ATI Nursing Education - Fundamentals for Nursing REVIEW MODULE EDITION 10.0-ATI (2019).pdf

Fundamentals for Nursing REVIEW MODULE EDITION 10.0 Consultants Christi Blair, DNP, RN Contributors Tracey Bousquet, BSN, RN Honey C. Holman, MSN, RN Jenni L. Hoffman, DNP, FNP-C, CLNC, FAANP Debborah Williams, MSN, RN Mary Jane Janowski, RN, MA Sheryl Sommer PhD, RN, CNE Jessica L. Johnso...

Fundamentals for Nursing REVIEW MODULE EDITION 10.0 Consultants Christi Blair, DNP, RN Contributors Tracey Bousquet, BSN, RN Honey C. Holman, MSN, RN Jenni L. Hoffman, DNP, FNP-C, CLNC, FAANP Debborah Williams, MSN, RN Mary Jane Janowski, RN, MA Sheryl Sommer PhD, RN, CNE Jessica L. Johnson DNP, MSN, BSN, RN Janean Johnson, MSN, RN CNE Lisa Kongable, MA, ARNP, PMHCNS, CNE Brenda S. Ball, MEd, BSN, RN Cindy Morris, DNP, RN, IBCLC Tomekia Luckett, PhD, RN Peggy Leehy MSN, RN Robin Hertel, EdS, MSN, RN, CMSRN Maria Sheilla Membrebe, MSN/Ed., RN, ONC, CMSRN, CBN INTELLECTUAL PROPERTY NOTICE ATI Nursing is a division of Assessment Technologies Institute®, LLC. Copyright © 2019 Assessment Technologies Institute, LLC. All rights reserved. The reproduction of this work in any electronic, mechanical or other means, now known or hereafter invented, is forbidden without the written permission of Assessment Technologies Institute, LLC. All of the content in this publication, including, for example, the cover, all of the page headers, images, illustrations, graphics, and text, are subject to trademark, service mark, trade dress, copyright, and/or other intellectual property rights or licenses held by Assessment Technologies Institute, LLC, one of its affiliates, or by third parties who have licensed their materials to Assessment Technologies Institute, LLC. REPRINTED APRIL 2021 FUNDAMENTALS FOR NURSING  I Director of content review: Kristen Lawler Director of development: Derek Prater Project management: Tiffany Pavlik, Shannon Tierney Coordination of content review: Honey C. Holman, Debborah Williams Copy editing: Kelly Von Lunen, Bethany Phillips, Kya Rodgers Layout: Spring Lenox, Maureen Bradshaw, Bethany Phillips Illustrations: Randi Hardy Online media: Brant Stacy, Ron Hanson, Britney Fuller, Barry Wilson Cover design: Jason Buck Interior book design: Spring Lenox IMPORTANT NOTICE TO THE READER Assessment Technologies Institute, LLC, is the publisher of this publication. The content of this publication is for informational and educational purposes only and may be modified or updated by the publisher at any time. This publication is not providing medical advice and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. 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II  CONTENT MASTERY SERIES User’s Guide Welcome to the Assessment Technologies Institute® Fundamentals for Nursing Review Module Edition 10.0. The mission of ATI’s Content Mastery Series® Review Modules is to provide user-friendly compendiums of nursing knowledge that will: ● Help you locate important information quickly. ● Assist in your learning efforts. ● Provide exercises for applying your nursing knowledge. ● Facilitate your entry into the nursing profession as a newly licensed nurse. This newest edition of the Review Modules has been redesigned to optimize your learning experience. We’ve fit more content into less space and have done so in a way that will make it even easier for you to find and understand the information you need. ACTIVE LEARNING SCENARIOS AND APPLICATION EXERCISES Each chapter includes opportunities for you to test your knowledge and to practice applying that knowledge. Active Learning Scenario exercises pose a nursing scenario and then direct you to use an ATI Active Learning Template (included at the back of this book) to record the important knowledge a nurse should apply to the scenario. An example is then provided to which you can compare your completed Active Learning Template. The Application Exercises include NCLEX-style questions (multiplechoice and multiple-select items), providing you with opportunities to practice answering the kinds of questions you might expect to see on ATI assessments or the NCLEX. After the Application Exercises, an answer key is provided, along with rationales. ORGANIZATION This Review Module is organized into units covering the NCLEX® major client needs categories: Safe, Effective Care Environment, Health Promotion, Psychosocial Integrity, and Physiological Integrity. Chapters within these units conform to one of four organizing principles for presenting the content. ● Nursing concepts ● Growth and development ● Procedures ● System Disorders Nutritional considerations for specific Nursing concepts chapters begin with an overview describing the central concept and its relevance to nursing. Subordinate themes are covered in outline form to demonstrate relationships and present the information in a clear, succinct manner. Nutritional considerations for specific Growth and development chapters cover expected growth and development, including physical and psychosocial development, age-appropriate activities, and health promotion, including immunizations, health screenings, nutrition, and injury prevention. Procedures chapters include an overview describing the procedure(s) covered in the chapter. These chapters provide nursing knowledge relevant to each procedure, including indications, nursing considerations, interpretation of findings, and complications. FUNDAMENTALS FOR NURSING NCLEX® CONNECTIONS To prepare for the NCLEX, it is important to understand how the content in this Review Module is connected to the NCLEX test plan. You can find information on the detailed test