growth and Development Circulatory System (Cardiovascular, Blood, and Lymphatic Systems) Respiratory System Gastrointestinal System Endocrine System Integumentary System Neuromusculoskeletal System Urinary/Reproductive Systems Infectious Diseases Drug-Related Growth and Development Circulatory System (Cardiovascular, Blood, and Lymphatic Systems) Respiratory System Gastrointestinal System Endocrine System Integumentary System Neuromusculoskeletal System Urinary/Reproductive Systems Infectious Diseases Drug-Related Responses Unit 3: Mental Health/Psychiatric Nursing Chapter 15: Foundations of Mental Health/Psychiatric Nursing Development of Personality Physiology, Cognition, Emotions, and Behavior Anxiety and Coping Behaviors Chapter 16: The Practice of Mental Health/Psychiatric Nursing Legal Concepts Related to Mental Health/Psychiatric Nursing  Community Health Services Therapeutic Nurse-Client Relationship Crisis Intervention Nursing Care in Relation to Violence Nursing Care in Relation to Therapeutic Modalities Chapter 17: Nursing Care of Clients with Disorders Usually First Evident in Infancy, Childhood, or Adolescence Overview General Nursing Care Related to Disorders First Evident in Infancy, Childhood, or Adolescence Major Disorders First Evident in Infancy, Childhood, or Adolescence Chapter 18: Nursing Care of Clients with Disorders Related to Alterations in Cognition and Perception Overview General Nursing Care of Clients with Disorders Related to Alterations in Cognition and Perception Major Disorders Related to Alterations in Cognition and Perception Chapter 19: Nursing Care of Clients with Disorders Related to Anxiety and Alterations in Mood Overview Major Disorders Associated with Anxiety Major Somatoform Disorders Major Disorders Related to Alterations in Mood Chapter 20: Nursing Care of Clients with Disorders Related to Alterations in Behavior Overview Major Disorders Related to Alterations in Behavior Chapter 21: Nursing Care of Clients with Sexual and Gender Identity Disorders Overview General Nursing Care of Clients with Sexual and Gender Identity Disorders Major Disorders Associated with Sexual and Gender Identity Conditions Chapter 22: Mental Health/Psychiatric Nursing: Review Questions with Answers and Rationales  Foundations of Mental Health/Psychiatric Nursing The Practice of Mental Health/Psychiatric Nursing Nursing Care of Clients with Disorders Usually First Evident in Infancy, Childhood, or Adolescence Nursing Care of Clients with Disorders Related to Alterations in Cognition and Perception Nursing Care of Clients with Disorders Related to Anxiety and Alterations in Mood Nursing Care of Clients with Disorders Related to Alterations in Behavior Nursing Care of Clients with Sexual and Gender Identity Disorders Foundations of Mental Health/Psychiatric Nursing The Practice of Mental Health/Psychiatric Nursing Nursing Care of Clients with Disorders Usually First Evident in Infancy, Childhood, or Adolescence Nursing Care of Clients with Disorders Related to Alterations in Cognition and Perception Nursing Care of Clients with Disorders Related to Anxiety and Alterations in Mood Nursing Care of Clients with Disorders Related to Alterations in Behavior Nursing Care of Clients with Sexual and Gender Identity Disorders Unit 4: Childbearing and Women’s Health Nursing Chapter 23: Nursing Care to Promote Childbearing and Women’s Health Health Promotion Family Planning Related Procedures Related Pharmacology Chapter 24: Nursing Care Related to Major Disorders Affecting Women’s Health Major Disorders Affecting Women’s Health Chapter 25: Nursing Care of Women during Uncomplicated Pregnancy, Labor, Childbirth, and the Postpartum Period Prenatal Period Intrapartum Period (Labor and Birth) Postpartum Period Chapter 26: Nursing Care of Women at Risk during Pregnancy, Labor, Childbirth, and the Postpartum Period  Tests to Identify and/or Monitor High-Risk Pregnancy Nursing Care of Pregnant Women with Special Needs Nursing Care of Pregnant Women with Preexisting Health Problems Nursing Care of Women with Complications during the Prenatal Period Nursing Care of Women with Complications During the Intrapartum Period Nursing Care of Women with Complications During the Postpartum Period Chapter 27: Nursing Care of the Newborn Foundations of Nursing Care for Newborns Nursing Care of High-Risk Newborns Chapter 28: Childbearing and Women’s Health Nursing: Review Questions with Answers and Rationales Nursing Care to Promote Childbearing and Women’s Health Nursing Care Related to Major Disorders Affecting Women’s Health Nursing Care of Women during Uncomplicated Pregnancy, Labor, Childbirth, and the Postpartum Period Nursing Care of Women at Risk during Pregnancy, Labor, Childbirth, and the Postpartum Period Nursing Care of the Newborn Nursing Care to Promote Childbearing and Women’s Health Nursing Care Related to Major Disorders Affecting Women’s Health Nursing Care of Women during Uncomplicated Pregnancy, Labor, Childbirth, and the Postpartum Period Nursing Care of Women at Risk during Pregnancy, Labor, Childbirth, and the Postpartum Period Nursing Care of the Newborn Unit 5: Child Health Nursing Chapter 29: Foundations of Child Health Nursing Growth and Development of the Child Play The Family Age-Related Responses to Pain Principles Related to Medications for Children Chapter 30: Nursing Care of Infants  Growth and Development Health Promotion of Infants Hospitalization of Infants Health Problems That Begin in Infancy and May Persist through Childhood (Nursing care includes care of the infant and child) Gastrointestinal Malformations Cardiac Malformations Neurologic Malformations Genitourinary Malformations Skeletal Malformations Health Problems that Develop during Infancy Chapter 31: Nursing Care of Toddlers Growth and Development Health Promotion of Toddlers Hospitalization of Toddlers Health Problems Most Common in Toddlers Chapter 32: Nursing Care of Preschoolers Growth and Development Health Promotion of Preschoolers Hospitalization of Preschoolers Health Problems Most Common in Preschoolers Chapter 33: Nursing Care of School-Age Children Growth and Development Health Promotion of School-Age Children Hospitalization of School-Age Children Health Problems Most Common in School-Age Children Skin Infections and Infestations Chapter 34: Nursing Care of Adolescents Growth and Development Health Promotion during Adolescence  Hospitalization of Adolescents Health Problems Most Common in Adolescents Chapter 35: Child Health Nursing: Review Questions with Answers and Rationales Nursing Care of Infants Nursing Care of Toddlers Nursing Care of Preschoolers Nursing Care of School-Age Children Nursing Care of Adolescents Nursing Care of Infants Care of Toddlers Nursing Care of Preschoolers Nursing Care of School-Age Children Nursing Care of Adolescents Unit 6: NCLEX Preparation Toolkit Chapter 36: Comprehensive Examination 1 Review Questions: Part A Review Questions: Part B Answers and Rationales: Part B Chapter 37: Study Worksheets for Reviewing Your Test-Taking Performance Introduction How to Maximize Use of the Comprehensive Examinations How to Develop a Focus for Study Index Copyright 3251 Riverport Lane St. Louis, Missouri 63043 MOSBY’S COMPREHENSIVE REVIEW OF NURSING FOR THE NCLEX-RN® EXAMINATION ISBN: 978-0-323-07895-5 Copyright © 2012 by Mosby, Inc., an imprint of Elsevier Inc. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher ’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). NCLEX® and NCLEX-RN® are registered trademarks and service marks of the National Council of State Boards of Nursing, Inc. Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Previous editions copyrighted 2009, 2006, 2003, 1999, 1996, 1993, 1990, 1987, 1984, 1981, 1977, 1973, 1969, 1965, 1961, 1958, 1955, 1951, 1949 Library of Congress Cataloging-in-Publication Data Mosby’s comprehensive review of nursing for the NCLEX-RN examination / editor, Patricia M. Nugent ; associate editors, Judith S. Green, Mary Ann Hellmer Saul ; editor emerita, Phyllis K. Pelikan.—20th ed. p. ; cm. Comprehensive review of nursing for the NCLEX-RN examination Rev. ed. of: Mosby’s comprehensive review of nursing for the NCLEX-RN examination / editors, Dolores F. Saxton, Patricia M. Nugent, Phyllis K. Pelikan. Includes bibliographical references and index. ISBN 978-0-323-07895-5 (pbk. : alk. paper) 1. National Council Licensure Examination for Registered Nurses—Study guides. 2. Nursing— Examinations, questions, etc. 3. Nursing—Outlines, syllabi, etc. I. Nugent, Patricia Mary II. Green, Judith S. III. Hellmer Saul, Mary Ann. IV. Title: Comprehensive review of nursing for the NCLEX-RN examination. [DNLM: 1. Nursing—Examination Questions. 2. Nursing—Outlines. WY 18.2] RT55.M64 2012 610.73076—dc23 2011020448 Executive Editor: Kristin Geen Senior Developmental Editor: Jamie Horn Publishing Services Manager: Deborah L. Vogel Project Manager: John W. Gabbert Design Direction: Karen Pauls Printed in the United States of America Last digit is the print number: 9 8 7 6 5 4 3 2 1 Contributing Authors Jane K. Brody, RN, PhD, Professor Nassau Community College Garden City, New York Catherine R. Coverston, PhD, Professor Emerita Brigham Young University Provo, Utah Christina Alg iere Kasprisin, RN, EdD, Consultant South Hero, Vermont Barbara A. Vitale, RN, MA, Professor Emerita Nassau Community College Garden City, New York Contributing Item Writers Arline J. Borella, RN, BSN, CIC, Consultant Seattle, Washington Linda Carman Copel, RN, PhD, Villanova University College of Nursing Villanova, Pennsylvania Theresa M. Dobrzykowski, RN, DNS, APRNC, Indiana University of South Bend South Bend, Indiana Carmel A. Esposito, RN, EdD, Nurse Educator Follansbee, West Virginia Jane E. Flicking er, RN, MSN, Rochester Community College, Retired Rochester, Minnesota Michael W. Mang ino, RN, MSN, NP—Psychiatry , Suffolk County Community College Selden, New York Cynthia C. Small, RN, MSN, APRN-BC, Lake Michigan College Benton Harbor, Michigan Darlene R. Sredl, RN, PhD, University of Missouri St. Louis, Missouri Judy E. White, RNC, MA, MSN, Southern Union State Community College Opelika, Alabama Reviewers Teresa Burckhalter, MSN, RN, BC, Nursing Faculty Technical College of the Lowcountry Beaufort, South Carolina Mary Helen Freter, MS, RN, CNE, Assistant Professor of Nursing Health Sciences Division Tulsa Community College Tulsa, Oklahoma Norlyn Hyde, RN, BC, MSN, CNS, Professor of Nursing Division of Nursing Louisiana Technical University Ruston, Louisiana Norah Johnson, PhD, RN, CPNP, Assistant Professor College of Nursing Marquette University Milwaukee, Wisconsin Pamela Newland, PhD, RN, Assistant Professor School of Nursing Southern Illinois University Edwardsville Edwardsville, Illinois Linda Rosier, RN, MSN, IBCLC, Associate Professor Nursing Program Montgomery College Takoma Park, Maryland Donna Russo, RN, MSN, CCRN, CNE, Nursing Instructor ARIA Health School of Nursing Philadelphia, Pennsylvania Kim Silvey, MSN, RN, Assistant Professor Department of Nursing Morehead State University Morehead, Kentucky Katrina Allen Thomas, RN, MSN, CCRN, Nursing Instructor Nursing Faulkner State Community College Bay Minette, Alabama Companion CD Audio Key Points Written by: Sharon Souter, PhD, RN, CNE, Dean and Associate Professor Scott and White College of Nursing University of Mary Hardin-Baylor Belton, Texas Narrated by: Carolyn Kruse, Above the Dogs St. Peters, Missouri Dedication To my husband Neil, the love of my life Thank you for always being there for me Patricia Nugent To my family Dale and Art, Richard, Eric and Miriam, Cheryl, and Steven Thank you for your unconditional support Judith Green To my children George, Matt, and Meredith for their inspiration and for teaching me so many valuable life lessons Mary Ann Hellmer Saul To my family The proverbial “Wind beneath my Wings” Phyllis K. Pelikan Preface The information in Mosby’s Comprehensive Review of Nursing for the NCLEX-RN® Examination has been totally revised and updated for this 20th edition. The progression of subject matter in each area reflects the consistent approach that has been used throughout the book. Information presented incorporates the latest knowledge, newest trends, and current practices in the profession of nursing. The Introduction for Students Preparing for the Licensure Examination provides information about the NCLEX-RN® Examination, including the classifications used in the test plan structure. It also reviews clues for answering multiple-choice questions, provides examples of alternate-format items, and discusses the comprehensive exams and how to use this book when studying. Foundations of Nursing Practice—Unit I (Chapters 1 through 3)—discusses factors that influence client needs, the basics of nursing practice, and integral aspects of nursing care. These chapters present information essential to the practice of nursing that is common to all of the clinical areas. Content related to Medical-Surgical Nursing is presented in Unit 2 (Chapters 5 through 13); content related to Mental Health/Psychiatric Nursing is presented in Unit 3 (Chapters 15 through 21); content related to Childbearing and Women’s Health Nursing is presented in Unit 4 (Chapters 23 through 27); and content related to Child Health Nursing is presented in Unit 5 (Chapters 29 through 34). Chapters 4, 14, 22, 28, and 35 consist of questions with their answers and rationales that relate to Foundations of Nursing Practice, Medical-Surgical Nursing, Mental Health Nursing, Childbearing and Women’s Health Nursing, and Child Health Nursing, respectively. Chapter 36 in Unit 6 contains a 265-item Comprehensive Exam that mirrors the NCLEX-RN® Examination. Chapter 37 in Unit 6 contains two Study Worksheets: Focus For Study Worksheet—Adapted NCLEX-RN Test Plan and Focus For Study Worksheet—Content Areas. These worksheets promote an individualized assessment that can focus future study. The Medical-Surgical, Mental Health/Psychiatric, Childbearing and Women’s Health, and Child Health Nursing chapters incorporate information from the basic sciences, nutrition, pharmacology, acute and long-term care, and physical and emotional nursing care. We continue to present the material in the traditional clinical groupings for we still believe that when preparing for a comprehensive examination, the average student will study all of the distinct parts before attempting to put them together. Although we believe that in practice the nursing process is continually evolving rather than remaining a clearly defined step-by-step process, we present the content under the following headings: Assessment/Analysis, Planning/Implementation, and Evaluation/Outcomes. We believe that this grouping avoids needless repetition, recognizes the abilities of our readers, and reflects current practice. Over 4200 questions have been included in this edition of Mosby’s Comprehensive Review of Nursing for the NCLEX-RN® Examination. More than 500 of them are new questions that reflect the increased emphasis on Management of Care, Reduction of Risk Potential, and Alternate Format Items. Although the majority of the questions are multiple-choice, the number of alternate format items (e.g., multiple-response items, ordered-response items, fill-in-the-blank items, hot spot items, and exhibit items) in the book was increased to 618. The questions in Chapters 4, 14, 22, 28, and 35 are grouped according to the chapter in which the content of the question is presented. For every question in this edition and on the CD-ROM we have provided rationales that state the reason why the correct answer is correct, as well as why the incorrect answers are incorrect. To further assist the user in studying/reviewing by a specific content area, the questions are classified according to Client Need, Cognitive Level, Nursing Process, Integrated Process (if applicable), and Reference. The Reference category at the end of each answer/rationale refers the student to the chapter and major headings under which the content in the question is presented in more detail in Mosby’s Comprehensive Review of Nursing for the NCLEX-RN Examination. One Comprehensive Exam is included in this textbook and on the Companion CD, along with a second Comprehensive Exam that appears only on the Companion CD-ROM. These comprehensive exams provide an opportunity for the test taker to experience testing situations that approximate the NCLEX-RN®. To parallel the NCLEX-RN®, the first 75 questions in each test reflect the minimal testing experience for students taking the NCLEX-RN®. The total number of 265 questions in each test reflects the maximum number of questions that a student can take on the NCLEX-RN®. On the CD all of the questions in the comprehensive exams have been analyzed as to Client Need, Cognitive Level, Nursing Process, Integrated Processes (if applicable), and Reference to content in Mosby’s Comprehensive Review of Nursing for the NCLEX-RN Examination. The Companion CD-ROM contains the 2245 questions from the book, as well as 1965 additional test questions that can be used in both study and test format. These questions also have been categorized by Client Need, Cognitive Level, Nursing Process, and Integrated Process (if applicable). Whether the test taker answers these questions in a written or computerized format the information being tested remains constant. To reinforce learned information and build confidence in taking a computerized test, we suggest that students practice answering questions on this CD to simulate the computerized NCLEX-RN®. The Companion CD has three practice modes: Study, Quiz, and Exam. The Study and Quiz modes allow a selection of topics and categories to create an exam consisting of as many items as desired. The Study mode provides immediate feedback and rationales as each question is answered. The Quiz mode provides an analysis of performance once all the questions on the exam have been answered. The Exam mode includes two Comprehensive Exams with 265 questions each that will appear in random order each time the test is taken. A third option, Comprehensive Exam Random generates 265 questions randomly from all questions available. Content selection allows for a choice of questions by client need, step of the nursing process, or content area to individualize a focused study. The Companion CD also includes brand new mp3 key point summaries that can be downloaded for on-the-go review. All of the questions used in this edition have been submitted by outstanding educators and practitioners/health care providers of nursing. Initially the editorial board reviewed all questions, selecting the most pertinent for inclusion in a mass field-testing project or analysis by a panel of expert nursing educators. Students graduating from baccalaureate, associate degree, and diploma nursing programs in various locations in the United States provided a diverse group for the mass field-testing project or focus group sessions. Results were statistically analyzed. This analysis, in addition to the input from the panel of expert nursing educators, was used to select questions for inclusion in the book. We would like to take this opportunity to thank Kristin Geen, Executive Editor, for her masterful leadership; Jamie Horn, Senior Developmental Editor, for her dedication to this project and for keeping us focused; Johnny Gabbert, Project Manager, for being always available and having the answers to all of our questions; Karen Pauls, Designer, for taking a complex manuscript and making it easy on the eyes and brain; Debbie Prato, Copyeditor, for ensuring a crisp, accurate manuscript; and finally Eloise DeHaan, Proofreader, for her meticulous attention to detail in relation to content and format. In addition, we recognize the exemplary work of the Contributing Authors, Contributing Item Writers, and Reviewers that reflects their dedication and expertise. We thank our proofreaders Erin Mitchell, Frances Timcheck, Kathleen Ashker, Cheryl Wolff, and Dorene Lebowitz for their help in the final stages of manuscript preparation. A special thank you goes to Barbara Vitale for work over and beyond the call of her content editorial duties. We especially appreciate our families for their patience and understanding when the production of this book consumed most of our time and energy. Patricia M. Nugent Judith S. Green Mary Ann Hellmer Saul Introduction for Students Preparing for the NCLEX-RN® Examination Overview The NCLEX-RN® examination is integrated and comprehensive. Nursing candidates are required to answer questions that necessitate a recognition and understanding of the physiologic, biologic, and social sciences, as well as the specific nursing skills and abilities involved in a given client situation. This textbook and CD contain a total of 4210 questions. They include objective multiple-choice questions, as well as alternate-format questions (615 items) such as multiple-response items, ordered- response items, fill-in-the-blank items, hot spot items, exhibit items, and audio items. To answer the questions appropriately, a candidate needs to understand and correlate certain aspects of anatomy and physiology, the behavioral sciences, fundamentals of nursing, the effects of medications administered, the client’s attitude toward illness, and other pertinent factors such as legal responsibilities, leadership and management, and critical thinking. Most questions are based on nursing situations similar to those with which candidates have had experiences because they emphasize the nursing care of clients with representative common health problems. Some questions, however, require candidates to apply basic principles and techniques to clinical situations with which they have had little, if any, actual experience. To prepare adequately for an integrated comprehensive examination, it is necessary to understand the discrete parts that compose the universe of material under consideration. This is one of the major principles of learning that has contributed to the development of Mosby’s Comprehensive Review of Nursing for the NCLEX-RN® Examination. Using this principle, the text begins with Unit 1—Foundations of Nursing Practice. The information in this unit is essential to each of the major clinical areas: Unit 2—Medical-Surgical Nursing, Unit 3 —Mental Health/Psychiatric Nursing, Unit 4—Childbearing and Women’s Health Nursing, and Unit 5 —Child Health Nursing. Chapters at the end of each unit contain questions that test the student’s knowledge of principles and theories underlying nursing care specific to the content within the unit. The questions represent a variety of situations, in a variety of settings, and with a variety of nursing objectives. Each question has rationales for the correct answer and incorrect options, as well as a classification of the question that reflects the NCLEX-RN® examination test plan. The following descriptions are presented to assist in the understanding of these classifications. Classification of Questions Every question in the book and in both comprehensive exams is classified by the following categories: Client Need, Cognitive Level, Integrated Process, Nursing Process, and a Reference to content within Mosby’s Comprehensive Review of Nursing for the NCLEX-RN® Examination. In the Comprehensive Exams the percentage of test questions assigned to each Client Need category and subcategory reflects the 2010 NCLEX-RN Test Plan. These percentages are included adjacent to the specific Client Need category. Client Need These categories reflect activities most frequently performed by entry-level nurses. 