plan at the National Council of State Boards of Nursing’s website, www.ncsbn.org. When reviewing content in this Review Module, regularly ask yourself, “How does this content fit into the test plan, and what types of questions related to this content should I expect?” To help you in this process, we’ve included NCLEX Connections at the beginning of each unit and with each question in the Application Exercises Answer Keys. The NCLEX Connections at the beginning of each unit point out areas of the detailed test plan that relate to the content within that unit. The NCLEX Connections attached to the Application Exercises Answer Keys demonstrate how each exercise fits within the detailed content outline. These NCLEX Connections will help you understand how the detailed content outline is organized, starting with major client needs categories and subcategories and followed by related content areas and tasks. The major client needs categories are: ● Safe and Effective Care Environment ◯ Management of Care ◯ Safety and Infection Control ● Health Promotion and Maintenance ● Psychosocial Integrity ● Physiological Integrity ◯ Basic Care and Comfort ◯ Pharmacological and Parenteral Therapies ◯ Reduction of Risk Potential ◯ Physiological Adaptation An NCLEX Connection might, for example, alert you that content within a unit is related to: ● Basic Care and Comfort ◯ Assistive Devices ■ Assess client use of assistive devices. USER’S GUIDE III QSEN COMPETENCIES As you use the Review Modules, you will note the integration of the Quality and Safety Education for Nurses (QSEN) competencies throughout the chapters. These competencies are integral components of the curriculum of many nursing programs in the United States and prepare you to provide safe, high-quality care as a newly licensed nurse. Icons appear to draw your attention to the six QSEN competencies. Safety: The minimization of risk factors that could cause injury or harm while promoting quality care and maintaining a secure environment for clients, self, and others. Patient-Centered Care: The provision of caring and compassionate, culturally sensitive care that addresses clients’ physiological, psychological, sociological, spiritual, and cultural needs, preferences, and values. Evidence-Based Practice: The use of current knowledge from research and other credible sources, on which to base clinical judgment and client care. Informatics: The use of information technology as a communication and information-gathering tool that supports clinical decision-making and scientifically based nursing practice. Quality Improvement: Care related and organizational processes that involve the development and implementation of a plan to improve health care services and better meet clients’ needs. Teamwork and Collaboration: The delivery of client care in partnership with multidisciplinary members of the health care team to achieve continuity of care and positive client outcomes. ICONS Icons are used throughout the Review Module to draw your attention to particular areas. Keep an eye out for these icons. This icon is used for NCLEX Connections. This icon indicates gerontological considerations, or knowledge specific to the care of older adult clients. This icon is used for content related to safety and is a QSEN competency. When you see this icon, take note of safety concerns or steps that nurses can take to ensure client safety and a safe environment. This icon is a QSEN competency that indicates the importance of a holistic approach to providing care. This icon, a QSEN competency, points out the integration of research into clinical practice. This icon is a QSEN competency and highlights the use of information technology to support nursing practice. This icon is used to focus on the QSEN competency of integrating planning processes to meet clients’ needs. This icon highlights the QSEN competency of care delivery using an interprofessional approach. This icon appears at the top-right of pages and indicates availability of an online media supplement (a graphic, animation, or video). If you have an electronic copy of the Review Module, this icon will appear alongside clickable links to media supplements. If you have a hard copy version of the Review Module, visit www.atitesting.com for details on how to access these features. FEEDBACK ATI welcomes feedback regarding this Review Module. Please provide comments to [email protected]. As needed updates to the Review Modules are identified, changes to the text are made for subsequent printings of the book and for subsequent releases of the electronic version. For the printed books, print runs are based on when existing stock is depleted. For the electronic versions, a number of factors influence the update schedule. As such, ATI encourages faculty and students to refer to the Review Module addendums for information on what updates have been made. These addendums, which are available in the Help/FAQs on the student site and the Resources/eBooks & Active Learning on the faculty site, are updated regularly and always include the most current information on updates to the Review Modules. IV USER’S GUIDE CONTENT MASTERY SERIES Table of Contents NCLEX® Connections UNIT 1 1 Safe, Effective Care Environment SECTION: Management of Care 3 3 CHAPTER 1 Health Care Delivery Systems 3 CHAPTER 2 The Interprofessional Team 7 CHAPTER 3 Ethical Responsibilities 11 CHAPTER 4 Legal Responsibilities 15 CHAPTER 5 Information Technology 21 CHAPTER 6 Delegation and Supervision 27 CHAPTER 7 Nursing Process 31 CHAPTER 8 Critical Thinking and Clinical Judgment 37 CHAPTER 9 Admissions, Transfers, and Discharge 41 