1. Safe and Effective Care Environment Management of Care (16% to 22%): These questions provide or direct the nursing activities that promote the delivery of care to clients, family members, significant others, and other health care personnel. Safety and Infection Control (8% to 14%): These questions address the protection of clients, family members, significant others, and health care personnel from health and environmental hazards. 2. Health Promotion and Maintenance (6% to 12%) These questions provide or direct the nursing care of the client, family members, and significant others. They include knowledge of the principles of growth and development, prevention and/or detection of health problems, and interventions to achieve optimum health. 3. Psychosocial Integrity (6% to 12%) These questions provide or direct the nursing care that supports and promotes the emotional, mental, and social well-being of the client, family members, and significant others experiencing stressful events, as well as clients with acute or chronic mental health illness. 4. Physiological Integrity Basic Care and Comfort (6% to 12%): These questions address the provision of comfort and support in the performance of the activities of daily living. These include elimination, mobility, hydration, nutrition, hygiene, comfort, rest, and sleep. Pharmacological and Parenteral Therapies (13% to 19%): These questions address the provision of care related to the administration of medications, parenteral therapies, and blood products. Reduction of Risk Potential (10% to 16%): These questions address the nursing care that may limit the likelihood of the development of complications or health problems related to existing disorders, treatments, or procedures. Physiological Adaptation (11% to 17%): These questions address the provision and management of the nursing care for clients with acute, chronic, or life-threatening physical health problems. Cognitive Level This category reflects the thinking processes required to answer the question. Knowledge: These questions require the test taker to recall information from memory. For example, they involve knowledge of facts, principles, generalizations, terminology, and trends. Comprehension: These questions require the test taker to understand information. They involve the interpretation, paraphrasing, and summarization of information, as well as the determination of implications and consequences of information. Application: These questions require the test taker to use information, principles, or concepts. They involve identifying, manipulating, changing, or modifying information as well as performing mathematical calculations. Analysis: These questions require the test taker to interpret a variety of information. It involves the recognition of commonalities, differences, and interrelationships among data, concepts, principles, and situations. Integrated Process Integrated processes are fundamental components critical to the practice of nursing. They include the nursing process, caring, communication and documentation, and teaching and learning. Because the nursing process (a scientific problem-solving process that involves critical thinking) is essential to all nursing care, it is included in each answer/rationale. Caring: These questions reflect interactions between the nurse and client/significant others that demonstrate mutual trust and respect. They include the nursing care that provides support, encouragement, hope, and compassion. Communication/Documentation: These questions involve verbal and nonverbal interactions between the nurse and client, significant others, and members of the health care team. Client status, events, and interventions are communicated and documented according to rights, responsibilities, and standards of care. Teaching/Learning: These questions include nursing assessments and interventions that relate to the attainment of knowledge, skills, or attitudes that meet client needs. Phases of the Nursing Process This category reflects the problem-solving process used by nurses to identify client needs, plan and implement nursing care, and evaluate client responses to care. Assessment/Analysis: This phase requires the nurse to obtain objective and subjective data from primary and secondary sources, to identify and group significant data, and to communicate this information to other members of the health team. This phase also requires the nurse to interpret data gathered through assessment in order to make nursing decisions. Client and family needs are identified, and short-term and long-term goals/outcomes are set. Planning/Implementation: This phase requires the nurse to design and implement a regimen with the client, family, and other health team members to achieve goals/outcomes set during the assessment/analysis phase. It also requires setting priorities for intervention. The client may be given total care or may be assisted and encouraged to perform activities of daily living or follow the regimen prescribed by the health care provider. In addition, it involves activities such as counseling, teaching, and supervising health team members. Evaluation/Outcomes: This phase requires the nurse to determine the effectiveness of nursing care. Care is reviewed, the client’s response to intervention is identified, and a determination is made as to whether the client has achieved the predetermined outcomes and goals. It also includes the appraisal of factors that influence goal achievement (e.g., the client’s abilities to fulfill the health care plan— physical, emotional, financial) and modification of the original plan as needed. Reference Each question in the book and questions in both comprehensive examinations on the CD refer the test taker to the section where the related content concerning the question is within Mosby’s Comprehensive Review of Nursing for the NCLEX-RN® Examination. This promotes a review of the specific information as it relates to the question and permits a more thorough review of related information. General Clues for Answering Multiple-Choice Questions On a multiple-choice test, the question and possible answers are called a test item. The part of the item that asks the question or poses a problem is called the stem. All of the possible answers presented are called options. One of the options is the correct answer or key; the remaining options are incorrect. The incorrect options are called distractors because their major purpose is to distract the test taker from the correct answer. A Read the question carefully before looking at the answers. 1. Determine what the question is really asking; look for key words. 2. Read each answer thoroughly and see if it completely covers the material asked by the question. 3. Narrow the choices by immediately eliminating answers you know are incorrect. B Because few things in life are absolute without exceptions, avoid selecting answers that include words such as always, never, all, every, and none. Answers containing these key words are rarely correct. C Attempt to select the answer that is most complete and includes the other answers within it. An example might be as follows. A stem might ask “A child’s intelligence is influenced by:” and three options might be genetic inheritance, environmental factors, and past experiences. The fourth option might be multiple factors, which is a more inclusive choice and therefore the correct answer. D Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. E Watch for grammatical inconsistencies. If one or more of the options is not grammatically consistent with the stem, the alert test taker can identify it as a probable incorrect option. When the stem is in the form of an incomplete sentence, each option should complete the sentence in a grammatically correct way. F Avoid selecting answers that state hospital rules or regulations as a reason or rationale for action. G Look for answers that focus on the client or are directed toward feelings. H If the question asks for an immediate action or response, all of the answers may be correct, so base your selection on identified priorities for action. I Do not select answers that contain exceptions to the general rule, controversial material, or degrading responses. J Reread the question if the answers do not seem to make sense, because you may have missed words such as not or except in the statement. K Do not worry if you select the same numbered answer repeatedly, because there usually is no pattern to the answers. L Mark the number next to the answer you have chosen. M Answer every question because on the NCLEX-RN® exam you must answer a question before you can move on to the next question. Alternate Item Formats In addition to multiple-choice questions, the NCLEX-RN® exam includes alternate-format questions. These questions consist of five types: multiple-response items, ordered-response (drag and drop) items, fill-in-the-blank items, hot spot, and exhibit items. The following examples reflect these alternate item formats. Multiple-Response Item Multiple-response items pose a question and then include a list of responses that may or may not answer the question. The test taker is directed to indicate all the correct options. The nurse suspects that a postpartum client is experiencing postpartum depression without psychotic features. Which assessment findings support this conclusion? Select all that apply. 1. _____ Delusions 2. _____ Somnolence 3. _____ Ambivalence 4. _____ Increased appetite 5. _____ Emotional lability Answer: 2, 4, 5. 1. Delusions occur 50% of the time with postpartum depression with psychotic features. 2. A yearning for sleep, sleeping heavily, and an inability to go back to sleep if awakened are all associated with postpartum depression without psychotic features. 