NCLEX® Connections SECTION: 47 Safety and Infection Control 49 CHAPTER 10 Medical and Surgical Asepsis 49 CHAPTER 11 Infection Control 53 CHAPTER 12 Client Safety 59 CHAPTER 13 Home Safety 65 CHAPTER 14 Ergonomic Principles 73 CHAPTER 15 Security and Disaster Plans 77 FUNDAMENTALS FOR NURSING TABLE OF CONTENTS V NCLEX® Connections UNIT 2 Health Promotion SECTION: Nursing Throughout the Lifespan 85 85 CHAPTER 16 Health Promotion and Disease Prevention 85 CHAPTER 17 Client Education 89 CHAPTER 18 Infants (2 Days to 1 Year) 93 CHAPTER 19 Toddlers (1 to 3 Years) 99 CHAPTER 20 Preschoolers (3 to 6 Years) 103 CHAPTER 21 School‑Age Children (6 to 12 Years) 107 CHAPTER 22 Adolescents (12 to 20 Years) 111 CHAPTER 23 Young Adults (20 to 35 Years) 115 CHAPTER 24 Middle Adults (35 to 65 Years) 119 CHAPTER 25 Older Adults (65 Years and Older) 123 NCLEX® Connections SECTION: VI 83 127 Health Assessment/Data Collection 129 CHAPTER 26 Data Collection and General Survey 129 CHAPTER 27 Vital Signs 135 CHAPTER 28 Head and Neck 145 CHAPTER 29 Thorax, Heart, and Abdomen 153 CHAPTER 30 Integumentary and Peripheral Vascular Systems 163 CHAPTER 31 Musculoskeletal and Neurologic Systems 169 TABLE OF CONTENTS CONTENT MASTERY SERIES NCLEX® Connections UNIT 3 175 Psychosocial Integrity 177 CHAPTER 32 Therapeutic Communication 177 CHAPTER 33 Coping 183 CHAPTER 34 Self‑Concept and Sexuality 189 CHAPTER 35 Cultural and Spiritual Nursing Care 193 CHAPTER 36 Grief, Loss, and Palliative Care 203 NCLEX® Connections UNIT 4 209 Physiological Integrity SECTION: Basic Care and Comfort 211 211 CHAPTER 37 Hygiene 211 CHAPTER 38 Rest and Sleep 217 CHAPTER 39 Nutrition and Oral Hydration 221 CHAPTER 40 Mobility and Immobility 227 CHAPTER 41 Pain Management 235 CHAPTER 42 Complementary and Alternative Therapies 241 CHAPTER 43 Bowel Elimination 245 CHAPTER 44 Urinary Elimination 251 CHAPTER 45 Sensory Perception 259 FUNDAMENTALS FOR NURSING TABLE OF CONTENTS VII NCLEX® Connections SECTION: Pharmacological and Parenteral Therapies 269 CHAPTER 46 Pharmacokinetics and Routes of Administration 269 CHAPTER 47 Safe Medication Administration and Error Reduction 277 CHAPTER 48 Dosage Calculation 285 CHAPTER 49 Intravenous Therapy 299 CHAPTER 50 Adverse Effects, Interactions, and Contraindications 307 CHAPTER 51 Individual Considerations of Medication Administration 313 NCLEX® Connections 317 Reduction of Risk Potential 319 CHAPTER 52 Specimen Collection for Glucose Monitoring 319 CHAPTER 53 Airway Management 323 SECTION: CHAPTER 54 Pulse oximetry and oxygen therapy 323 Specimen collection and airway clearance 327 Artificial airways and tracheostomy care 329 Nasogastric Intubation and Enteral Feedings NCLEX® Connections SECTION: VIII 267 333 339 Physiological Adaptation 341 CHAPTER 55 Pressure Injury, Wounds, and Wound Management 341 CHAPTER 56 Bacterial, Viral, Fungal, and Parasitic Infections 349 CHAPTER 57 Fluid Imbalances 355 TABLE OF CONTENTS CONTENT MASTERY SERIES CHAPTER 58 Electrolyte Imbalances 359 Sodium imbalances 359 Potassium imbalances 360 Calcium imbalances 362 Magnesium imbalances 363 References Active Learning Templates 367 A1 Basic Concept A1 Diagnostic Procedure A3 Growth and Development A5 Medication A7 Nursing Skill A9 System Disorder A11 Therapeutic Procedure A13 Concept Analysis A15 FUNDAMENTALS FOR NURSING TABLE OF CONTENTS IX X TABLE OF CONTENTS CONTENT MASTERY SERIES NCLEX® Connections When reviewing the following chapters, keep in mind the relevant topics and tasks of the NCLEX outline, in particular: Management of Care CONCEPTS OF MANAGEMENT: Identify roles/ responsibilities of health care team members. ASSIGNMENT, DELEGATION AND SUPERVISION: Identify tasks for assignment or delegation based on client needs. CONTINUITY OF CARE Perform procedures necessary to safely admit, transfer, or discharge a client. Provide and receive off of care (report) on assigned clients. ESTABLISHING PRIORITIES: Prioritize the delivery of client care. ETHICAL PRACTICE Recognize ethical dilemmas and take appropriate action. Practice in a manner consistent with a code of ethics for nurses. INFORMATION TECHNOLOGY: Utilize valid resources to enhance the care provided to a client. LEGAL RIGHTS AND RESPONSIBILITIES: Identify legal issues affecting the client. REFERRALS: Assess the need for referrals and obtain necessary orders. ADVANCE DIRECTIVES/SELF-DETERMINATION/LIFE PLANNING: Assess client and/or staff member knowledge of advance directives. INFORMED CONSENT: Participate in obtaining informed consent. CONFIDENTIALITY/INFORMATION SECURITY: Assess staff member and client understanding of confidentiality requirements. Safety and Infection Control REPORTING OF INCIDENT/EVENT/IRREGULAR OCCURENCE/ VARIENCE: Identify need/situation where reporting of incident/ event/irregular occurence/cariance is appropriate. FUNDAMENTALS FOR NURSING NCLEX® CONNECTIONS 1 Health Promotion and Maintenance HEALTH PROMOTION/DISEASE PREVENTION: Assist the client in maintaining an optimum level of health. TECHNIQUES OF PHYSICAL ASSESSMENT: Apply knowledge of nursing procedures and psychomotor skills to techniques of physical assessment. 