3. Ambivalence is experienced by many postpartum women and during postpartum blues. With postpartum depression without psychotic features the woman is often fearful, anxious, angry, and despondent. 4. Women with postpartum depression without psychotic features often have odd food cravings (often desserts) and tend to binge eat and gain weight. 5. These women are irritable, and their behavior escalates with little provocation. They experience spontaneous crying episodes and have severe anxiety and panic attacks. Client Need: Psychosocial Integrity; Cognitive Level: Analysis; Nursing Process: Assessment/Analysis; Reference: Ch 25, Postpartum Period, Data Base Ordered-Response (Drag and Drop) Item Ordered-response items present information or a series of statements and then ask the test taker to place them in order of priority. A client is receiving an IV piggyback oxytocin (Pitocin) infusion to induce labor. The client experiences three contractions that are 90 seconds long and occur less than 2 minutes apart. List in order of priority the nursing actions that should be taken. 1. ______ Administer oxygen 2. ______ Call the health care provider 3. ______ Interrupt the oxytocin infusion 4. ______ Assess maternal/fetal responses 5. ______ Document fetal/maternal responses Answer: 3, 1, 4, 2, 5. 3. The dose of oxytocin is excessive, causing prolonged, intense uterine contractions that can precipitate uterine rupture. The oxytocin (Pitocin) must be stopped immediately. 1. Excessive contractions decrease blood flow to the placenta; this can result in fetal heart rate decelerations (e.g., bradycardia, diminished variability, late decelerations) and fetal hypoxia. Oxygen will improve the amount of oxygen being supplied to the placenta and eventually to the fetus. 4. Maternal and fetal responses to the cessation of the oxytocin infusion and the administration of oxygen should be evaluated next. The mother and fetus are the priority. 2. The health care provider should be notified as soon as the initial interventions are implemented and the maternal and fetal responses are evaluated. 5. Documentation of the event (e.g., length and intensity of contractions, nursing interventions, maternal and fetal responses, and notification of the health care provider) is done last after the needs of the mother and fetus are met. Client Need: Pharmacological and Parenteral Therapies; Cognitive Level: Analysis; Nursing Process: Planning/Implementation; Reference: Ch 26, Induction or Stimulation of Labor, Nursing Care of Women during Induction or Stimulation of Labor Fill-in-the-Blank Item Fill-in-the-blank items involve a calculation. The question presents information and requires the test taker to manipulate the information to solve the problem posed, and then the test taker must record the solution to the problem. The health care provider prescribes an IVPB infusion of 500 mg of an antibiotic to be added to 50 mL of normal saline to be administered four times daily. The antibiotic is supplied in single-dose vials containing 1 g each. The directions advise that the instillation of 0.8 mL of normal saline will yield 1.2 mL of solution. How much antibiotic solution should be added to the 50 mL of normal saline? Record your answer using one decimal place. Answer: __________ mL Answer: 0.6 mL. First convert 500 mg to 1 g by using ratio and proportion. Then solve the problem by using ratio and proportion.  Client Need: Pharmacological and Parenteral Therapies; Cognitive Level: Application; Nursing Process: Planning/Implementation; Reference: Ch 2, Medication Administration, Nursing Responsibilities Related to Medication Administration Hot Spot Item* Hot spot items present a problem in relation to a figure. You are asked to answer the question by placing an X over an area on the figure. These items may focus on areas to be assessed or sites of clinical manifestations. A nurse is assessing a client with the diagnosis of hypoparathyroidism. As part of the assessment the nurse assesses the client for Chvostek’s sign. Place an X where the nurse should tap to elicit this sign. Answer: Low serum calcium levels increase the movement of sodium across excitable membranes; depolarization occurs more easily. Tapping the face just below and in front of the ear stimulates the facial nerve; in the presence of hypocalcemia, muscle twitching on one side of the mouth, nose, and cheek occurs (Chvostek’s sign).  Client Need: Physiological Adaptation; Cognitive Level: Analysis; Nursing Process: Assessment/Analysis; Reference: Ch 9, Hypoparathyroidism, Nursing Care Exhibit Item Exhibit items present a situation and ask a question. A variety of objective and subjective information is presented about the client in formats such as the hospital record (e.g., laboratory test results, results of diagnostic procedures, progress notes, health care provider orders, medication administration record, health history), physical assessment data, and nurse/client interactions. After analyzing the information presented, the test taker answers the question. These questions usually reflect the analysis level of cognitive thinking.  A parent brings a 4-year-old child to the clinic because the child is no longer able to keep up with older siblings when playing sports in the yard. The nurse obtains the child’s vital signs, performs a physical assessment, and reviews the child’s laboratory reports. What should be the nurse’s primary intervention? 1. Preventing bleeding 2. Instituting contact precautions 3. Initiating a strict intake and output 4. Monitoring for cardiac decompensation Answer: 4 This child is severely anemic. The decreased red blood cells (the expected range for a 4-year-old is 4.0 to 5.5 × 106/µL), low hematocrit (the expected range for a 4-year-old is 30% to 40%), and low hemoglobin (the expected range for a 4-year-old is 9.5 to 14 g/dL) place the child at risk for cardiac decompensation and heart failure. The child’s cardiovascular status must be monitored closely. 1. There is no information to indicate that the child is at risk for bleeding. The child’s platelet count is within the expected range of 150,000 to 400,000/mm3. 2. The child’s WBC count is within the expected range of 5000 to 10,000/mm3. There is no information to indicate that the child has an infection. 3. Although this may be done, it is not the priority. Client Need: Reduction of Risk Potential; Cognitive Level: Analysis; Nursing Process: Planning/Implementation; Reference: Ch 31, Iron Deficiency Anemia, Data Base Comprehensive Examinations and Focus for Study Worksheets Mosby’s Comprehensive Review of Nursing for the NCLEX-RN® Examination contains two comprehensive examinations, one in chapter 36 and one on the enclosed Companion CD. These tests approximate the NCLEX-RN® test plan. The first 75 questions in each examination reflect the minimum testing experience for students taking the NCLEX-RN® examination. The 265 questions in each test reflect the maximum number of questions a student will be asked on the NCLEX-RN® exam. The questions require the test taker to cross clinical disciplines and respond to individual and specific needs associated with given health problems. Rationales are also provided for the correct answers and the incorrect options to these questions. In addition, each question is classified according to client need, cognitive level, integrated process, and nursing process, and a reference is provided as to where the content in the question can be found in Mosby’s Comprehensive Review of Nursing for the NCLEX-RN Examination. The purpose of these comprehensive tests is to provide students with an opportunity to simulate the NCLEX-RN® exam experience at the completion of a personalized program review. In chapter 37, Focus for Study Worksheets, two tools are present to help students analyze their test performance and provide information for designing a plan for study. The Focus for Study Worksheet —Adapted NCLEX-RN Test Plan addresses the classifications used to reflect content on the NCLEX- RN examination. The Focus for Study Worksheet—Content Areas reflects content within the domain of nursing and where the information can be found in Mosby’s Comprehensive Review of Nursing for the NCLEX-RN Examination. Companion CD The Companion CD contains the 2245 questions that are in the book and an additional 1965 bonus questions, for a total of 4210 questions. Of these questions, 615 are alternate format items. It contains three practice modes: Study, Quiz, and Exam. The Study and Quiz modes allow the test taker to select topics and categories to create an exam consisting of as many items as desired. The Study mode provides immediate feedback and rationales as each question is answered. The Quiz mode provides an analysis of the test taker ’s performance once all of the questions on the exam have been answered. The Exam mode includes two Comprehensive Exams with 265 questions each that will appear in random order each time a test is taken. A third option, Comprehensive Exam Random, generates 265 questions randomly from all of the questions available. Items can be selected by client need, the step of the nursing process, and the content area so that the test taker can focus studying based on a self- assessment of individual needs or the results of a personal analysis from the Study Worksheets. How to Use This Book When Studying A Start in one area. Study the material covered by the section. Refer to other textbooks to find additional details if you are unsure of a specific fact. B Answer the questions following the area. As you answer each question, write a few words about why you think that answer is correct; in other words, justify why you selected that answer. If an answer you provide is a guess, mark the question to identify it. This will permit you to recognize areas that need further review. It will also help you to see how correct your “guessing” can be. Remember: on the licensure examination you must answer each question before moving on to the next question. C Record the answer by circling the number of the option you believe is correct. D Compare your answers with those provided. If you answered the item correctly, check your reason for selecting the answer with the rationale presented. If you answered the item incorrectly, read the rationale to determine why the option you selected was incorrect. In addition, you should review the correct answer and rationale for each item answered incorrectly. If you still do not understand your mistakes, review the material pertaining to these questions. The Content Area following the answers and rationales informs you of the area within Mosby’s Comprehensive Review of Nursing for the NCLEX-RN® Examination where you can find related information included in the question. You should carefully review all questions and rationales for items you identify as guesses because you do not have mastery of the material being questioned. E Following the rationales for the correct answer and the incorrect options, you will find that each question in the book is classified according to Client Need, Cognitive Level, Integrated Process, Nursing Process, and Reference. These categories were described previously in this Introduction and should help you to understand the question in relation to the NCLEX-RN® examination test plan. F After you have completed the area questions, begin taking the comprehensive tests because they will assist you in applying knowledge and principles from the specific clinical area to any nursing situation. 