2 NCLEX® CONNECTIONS CONTENT MASTERY SERIES CHAPTER 1 UNIT 1 CHAPTER 1 SAFE, EFFECTIVE CARE ENVIRONMENT ● SECTION: MANAGEMENT OF CARE ● Health Care Delivery Systems ● ● ● ● ● ● Health care delivery systems incorporate interactions between health care providers and clients within the constraints of financing mechanisms and regulatory agencies. ● ● REGULATORY AGENCIES ● Health care systems include the clients who participate, the settings in which health care takes place, the agencies that regulate health care, and the mechanisms that provide financial support. Most nurses deliver care within the context of health care systems. As these systems continue to become more business‑driven and less service‑oriented, the challenge to nursing today is to retain its caring values while practicing within a cost‑containment structure. COMPONENTS OF HEALTH CARE SYSTEMS PARTICIPANTS Consumers (clients) Licensed providers ● Registered nurses ● Licensed practical nurses (also known as licensed vocational nurses) ● Advanced practice nurses (APN) ● Medical doctors ● Pharmacists ● Dentists ● Dietitians ● Physical, respiratory, and occupational therapists Unlicensed providers(assistive personnel) SETTINGS ● ● ● ● ● ● ● ● Hospitals Homes Skilled‑nursing, assisted‑living, and extended‑care facilities Community/health departments Adult day care centers Schools Hospices Providers’ offices FUNDAMENTALS FOR NURSING Ambulatory care clinics Occupational health clinics Stand‑alone surgical centers Urgent care centers Complementary therapy centers Urgent and emergent care centers Public health agencies Crisis centers Diagnostic centers Specialized services (dialysis, oncology, rehabilitation, burn) centers ● ● ● ● ● ● U.S. Department of Health and Human Services U.S. Food and Drug Administration (FDA) State and local public health agencies State licensing boards to ensure that health care providers and agencies comply with state regulations The Joint Commission to set quality standards for accreditation of health care facilities Professional Standards Review Organizations to monitor health care services provided Utilization review committees to monitor for appropriate diagnosis and treatment of hospitalized clients HEALTH CARE FINANCING MECHANISMS PUBLIC FEDERALLY FUNDED PROGRAMS Medicare is for clients 65 years of age or older and those who have permanent disabilities. ● Part A: Insurance for hospital stays, home health, and hospice (available to those 65 years of age or older and those who have permanent disabilities) ● Part B: Insurance for outpatient and provider services (available to those 65 years or older and those who have permanent disabilities, but is voluntary and requires a monthly premium) ● Part C: A Medicare advantage or supplement plan (covering parts A and B, and sometimes D) ● Part D: Medication coverage for those eligible and requires a monthly premium Medicaid is for clients who have low incomes. ● It is federally and state funded. ● Individual states determine eligibility requirements. The Patient Protection and Affordable Care Act of 2010 is a federal statute aimed at: ● Increasing access to health care for all individuals and instituting an individual mandate for health insurance. ● Decreasing health care costs. ● Providing opportunities for uninsured people to become insured at an affordable cost. State Children’s Health Insurance Program: Coverage for uninsured children up to age 19 at low cost to parents CHAPTER 1 Health Care Delivery Systems 3 PRIVATE PLANS ● ● ● ● ● Traditional insurance reimburses for services on a fee‑for‑service basis. Managed care organizations (MCOs): Primary care providers oversee comprehensive care for enrolled clients and focus on prevention and health promotion. Preferred provider organizations (PPOs): Clients choose from a list of contracted providers and hospitals. Using non‑contracted providers increases the out‑of‑pocket costs. Exclusive provider organizations (EPOs): Clients choose from a list of providers and hospitals within a contracted organization with no out‑of‑network coverage. Long‑term care insurance: A supplement for long‑term care expenses Medicare does not cover LEVELS OF HEALTH CARE Preventive health carefocuses on educating and equipping clients to reduce and control risk factors for disease. Examples include programs that promote immunization, stress management, occupational health, and seat belt use. Primary health careemphasizes health promotion and includes prenatal and well‑baby care, family planning, nutrition counseling, and disease control. This level of care is a sustained partnership between clients and providers. Examples include office or clinic visits, community health centers, and scheduled school‑ or work‑centered screenings (vision, hearing, obesity). Secondary health careincludes the diagnosis and treatment of acute illness and injury. Examples include care in hospital settings (inpatient and emergency departments), diagnostic centers, and urgent and emergent care centers. Tertiary health care, or acute care, involves the provision of specialized and highly technical care. Examples include intensive care, oncology centers, and burn centers. Restorative health careinvolves intermediate follow‑up care for restoring health and promoting self‑care. Examples include home health care, rehabilitation centers, and skilled nursing facilities. Continuing health careaddresses long‑term or chronic health care needs over a period of time. Examples include end‑of‑life care, palliative care, hospice, adult day care, assisted living, and in‑home respite care. RELATIONSHIP BETWEEN HEALTH CARE SYSTEMS AND LEVELS OF CARE People:The level of care depends on the needs of the client. Licensed and unlicensed health care personnel work in every level of care. Setting:The settings for secondary and tertiary care are usually within a hospital or specific facility. Settings for other levels of care vary. Regulatory agencieshelp ensure the quality and quantity of health care and the protection of health care consumers. Health care financeinfluences the quality and type of care by setting parameters for cost containment and reimbursement. SAFETY AND QUALITY In response to concerns about the safety and quality of client care in the United States, Quality and Safety Education for Nurses (QSEN) assists nursing programs in preparing nurses to provide safe, high‑quality care. To draw attention to the six QSEN competencies, these icons appear throughout the review modules. Safety:The minimization of risk factors that could cause injury or harm while promoting high‑quality care and maintaining a secure environment for clients, self, and others Patient‑Centered Care:The provision of caring and compassionate, culturally sensitive care that addresses clients’ physiological, psychological, sociological, spiritual, and cultural needs, preferences, and values. The client is included in the decision‑making process. Evidence Based Practice:The use of current knowledge from research and other credible sources on which to base clinical judgment and client care Informatics:The use of information technology as a communication and information‑gathering tool that supports clinical decision‑making and scientifically-based nursing practice Quality Improvement:Care‑related and organizational processes that involve the development and implementation of a plan to improve health care services and better meet clients’ needs Teamwork and Collaboration:The delivery of client care in partnership with interprofessional members of the health care team to achieve continuity of care and positive client outcomes THE FUTURE OF HEALTH CARE The ultimate issue in designing and delivering health care is ensuring the health and welfare of the population. 4 CHAPTER 1 Health Care Delivery Systems CONTENT MASTERY SERIES Application Exercises 1. A nurse is discussing restorative health care with a newly licensed nurse. Which of the following examples should the nurse include in the teaching? (Select all that apply.) A. Home health care B. Rehabilitation facilities Active Learning Scenario A nurse on a medical‑surgical unit is acquainting a group of nurses with the Quality and Safety Education for Nurses (QSEN) initiative. Use the ATI Active Learning Template: Basic Concept to complete this item. RELATED CONTENT: List the six QSEN competencies, along with a brief description of each. C. Diagnostic centers D. Skilled nursing facilities E. Oncology centers 2. A nurse is explaining the various types of health care coverage clients might have to a group of nurses. Which of the following health care financing mechanisms should the nurse include as federally funded? (Select all that apply.) A. Preferred provider organization (PPO) B. Medicare C. Long‑term care insurance D. Exclusive provider organization (EPO) E. Medicaid 3. A nurse manager is developing strategies to care for the increasing number of clients who have obesity. Which of the following actions should the nurse include as a primary health care strategy? A. Collaborating with providers to perform obesity screenings during routine office visits B. Ensuring the availability of specialized beds in rehabilitation centers for clients who have obesity C. Providing specialized intraoperative training in surgical treatments for obesity D. Educating acute care nurses about postoperative complications related to obesity 4. A nurse is discussing the purpose of regulatory agencies during a staff meeting. Which of the following tasks should the nurse identify as the responsibility of state licensing boards? A. Monitoring evidence‑based practice for clients who have a specific diagnosis B. Ensuring that health care providers comply with regulations C. Setting quality standards for accreditation of health care facilities D. Determining whether medications are safe for administration to clients 5. A nurse is explaining the various levels of health care services to a group of newly licensed nurses. Which of the following examples of care or care settings should the nurse classify as tertiary care? (Select all that apply.) A. Intensive care unit B. Oncology treatment center C. Burn center D. Cardiac rehabilitation E. Home health care FUNDAMENTALS FOR NURSING CHAPTER 1 Health Care Delivery Systems 5 Active Learning Scenario Key Application Exercises Key 1. A. CORRECT: Restorative health care involves intermediate follow‑up care for restoring health and promoting self‑care. Home health care is a type of restorative health care. B. CORRECT: Restorative health care involves intermediate follow‑up care for restoring health and promoting self‑care. Rehabilitation facilities are a type of restorative health care. C. Secondary health care includes the diagnosis and treatment of acute injury or illness. Diagnostic centers are a type of secondary health care. D. CORRECT: Restorative health care involves intermediate follow‑up care for restoring health and promoting self‑care. Skilled nursing facilities are a type of restorative health care. E. Tertiary health care is specialized and highly technical care. An oncology center is a type of tertiary health care. NCLEX® Connection: Management of Care, Health Promotion/Disease Prevention 2. A. PPOs are privately funded. B. CORRECT: Medicare is federally funded. C. Long‑term care insurance is privately funded. D. EPOs are privately funded. E. CORRECT: Medicaid is federally funded. NCLEX® Connection: Management of Care, Information Technology Using the ATI Active Learning Template: Basic Concept RELATED CONTENT Safety: Minimization of risk factors that could cause injury or harm while promoting quality care and maintaining a secure environment for clients, self, and others Patient‑Centered Care: Provision of caring and compassionate, culturally sensitive care that addresses clients’ physiological, psychological, sociological, spiritual, and cultural needs, preferences, and values Evidence‑Based Practice: Use of current knowledge from research and other credible sources on which to base clinical judgment and client care Informatics: Use of information technology as a communication and information‑gathering tool that supports clinical decision‑making and scientifically based nursing practice Quality Improvement: Care‑related and organizational processes that involve the development and implementation of a plan to improve health care services and better meet clients’ needs Teamwork and Collaboration: Delivery of client care in partnership with multidisciplinary members of the health care team to achieve continuity of care and positive client outcomes ● ● ● ● ● ● NCLEX® Connection: Management of Care, Information Technology 3. A. CORRECT: Identify obesity screenings at office visits as an example of primary health care. Primary health care emphasizes health promotion and disease control, is often delivered during office visits, and includes screenings. B. Identify care that is provided in a rehabilitation center as an example of restorative health care. C. Identify specialized and highly technical care as an example of tertiary health care. D. Identify acute care of clients as an example of secondary health care. NCLEX® Connection: Health Promotion and Maintenance, Health Promotion/Disease Prevention 4. A. Identify that utilization review committees have the responsibility of monitoring for appropriate diagnosis and treatment according to evidence‑based practice for diagnosis and treatment of hospitalized clients. B. CORRECT: Identify that state licensing boards are responsible for ensuring that health care providers and agencies comply with state regulations. C. Identify that the Joint Commission has the responsibility of setting quality standards for accreditation of health care facilities. D. Identify that the U.S. Food and Drug Administration has the responsibility of determining whether medications are safe for administration to clients. NCLEX® Connection: Management of Care, Information Technology 5. A. CORRECT: Tertiary health care involves the provision of specialized and highly technical care (the care nurses deliver in intensive care units). B. CORRECT: Tertiary health care involves the provision of specialized and highly technical care (the care nurses deliver in oncology treatment centers). C. CORRECT: Tertiary health care involves the provision of specialized and highly technical care (the care nurses deliver in burn centers). D. This is an example of restorative care and also of tertiary prevention, but not of tertiary care. E. This is an example of restorative care. NCLEX® Connection: Health Promotion and Maintenance, Health Promotion/Disease Prevention 6 CHAPTER 1 Health Care Delivery Systems CONTENT MASTERY SERIES CHAPTER 2 SAFE, EFFECTIVE CARE ENVIRONMENT UNIT 1 SECTION: MANAGEMENT OF CARE CHAPTER 2 The Interprofessional Team RNs and practical nurses (PNs) are integral members of the interprofessional health care team. Each discipline represented on an interprofessional team uses a set of skills within the scope of practice for the specific profession. In some instances, the scope of practice for one discipline overlaps with the scope of practice or set of skills for another profession. For example, the nurse and the respiratory care therapist both possess the knowledge and skill to perform chest physiotherapy (using postural drainage, percussion, and vibration to promote drainage of secretions from the lungs). The interprofessional health care team works collaboratively to provide holistic care to clients. The nurse is most often the manager of care and must understand the roles and responsibilities of other health care team members to collaborate and make appropriate referrals. INTERPROFESSIONAL PERSONNEL (NON‑NURSING) Spiritual support staff:Provides spiritual care (pastors, rabbis, priests). Example of when to refer: A client requests communion, or the family asks for prayer prior to the client undergoing a procedure. Registered dietitian:Assesses, plans for, and educates regarding nutrition needs. Designs special diets, and supervises meal preparation. Example of when to refer: A client has a low albumin level and recently had an unexplained weight loss. Laboratory technician:Obtains specimens of body fluids, and performs diagnostic tests. Example of when to refer: A provider needs to see a client’s complete blood count (CBC) results immediately. Online Video: Interdisciplinary Team Occupational therapist: A ssesses and plans for clients to regain activities of daily living (ADL) skills, especially motor skills of the upper extremities. Example of when to refer: A client has difficulties using an eating utensil with their dominant hand following a stroke. Pharmacist: Provides, monitors, and evaluates medication. Supervises pharmacy technicians in states that allow this practice. Example of when to refer: A client is concerned about a new medication’s interactions with any of their other medications. Physical therapist: A ssesses and plans for clients to increase musculoskeletal function, especially of the lower extremities, to maintain mobility. Example of when to refer: Following hip arthroplasty, a client requires assistance learning to ambulate and regain strength. Provider: A ssesses, diagnoses, and treats disease and injury. Providers include medical doctors (MDs), doctors of osteopathy (DOs), advanced practice nurses (APNs), and physician assistants (PAs). State regulations vary in their requirements for supervision