1. Arrange a quiet, uninterrupted time span for each part of a comprehensive test. 2. Avoid spending excessive time on any one question. Most questions can be answered in 1 to 2 minutes. 3. Make educated guesses when necessary. 4. Read carefully and answer the question asked; pay attention to specific details in the question. 5. Try putting questions and answers in your own words to test your understanding. G To help analyze your mistakes on the comprehensive examinations and to provide a data base for making future study plans, Study Worksheets follow each of the comprehensive tests. These worksheets are designed to aid you in identifying and recording errors in the way you apply information and to help you identify and record gaps in knowledge. H After completing your worksheets, do the following: 1. Identify the frequency with which you made particular errors. As you review material in class notes or this review book, pay special attention to acquiring information related to content that you found difficult on the tests. 2. Identify the topics you want to review. It might be helpful to set priorities; review the most difficult topics first so you will have time to review them more than once. I Use the Companion CD to individualize your style of review. Use one or more of the practice modes (e.g., Study, Quiz, and Exam) to personalize your focus of study based on a self-assessment of needs and/or an analysis of your Study Worksheets. Taking the Licensure Examination The computerized NCLEX-RN® exam is an individualized testing experience in which the computer chooses your next question based on the ability and competency you have demonstrated on previous questions. The minimum number of questions will be 75 and the maximum 265. You must answer each question before the computer will present the next question, and you cannot go back to any previously answered questions. Remember that you do not have to answer all of the questions correctly to pass. The following are crucial requisites for doing well on the licensure examination: A sound understanding of the subject The ability to follow explicitly the directions given at the beginning of the test The ability to comprehend what is read The patience to read each question and set of options carefully before deciding how to answer the question The ability to use the computer correctly to record answers The determination to do well A degree of confidence * Image from Thompson JM and others: Mosby’s manual of clinical nursing, ed 5, St. Louis, 2001, Mosby. U N IT 1 Foundations of Nursing Practice C H AP T E R 1 Factors Influencing Client Needs and Nursing Care Concepts from Sociology Basic Concepts A Every human society has a process for socialization of its members 1. Cultural groups establish rules and codes of conduct using a system of rewards and punishment to govern members, and these become norms, values, and mores of a group a. Reward leads to acceptance as a member of a group b. Punishment for antisocial behavior leads to rejection and separation from a group 2. Role of members includes specified rights, duties, attitudes, and actions 3. Social boundaries separate one group from another; nonmembers have limited social contacts with members; causes a segmentation of relationships and provides few rewarding experiences for nonmembers 4. Leader ’s influence is limited to conditions placed on leader by total group B A society is a reflection of all functional relationships that occur among its individual members; participation in society is a major influence on an individual’s intellect, creativity, memory, thinking, and feeling C Society or a group can change because of conflict among members 1. Conflict is greatest when there is absence of certain members, introduction of new members, or change in leadership 2. Ensuing reorganization goes through three stages a. Tension: caused by conflict b. Integration: members learn about “the other ’s” problem c. Resolution: reconstruction of group’s norms and values 3. Resolution of conflict and restoration of equilibrium a. Occurs when members interact with one another and group is dynamic b. Conflicts are not resolved when groups are rigid with fixed ideas Culture and Health A General influences 1. Culture defines for its people what is important and what is true and real 2. Age, ethnicity, gender, education, income, and belief system (e.g., worldview, religion, or spirituality) make up sociocultural profile of clients 3. Clients’ perceptions of health and illness, their help-seeking behavior, and adherence to treatment depend on beliefs, social norms, and cultural values 4. When clients face increased stressors, suffering, or pain, belief systems play a greater role in their lives 5. Ethnocentrism: belief that one’s own culture is generally right or best 6. Assimilation: integration of common values, beliefs, attitudes, and behaviors of dominant culture 7. Common sociocultural stressors: stereotyping, intolerance, stigma, prejudice, discrimination, and racism B Implications for nurses 1. Nurses should be in touch with their own personal and cultural experiences 2. Culturally competent nurses have an understanding of cultural diversity to provide care within a  context that is appropriate for clients 3. Nurses must have a holistic perspective to assess sociocultural context of clients from different cultures Nurses must appreciate that clients bring their own cultures, attitudes, and belief systems to a situation 4. Together, nurse and client should agree on the nature of a client’s coping responses and set goals and behavioral outcomes within client’s sociocultural context 5. Degree of compatibility between client’s and nurse’s belief systems often determines greater satisfaction with treatment, adherence to therapeutic regimens, and treatment outcomes Society and Health A Role of society 1. Societies traditionally are responsible for caring for their ill 2. Society’s role in health maintenance and prevention of disease has intensified 3. Society’s provision for health maintenance includes a. Establishment of public health care agencies for supervision, prevention, and control of disease and illness; protection of food, water, and drug supplies; development of public education programs b. Awarding scholarships/grants for health education and research c. Development of unemployment insurance programs and Workers’ Compensation insurance; laws to ensure universal health insurance d. Establishment of Social Security and Medicare programs; establishment of social welfare services and Medicaid programs e. Supervision of medical and hospital insurance programs B Health care agencies function as a subculture of society 1. Employees develop both written and unwritten agency policies that a. Set standards of acceptable behavior for both clients and staff b. Provide formal delivery of nursing care (e.g., primary nursing, team nursing) c. Avoid rewarding unacceptable behaviors by any members of a group, including the client 2. Health care agencies have several functions a. Treatment of illness b. Rehabilitation c. Maintenance of health d. Palliative care e. Hospice care f. Protection of clients’ legal rights g. Education of health professionals h. Education of general public i. Research C Delivery of health services is the responsibility of the community 1. Health maintenance and treatment are no longer considered a privilege, but a right of all members of society 2. Members of society become active participants in prevention of illness 3. Services provided by health care agencies are influenced by community needs (e.g., based on shorter length of hospitalization; clients’ need for transitional care provided by home care  agencies, extended care, or assisted living facilities) Groups A Group membership helps individuals achieve goals that are not attainable through individual effort 1. Types of groups include social, self-awareness, task-oriented, and therapy 2. Group functional roles include task roles, group-building or maintenance roles, individual or self- serving roles 3. Group content refers to subject matter or task being addressed 4. Group process refers to what is happening among and to group members while working; it addresses morale, feeling tones, influence, competition, conflict 5. Types of roles assumed by members of group a. Harmonizer: brings other group members into accord while reconciling opposing positions b. Questioner: asks questions, seeks information, and gives constructive criticism to group members c. Deserter: talks about irrelevant material; usually disruptive in some manner d. Tension reducer: introduces levity when needed and appropriate e. Encourager: contributes to ego of others and is a responsive member f. Monopolizer: attempts to control group; does not allow others to talk g. Clarifier: restates issues for clarification and then summarizes for group h. Opinion giver: uses own experience to back up opinion or belief i. Initiator: proposes ideas or topics for discussion and suggests possible solutions for group discussion j. Listener: shows interest in group by expressions on face or by body language while making little or no comment k. Negativist: pessimistic, argumentative, and uncooperative l. Energizer: pushes group into action m. Aggressor: hostile and aggressive, verbally attacks other group members B Family is the primary group 1. Helps society to establish and maintain its code of behavior 2. Provides individual family members with nontangible support a. Strong emotional ties that occur when members (1) Experience sensory stimuli through close contacts (2) Learn to care about emotional and physical well-being of one another (3) Are responsive to one another ’s feelings, acts, and opinions (4) Learn empathy by vicariously living experiences of others (5) View selves through others’ eyes b. Feeling of security by meeting dependent needs c. System of communication: overt (e.g., words) or covert (e.g., body language) d. Role identification and intimacy that help internalize acceptable behavioral patterns of family e. Spirit of cooperation and competition through sibling interaction 3. Changes that have influenced family’s ability to indoctrinate children with norms of society a. Society has progressed from an agrarian culture through Industrial Revolution to Age of Technology (1) Families have undergone change from extended to nuclear units, with increased  numbers of blended, single-parent, and same-gender parent households (2) New social groups are established to replace the extended family (3) Electronic influences (e.g., Internet, cell phones) have weakened family structure (4) Increased mobility of individuals has reduced contact with extended or separated family members (5) Participation in individual activities has grown, reducing time for involvement in family activities b. Altered male and female role patterns (1) Altered status of women: increase in level of education, numbers working outside home, and role in decision making (2) Altered status of men: increase in willingness to assume homemaking responsibilities and shared decision making with women (3) Increased partnership in home and financial management has resulted in less stereotyped gender roles (4) Increased numbers of divorced or single parents, both male and female, rearing biological or adopted offspring (5) Increase in number of financially independent women conceiving or adopting a child or children outside of marriage c. Factors resulting in reduction in size of families (1) Choosing to marry in later adulthood (2) Delaying start of a family until later years (3) Emphasis on limited population growth (4) Dissemination of birth control information (5) Legalization of abortions (6) Increase in financial cost involved in raising and educating children C Peer groups help to establish norms of behavior 1. Youth learns about society through contact with peer group, which assists in rites of passage from family group to society 2. Youth develops further self-concept in contact with other youths 3. Peer group interaction can produce change in its individual members 4. Members have a strong loyalty to peer group because of reciprocal relationships and other rewards the group offers 5. Peer group norms may conflict with family or societal norms D Crisis intervention groups 1. Services a. Provide assistance for people in crises; clients’ previous methods of adaptation are inadequate to meet present needs b. Group focus can be specific (e.g., poison control, drug-addiction centers, and suicide prevention) or general (e.g., walk-in mental health clinics and hospital emergency services) c. Some crisis intervention groups provide service via the phone (e.g., poison control, AIDS hotline, and suicide prevention centers); others help those who are physically present (e.g., hospital emergency services and walk-in mental health clinics) 2. Success factors a. Provide help requested by client or family b. Address immediate problem  c. Facilitate exploring feelings d. Assist client in perceiving event realistically e. Maximize client’s coping mechanisms f. Provide assistance in investigating alternative approaches to solve problem g. Identify support systems h. Review how present situation may help in coping with future crises i. Provide information about other health resources where additional assistance can be obtained E Self-help groups 1. Services a. Organized by clients or their families to provide services that are not adequately supplied by other organizations b. Meet needs of clients and families with chronic problems requiring intervention over an extended time c. Focus usually is specific (e.g., Gamblers Anonymous); some address a range of problems (e.g., Association for Children with Learning Disabilities) d. Some are nonprofit (e.g., Alcoholics Anonymous); others are profit-making organizations (e.g., Weight Watchers International) e. Provide help to people who do not or cannot conform to societal expectations (e.g., addicts, child abusers, mentally ill, obese, or brain-injured); many use 12-step program developed by Alcoholics Anonymous 2. Success factors a. All members are accepted and respected as equals b. All members have experienced similar problems c. Members feel a decrease in sense of isolation that has occurred as a result of their problems d. Members address behavior and changes in behavior rather than underlying causes of behavior e. Members have a ready supply of human resources available, such as personal resources, help from peers, and ultimately extension of self to others as a role model f. Each member has identified the problem and wants help in meeting needs—self-motivation g. Ritual and language may be specific to the group and/or the problems h. Members retain leadership of group i. Group interaction (1) Identification with peers—sense of belonging (2) Group expectations—self-discipline required of members (3) Small steps encouraged and, when attained, reinforced by group j. As member achieves success within the group, reinforcement often is received from outside the group k. Participation in 12-step programs is a lifelong, continuous process; one is never “recovered” but always “recovering” one day at a time F Community is a social organization that is considered a secondary group 1. Relationships among members usually are more impersonal 2. Individuals participate in a more limited manner or in a specific capacity 3. Group frequently functions as a means to an end, enables diversified groups to communicate, and helps other groups identify community problems and possible solutions 4. Secondary group usually is large and meets on an intermittent basis; contacts usually are maintained through correspondence 5. Community leaders facilitate group interaction because they have knowledge of the community and its needs and the skill to motivate others to act 6. Secondary groups help establish laws that are necessary to limit antisocial behavior; they provide diversified groups with a common base of acceptable behavior, but they may favor and protect vested interests of specific groups within society G Health educational groups 1. Services a. Provide health information/support to change behavior b. Meet needs of clients or families adapting to change c. Focus usually is specific (e.g., diabetes education group, parenting group, Weight Watchers) d. Majority of educational groups are conducted by health care providers and are nonprofit e. In-service educational groups are included in this category 2. Success factors a. All members are accepted and respected as equals b. All members have the same educational needs and have experienced similar problems (e.g., managing diabetes) c. Members experience a decrease in isolation and frustration as knowledge increases d. Members have identified the problem and generally are motivated to manage more effectively e. Nurse leader is able to educate more people more efficiently using a group structure f. Members aid one another as they learn together, and share information and experiences Hierarchy of Needs Figure 1-1: Maslow’s Hierarchy of Needs. FIGURE 1-1 Maslow’s Hierarchy of Needs. (Redrawn from Maslow AH: Motivation and personality, Upper Saddle River, NJ, 1970, Prentice Hall.) A Need to survive: physiologic needs for air, food, and water B Need for safety and comfort: physical and psychologic security C Interpersonal needs: social needs for love and acceptance D Intrapersonal needs: self-esteem and self-actualization Individual Factors Affecting Health A Physiologic capacity: all diseases and conditions have a genomic component; genomics refers to the study of genes and their interactions with other genes, the environment, and psychosocial factors B Developmental level 1. Infant: must adapt to a new environment; stress caused by transition from intrauterine to extrauterine living is compounded for infant with a congenital problem 2. Child: maturation involves physical, functional, and emotional growth; it is an ever-changing process that produces stress; disabilities add factors that may quantitatively or qualitatively affect maturation 3. Adolescent: experiences physical, psychologic, and social growth spurt; asks, “Who am I?” while developing self-image; limitations cause additional stress during identity formation 4. Adult: expected to be independent, productive, provide for self and family; if one cannot partially or totally accomplish this, additional stress occurs 5. Older adult: American society tends to value youth and devalue old age; many older adults are experiencing multiple stresses (e.g., loss of loved ones, changes in lifestyle, loss of physical vigor, and thought of approaching death) at a time when ability to adapt is compromised by anatomic, physiologic, and psychologic alterations that occur during the aging process C Intelligence: genetic intellectual potential; amount of formal/informal education; level of intellectual development; and ability to reason, conceptualize, and translate words into actions D Level of self-esteem: attitude that reflects individual’s perception of self-worth; personal subjective judgment of oneself; positively influenced by success; negatively influenced by loss of independence and unacceptable change in role E Experiential background: knowledge derived from one’s own actions, observations, or perceptions; maturation, culture, and environment influence individual’s experiential foundation F Level of motivation: internal desire or incentive to accomplish goals G Values: factors that are important to individual; often influenced by culture and religion H Religion: deep personal belief in higher force than humanity I Socioeconomic status: measure of relative social and economic standing based on income, education, and occupation J Social interaction: ability to clearly communicate needs and desires to others; support systems K Stress control: development of varied effective coping skills Stress Response A Human beings must be able to perceive and interpret stimuli to interact with the environment 1. Perception and cognitive functioning influenced by a. Nature of stimuli b. Culture, beliefs, attitudes, and age c. Past experiences d. Present physical and emotional needs 2. Personality development is influenced by ability to perceive and interpret stimuli a. External world is internalized through these processes b. External world may in turn be distorted by perceptions B Selye’s general adaptation syndrome (GAS) is body’s nonspecific physiologic response to stress; occurs in three stages: alarm, resistance, and exhaustion 1. Stress produces wear and tear on body; can be internal or external, beneficial or detrimental, and always elicits some response from or change in the individual 2. Alarm phase: sympathetic nervous system prepares body’s physiologic defense for fight or flight by stimulating adrenal medulla to secrete epinephrine and norepinephrine; adrenocortical hormones (aldosterone and cortisol) are secreted (Figure 1-2: Fight-or-flight response)  FIGURE 1-2 Fight-or-flight response. (From Harkreader H, Hogan MA, Thobaben M: Fundamentals of nursing: caring and clinical judgment, ed 3, St. Louis, 2007, Saunders.) a. Heartbeat increases to pump more blood to muscles b. Peripheral blood vessels constrict to provide more blood to vital organs c. Bronchioles dilate, and breathing becomes rapid and deep to supply more oxygen to cells d. Pupils dilate to increase vision e. Liver releases glucose for quick energy f. Prothrombin time is shortened to protect body from loss of blood in event of injury g. Sodium is retained to maintain blood volume 3. Resistive stage: when stress continues, increased secretion of cortisone enables body to cope with stress 4. Exhaustion: if stress continues and responses are no longer effective, the last stage is exhaustion and death C Local inflammatory response: body’s nonspecific response of tissue to injury or infection 1. Erythema (redness): histamine is released at site of injury, causing vasodilation (hyperemia) 2. Heat: vasodilation brings more core-warmed