of APNs and PAs by a physician (MDs and DOs). Example of when to refer: A client has a temperature of 39º C (102.2º F), is achy and shaking, and reports feeling cold. Radiologic technologist:Positions clients and performs x‑rays and other imaging procedures for providers to review for diagnosis of disorders of various body parts. Example of when to refer: A client reports severe pain in their hip after a fall, and the provider prescribes an x‑ray of the client’s hip. Respiratory therapist: Evaluates respiratory status and provides respiratory treatments including oxygen therapy, chest physiotherapy, inhalation therapy, and mechanical ventilation. Example of when to refer: A client who has respiratory disease is short of breath and requests a nebulizer treatment. Social worker: Works with clients and families by coordinating inpatient and community resources to meet psychosocial and environmental needs that are necessary for recovery and discharge. Example of when to refer: A client who has terminal cancer wishes to go home but is no longer able to perform many ADLs. The client’s partner needs medical equipment in the home to care for the client. Speech‑language pathologist: Evaluates and makes recommendations regarding the impact of disorders or injuries on speech, language, and swallowing. Teaches techniques and exercises to improve function. Example of when to refer: A client is having difficulty swallowing a regular diet after trauma to the head and neck. FUNDAMENTALS FOR NURSING CHAPTER 2 THE INTERPROFESSIONAL TEAM 7 NURSING PERSONNEL The nursing team works together to advocate for and meet the needs of clients within the health care delivery system. Registered nurse (RN) The RN is the lead team member, soliciting input from all nursing team members and setting priorities for the coordination of client care. EDUCATIONAL PREPARATION ● ● Must meet the state board of nursing’s requirements for licensure. Requires completion of a diploma program, an associate degree, or a baccalaureate degree in nursing prior to taking the licensure exam (licensed). ROLES AND RESPONSIBILITIES ● ● ● ● Function legally under state nurse practice acts. Perform assessments; establish nursing diagnoses, goals, and interventions; and conduct ongoing client evaluations. Develop interprofessional plans for client care. Share appropriate information among team members; initiate referrals for client assistance, including health education; and identify community resources. Practical nurse (PN) EXPANDED NURSING ROLES Advanced practice nurse (APN):Has a great deal of autonomy. APNs usually have a minimum of a master’s degree in nursing (or related field), advanced education in pharmacology and physical assessment, and certification in a specialized area of practice. Included in this role are the following. ● Clinical nurse specialist (CNS):Typically specializes in a practice setting or a clinical field. ● Nurse practitioner (NP):Collaborates with one or more providers to deliver nonemergency primary health care in a variety of settings. ● Certified registered nurse anesthetist (CRNA): Administers anesthesia and provides care during procedures under the supervision of an anesthesiologist. ● Certified nurse‑midwife (CNM):Collaborates with one or more providers to deliver care to maternal‑newborn clients and their families. Nurse educator:Teaches in schools of nursing, staff development departments in health care facilities, or client education departments. Nurse administrator:Provides leadership to nursing departments within a health care facility. Nurse researcher:Conducts research primarily to improve the quality of client care. EDUCATIONAL PREPARATION ● ● Must meet the state board of nursing’s requirements Requires vocational or community college education prior to taking the licensure exam (licensed) ROLES AND RESPONSIBILITIES ● ● ● ● Work under the supervision of the RN. Collaborate within the nursing process, assist with the plan of care, consult with other team members, and recognize the need for referrals to assist with actual or potential problems. Possess technical knowledge and skills. Participate in the delivery of nursing care, using the nursing process as a framework. Assistive personnel (AP) This includes certified nursing assistants (CNAs) and certified medical assistants (CMAs), and non‑nursing personnel (dialysis technicians, monitor technicians, and phlebotomists). Active Learning Scenario A nurse is teaching a group of newly licensed nurses about the various nursing roles they can aspire to after they achieve mastery in basic nursing skills. Use the ATI Active Learning Template: Basic Concept to complete this item. RELATED CONTENT: Describe at least five types of advance practice nursing roles, including a brief description of their primary responsibilities. EDUCATIONAL PREPARATION ● ● Must meet the state’s formal or informal training requirements Requirement by most states for training and examination to attain CNA status ROLES AND RESPONSIBILITIES ● ● ● 8 Work under the direct supervision of an RN or PN. Position description in the employing facility outlines specific tasks. Tasks can include feeding clients, preparing nutritional supplements, lifting, basic care (grooming, bathing, transferring, toileting, positioning), measuring and recording vital signs, and ambulating clients. CHAPTER 2 The Interprofessional Team CONTENT MASTERY SERIES Application Exercises 1. A nurse is caring for a group of clients on a medical‑surgical unit. For which of the following client care needs should the nurse initiate a referral for a social worker? (Select all that apply.) 