blood to area 3. Edema (swelling): histamine causes increased capillary permeability, allowing fluid, protein, and white blood cells (WBCs) to move into interstitial space 4. Pain: nerve endings are irritated by chemical mediators (e.g., serotonin, prostaglandin, and kinins) and pressure from edema 5. Loss of function: a protective response because of pain and edema Grieving Process Basic Concepts A Loss is experienced when something of value (e.g., object, person) is changed or gone 1. Actual: can be validated by others (e.g., death of spouse) 2. Perceived: experienced internally; cannot be verified by others (e.g., loss of youth) 3. Anticipatory: occurs before loss is experienced (e.g., scheduled amputation) B Grief: response to an actual or perceived loss 1. Bereavement: emotional response to loss 2. Mourning: behavioral response to loss; influenced by culture Theorists: Stages of Grieving A Kübler-Ross: denial, anger, bargaining, depression, acceptance B Lindemann: somatic distress, preoccupation with image of the deceased, guilt, hostile reactions, loss of patterns of conduct C Engle: shock/disbelief, developing awareness, and restitution/resolution Grieving Process and Nursing Care See Table 1-1: Grieving Process and Nursing Care. Table 1-1 Grieving Process and Nursing Care Stage of Grieving Client Response Nursing Care Denial, disbelief Disbelief, intellectualization Accept response but do not reinforce denial Anger, hostility Verbally hostile Do not become defensive, meet client needs Bargaining Seeks to avoid loss, may express feelings of guilt Listen attentively, refer to spiritual counselor if appropriate Depression, Grieves about w hat may never be, may be verbal or w ithdraw n Listen attentively, sit quietly, use touch if appropriate sadness Acceptance, Comes to terms w ith loss, may make future plans, may have decreased interest in people and Be quiet but available, help family to accept client’s resolution surroundings behavior Health-Illness Continuum and Rehabilitation A Health-illness continuum: concept reflecting dynamic state of health in which one end of continuum represents high-level wellness and the other death B Rehabilitation 1. Assists clients to attain maximum level of wellness on continuum after negative change in health; involves establishing lost function while expanding, maintaining, and supporting limited remaining function 2. Focuses on interventions that improve quality of life rather than saving life 3. Involves client, family, health care team, community, and society; not an isolated process 4. Socially significant because health problems cause disabilities that are costly personally and financially (both to individual and society) 5. Increased numbers of individuals requiring rehabilitation a. Advances in technology and health science have increased survival rates from birth defects, traumatic injuries, and infection b. Aging has increased incidence of chronic illness Type of Condition Affecting Client A Acute illness: caused by health problem that produces signs and symptoms abruptly and runs a short course; may develop into long-term illness B Chronic illness: caused by health problem that produces signs and symptoms over time and runs a long course 1. Exacerbation: period when chronic illness becomes more active and recurrence of pronounced signs and symptoms of disease occur 2. Remission: period when chronic illness is controlled, and signs and symptoms are reduced or not obvious 3. Progressive degeneration: continuous deterioration or increased impairment of a person’s physical state C Terminal illness: caused by health problem that is expected to result in death, often within 6 months; focus of hospice and palliative care is improving quality of life, rather than cure, by meeting client’s physical, psychosocial, and spiritual needs Level of Preventive Care A Primary prevention 1. Interventions aimed at health promotion; precedes disease or disability 2. Examples a. Following a heart-healthy diet b. Avoiding smoking c. Being immunized d. Maintaining ideal weight e. Exercise B Secondary prevention 1. Interventions directed at diagnosis and prompt intervention; prevents extension of disease or development of complications 2. Examples a. Performing monthly self breast and testicular examinations b. Having routine screening tests (e.g., mammography, colonoscopy, Pap smear) C Tertiary prevention 1. Interventions that minimize effects of long-term disease or disability; maximizes individual’s potential after disease or disability occurs; includes rehabilitative and end-of-life care 2. Examples a. Adhering to rehabilitation programs after brain attack (cerebrovascular accident) or head trauma b. Participating in a cardiac rehabilitation program c. Learning to walk after amputation or joint replacement d. Palliative care to support quality of life for clients and family members C H AP T E R 2 Basics of Nursing Practice Nursing Process A Assessment/Analysis 1. Types of data: objective (overt, measurable, detected by physical assessment); subjective (covert, feelings, sensations, and symptoms verbalized by client) 2. Sources of data: client (primary); family/friends, health care team members, clinical record and other documents, textbooks (secondary) 3. Methods of data collection: interviewing, observation of nonverbal cues, congruency between verbal and nonverbal data, physical assessment (e.g., observation, palpation, auscultation, percussion) (Figure 2-1: Dimensions for gathering data for a health history) FIGURE 2-1 Dimensions for gathering data for a health history. (From Potter PA, Perry AG: Fundamentals of nursing, ed 7, St. Louis, 2009, Mosby.) 4. Management of data: screening, organizing, and grouping/clustering significant defining characteristics and related information 5. Identification of client’s problem, concerns, or deficits that can be altered by nursing interventions B Planning/Implementation 1. Establish client outcomes a. Outcomes are expected changes in client’s behavior, activity, or physical state  b. Outcomes must be objective, achievable, and measurable, and include a realistic period for accomplishment to determine whether outcome has been achieved 2. Collaborate with client, family/significant others, and appropriate health care team members to formulate a plan to reach identified outcomes; preparation for discharge begins at admission 3. Establish priorities of care using Maslow’s Hierarchy of Needs (see Figure 1-1) 4. Administer plan of care C Evaluation/Outcomes 1. Assess client’s response to care 2. Compare actual outcome to expected outcome 3. If outcome is not reached, previous steps must be examined to determine reason 4. Plan of care may need to be revised 5. Priorities may require reordering because process of evaluation is ongoing Ensuring Quality Health Care A Responsibility 1. The Joint Commission (TJC) 2. Agency-based quality assurance (QA) and quality improvement (QI) programs 3. Individual members of health team B Practices 1. TJC National Patient Safety Goals (e.g., increasing accuracy of client identification, improving effectiveness of communication among members of health team, reducing risk of health care– associated infections and falls, improving safety of medication administration) 2. TJC standardized performance measures (e.g., core measures) to determine compliance with standards of care 3. Evidence-based practice (EBP) involves using research findings, experience, or client values to guide clinical decision making a. Nurses must evaluate and participate in research that improves quality of nursing care b. Levels of evidence refer to strength of support for a particular nursing strategy; levels of support range from systematic review of all relevant randomized controlled trials (RCTs) to reports of a committee of experts 4. Identification of sentinel events a. An unexpected occurrence that leads to risk of or actual physical or psychological injury, or death b. Root cause analysis identifies factors contributing to violations of practice associated with the event c. Development and evaluation of plan to prevent recurrences Communication Basic Concepts A Need to communicate is universal B Through communication, humans maintain contact with reality, validate findings with others to interpret reality, and develop a concept of self in relation to others C Validation is enhanced when communication conveys an understanding of feelings D Communication is learned through the process of acculturation E Communication is the avenue used to make needs known and to satisfy needs Communication Process A Requires: sender, message, receiver, and response B Modes of communication 1. Verbal: related to anything associated with spoken word; includes speaking, writing, use of language or symbols, and arrangements of words or phrases; hearing is essential to development of effective speech because one learns to form words by hearing words of others; includes pace, intonation, simplicity, clarity, brevity, timing, relevance, adaptability, credibility, and humor 2. Nonverbal: related to messages sent and received without use of words and is expressed through appearance, body motions, use of space, nonverbal sounds, personal appearance, posture, gait, facial expression, gestures, and eye contact; more accurately conveys feelings because behavior is less consciously controlled than verbal communication 3. Confusion arises when there is a difference between verbal and nonverbal message received (lack of congruence in overt and covert messages) C Themes of communication: recurring thoughts and ideas that give insight into what client is feeling and that tie communication together 1. Content: conversation may appear superficial, but attention to underlying theme helps nurse identify problem areas while providing insight into client’s self-concept 2. Mood: emotion or affect that client communicates to nurse; includes personal appearance, facial expressions, and gestures that reflect client’s mood and feelings 3. Interaction: how client reacts or interacts with nurse; includes how client relates and what role is assumed when communicating with nurse and others D Factors affecting communication process: language, psychosociocultural influences, intellectual development, gender, values and perceptions, personal space (intimate, personal, social, and public), territoriality, roles and relationships, environment, congruence of verbal and nonverbal messages, and interpersonal attitudes E Barriers to communication 1. Variation in culture, language, and education 2. Problems in hearing, speech, or comprehension (ineffective reception or perception) 3. Refusal to listen to another point of view 4. Use of selective inattention; may cause an interruption or distortion of messages 5. Environmental considerations (e.g., noise, lack of privacy, room temperature) 6. Psychologic or physiologic discomfort (e.g., anxiety, hunger, pain) The Nurse-Client Relationship A Phases in a therapeutic relationship 1. Preinteraction: begins before nurse’s initial contact with client a. Self-exploration involves acknowledging one’s own feelings, fears, personal values, and attitudes, including identification of misconceptions and prejudices that are socially learned b. Self-awareness is necessary before establishing a relationship with others c. Tasks include gathering data about client and planning for first interaction with client 2. Orientation or introductory: the nurse, who initially is in the role of stranger, establishes a trusting relationship with the client by consistency in communication and actions; clients should never be pushed to discuss areas of concern that are upsetting to them a. Introduction of nurse, explanation of nurse’s role in multidisciplinary team, and purpose of interaction b. Contract outlining mutually agreed upon goals is set c. Confidentiality issues are discussed, and client rights are upheld d. Termination begins during orientation phase by establishing time parameters 3. Working: nurse and client discuss areas of concern, and client is helped to plan, implement, and evaluate a course of action a. Transference and countertransference may become an issue (see Chapter 16, Therapeutic Nurse-Client Relationship, Overview) b. Anxiety levels may increase; acting-out behaviors can and do occur; resistance to change need to be anticipated, identified, and addressed c. Problems need to be discussed and resolved d. New adaptive behaviors can be learned 4. Termination: end of therapeutic relationship between nurse and client; spacing meetings further apart near end facilitates termination a. Goals and objectives achieved are summarized b. Positive adaptive behaviors are reinforced c. Feelings and experiences for both client and nurse are shared d. Rejection, anger, regression, or other negative behaviors may be expressed as a means of coping with the impending termination of the relationship B Considerations fundamental to a therapeutic relationship 1. Client is unique and worthy of respect 2. Client needs to feel accepted a. Acceptance is an active process designed to convey respect for another through empathetic understanding b. Acceptance of others implies and requires acceptance of self c. Nurse’s identification of own attitudes and feelings and their effect on perception is necessary before developing a nonjudgmental attitude d. Acceptance requires that clients be permitted and even encouraged to express feelings and attitudes even though they may be divergent from a general viewpoint; setting limits might be required for inappropriate behavior in a manner that does not reject client e. Acceptance requires a nonjudgmental environment 3. The high stress/anxiety of most health settings is created in part by the health problem itself; treatments and procedures; nontherapeutic behavior of personnel; strange environment; inability to  use usual coping skills (e.g., exercise, talking with friends); and change in lifestyle, body image, and/or self-concept 4. Previous patterns of behavior may become inadequate under stress: health problems may produce change in family or community 5. Health problems may produce change in self-perception and role identity 6. All behavior has meaning and usually results from an attempt to cope with stress or anxiety 7. Value systems influence behavior 8. Cultural differences exist among people; one’s own culture is an integral part of an individual 9. Personal meaning of experiences to clients is important 10. Clients have potential for growth a. Clients need to learn about their own behaviors b. Exchanging experiences with others provides a new learning environment and reassurance that reactions are valid and feelings are shared c. Participating in groups increases knowledge of interpersonal relationships and helps individuals to identify strengths and resources d. Identifying client’s strengths and resources emphasizes positive attributes which form a basis for future growth 11. Behavioral changes are possible only when client has other defenses to maintain equilibrium 12. Providing information may not alter client’s behavior 13. Use of defense mechanisms needs to be identified 14. Maintaining confidentiality supports a trusting relationship 15. Use of therapeutic interviewing techniques communicates acceptance and supports expression of feelings 16. Nurses need to identify and cope with their own anxiety C Support of therapeutic communication 1. Maintenance of a nonjudgmental environment 2. Implementation of actions that support dignity and worth a. Maintaining eye contact when communicating b. Using names rather than labels such as room numbers or diagnoses; approach client as a person with difficulties, not as a “difficult person” c. Providing privacy d. Maintaining confidentiality e. Being courteous toward client, family, visitors, and members of the health team f. Permitting personal possessions when practical g. Providing explanations at client’s level of understanding 3. Encouragement of participation in problem solving and decision making 4. Spending time with client 5. Fostering trust through honesty, consistency, reliability, and competence 6. Answering client call bell immediately D Use of therapeutic techniques to facilitate communication 1. Reflection of feelings, attitudes, and words: helps client to identify feelings 2. Open-ended questions: permit client to focus on issues 3. Paraphrasing: rephrasing of feeling or thought in similar words to convey that message was understood or to provide an opportunity for clarification if necessary 4. Silence: provides nurse and client with necessary time for reflecting about what is being discussed  and allows time to formulate a response 5. Touch: conveys caring, but its effectiveness can vary among individuals and cultures 6. Clarification: helps to ensure that message is understood as intended 7. Direct questions: facilitate collection of objective data but may block expression of feelings E Avoidance of nontherapeutic communication 1. Any overt/covert response conveys a judgmental (approval or disapproval) or superior attitude 2. Direct personal questions are probing or invasive 3. Ridicule conveys a hostile attitude 4. Talking about one’s own problems and not listening convey a self-serving attitude and loss of interest in the client 5. Stereotyping devalues uniqueness of the client 6. Changing the subject conveys a lack of interest in the client’s concerns 7. False reassurance eventually results in lack of trust 8. Minimizing concerns is demeaning 9. Asking for explanations using the word “why” may put client on the defensive 10. Using clichés minimizes concerns 11. Using terms of endearment such as “honey” is demeaning 12. Defensive responses shut off communication 13. Giving advice interferes with the client’s ability to problem solve 14. Challenging client to defend a position/feeling may put client on the defensive Teaching-Learning A Learning: involves a change in or acquisition of new behavior and takes place within the individual 1. Cognitive: knowledge 2. Psychomotor: skill performance 3. Affective: attitudes, emotions B Motivation: desire for change in response to identified need 1. Intrinsic motivation: comes from within the learner; preferred to extrinsic motivation 2. Extrinsic motivation: comes from outside the learner 3. Readiness to learn (physical, emotional, and cognitive) a. Awareness of health problem and implications b. Willingness to ask questions c. Demonstration of indirect health-seeking behaviors d. Absence of acute distress reactions (e.g., severe anxiety, pain) that inhibit learning 4. Culture (e.g., language, values, beliefs) 5. Physical abilities (e.g., vision, hearing) 6. Cognitive ability (e.g., intelligence, developmental level, education) 7. Support systems C Teaching: activities that result in learning 1. Involving client and family to individualize teaching plan 2. Exhibiting nonjudgmental attitude 3. Building on client’s prior knowledge 4. Incorporating a variety of strategies (e.g., discussion, demonstration, practice, role playing, discovery, audiovisual aids, computer-assisted instruction) that involve multiple senses (e.g., sight, hearing, touch) 5. Establishing short-term achievable learning objectives to maintain motivation 6. Using positive reinforcement; learning by success or positive rewards is preferable to learning by failure or negative consequences 7. Establishing an environment conducive to learning (e.g., safe, limited noise, reduced distractions) 8. Evaluating client learning: observation of behavior; written tests; self-reports Leadership and Management Principles of Leadership A Leader: influences actions of individual or group toward specific goals; leadership style is affected by 1. Needs of group members 2. Characteristics of leader (e.g., personality, experiential background) 3. Cultural climate of organization B Types of leadership 1. Authoritarian or autocratic leader: uses leadership role for power; little communicating and interrelating between leader and group; leader sets goals, plans, makes decisions, and evaluates actions taken 2. Democratic leader: uses leadership role to stimulate others to achieve collective goal; fair and logical; encourages interrelating among members; weaknesses as well as strengths are accepted; contributions of all members are fostered and used; responsibilities for action are shared between leader and group 3. Emotional leader: reflects feeling tones, norms, and values of group 4. Laissez-faire leader: passive and nondirective; assumes participant-observer role and exerts little control or guidance over group behavior; input and control are minimal 5. Bureaucratic leader: rigid; assumes a role that is determined by formal criteria or rules that are inherent in an organization; leader is not emotionally involved and avoids interrelating with group members 6. Charismatic leader: can assume any of above behaviors because group attributes supernatural power to this person or the office and frequently follows directions without question C Effective leaders modify style to fit changing circumstances, problems, and people (e.g., autocratic style is appropriate in emergency situations; democratic style is appropriate when group acceptance and participation are essential; laissez-faire leadership is appropriate when group members are knowledgeable and capable of self-direction) D Interpersonal influence depends on 1. Knowledge of human behavior 2. Sensitivity to others feelings, values, and problems 3. Ability to communicate (see Communication Process) E Leader ’s success is influenced by ability to respond to group needs and by members’ perceptions of effectiveness 1. Role of leader is to serve individual’s or group’s needs; some roles are task-oriented and help group accomplish goals; other roles are more process-oriented and help group members to communicate effectively 2. Power is a leader ’s source of influence a. Positional power: acquired through position of leader in hierarchy of organization b. Professional power: acquired through knowledge or expertise displayed by leader and/or perceived by followers 3. Leadership moves from one person to another as changes in situation occur F Leadership process requires critical thinking skills associated with problem solving G Leader as change agent: movement from g