3. A. A client who has terminal cancer requests hospice care in the home. B. A client asks about community resources available for older adults. A. Provider C. A client states, “I would like to have my child baptized before surgery.” C. Pharmacist D. A client requests an electric wheelchair for use after discharge. E. Respiratory therapist E. A client states, “I do not understand how to use a nebulizer.” 2. A client who is postoperative following knee arthroplasty is concerned about the adverse effects of the medication prescribed for pain management. Which of the following members of the interprofessional care team can assist the client in understanding the medication’s effects? (Select all that apply.) B. Certified nursing assistant D. Registered nurse 4. A goal for a client who has difficulty with self‑feeding due to rheumatoid arthritis is to use adaptive devices. The nurse caring for the client should initiate a referral to which of the following members of the interprofessional care team? A. Social worker B. Certified nursing assistant C. Occupational therapist D. Speech‑language pathologist A. Social worker B. Certified nursing assistant C. Registered dietitian D. Occupational therapist A client who had a cerebrovascular accident has persistent problems with dysphagia. The nurse caring for the client should initiate a referral with which of the following members of the interprofessional care team? 5. A nurse is acquainting a group of newly licensed nurses with the roles of the various members of the health care team they will encounter on a medical‑surgical unit. When providing examples of the types of tasks certified nursing assistants (CNAs) can perform, which of the following client activities should the nurse include? (Select all that apply.) A. Bathing B. Ambulating C. Toileting D. Determining pain level E. Measuring vital signs FUNDAMENTALS FOR NURSING CHAPTER 2 The Interprofessional Team 9 Application Exercises Key 1. A. CORRECT: Initiate a referral for a social worker to provide information and assistance in coordinating hospice care for a client. B. CORRECT: Initiate a referral for a social worker to provide information and assistance in coordinating care for community resources available for clients. C. Initiate a referral for spiritual support staff if a client requests specific religious sacraments or prayers. D. CORRECT: Initiate a referral for a social worker to assist the client in obtaining medical equipment for use after discharge. E. Provide client teaching for concerns regarding the use of a nebulizer. If additional information is needed, initiate a referral for a respiratory therapist. NCLEX® Connection: Management of Care, Referrals Active Learning Scenario Key Using the ATI Active Learning Template: Basic Concept RELATED CONTENT Clinical nurse specialist (CNS): Typically specializes in a practice setting or a clinical field. Nurse practitioner (NP): Collaborates with one or more providers to deliver nonemergency primary health care in a variety of settings. Certified registered nurse anesthetist (CRNA): Administers anesthesia and provides care during procedures under the supervision of an anesthesiologist. Certified nurse‑midwife (CNM): Collaborates with one or more providers to deliver care to maternal‑newborn clients and their families. Nurse educator: Teaches in schools of nursing, staff development departments in health care facilities, or client education departments. Nurse administrator: Provides leadership to nursing departments within a health care facility. Nurse researcher: Conducts research primarily to improve the quality of client care. ● ● ● ● ● ● 2. A. A social worker can coordinate community services to help the client, but not specifically with self‑feeding devices. B. A certified nursing assistant can help the client with feeding, but does not typically procure adaptive devices for the client. C. A registered dietitian can help with educating the client about meeting nutritional needs, but cannot help with the client’s physical limitations. D. CORRECT: An occupational therapist can assist clients who have physical challenges to use adaptive devices and strategies to help with self‑care activities. ● NCLEX® Connection: Management of Care, Concepts of Management NCLEX® Connection: Management of Care, Referrals 3. A. CORRECT: The provider must be knowledgeable about any medication prescribed for the client, including its actions, effects, and interactions. B. It is not within the scope of a certified nursing assistant’s duties to counsel a client about medications. C. CORRECT: A pharmacist must be knowledgeable about any medication dispensed for the client, including its actions, effects, and interactions. D. CORRECT: A registered nurse must be knowledgeable about any medication administered, including its actions, effects, and interactions. E. Although some analgesics can cause respiratory depression, requiring assistance from a respiratory therapist, it is not within this therapist’s scope of practice to counsel the client about medications prescribed by the provider. NCLEX® Connection: Management of Care, Referrals 4. A. A social worker can coordinate community services to help the client, but not specifically with dysphagia. B. A certified nursing assistant can help the client with feeding, but cannot assess and treat dysphagia. C. An occupational therapist can assist clients who have motor challenges to improve abilities with self‑care and work, but cannot assess and treat dysphagia. D. CORRECT: A speech‑language pathologist can initiate specific therapy for clients who have difficulty with feeding due to swallowing difficulties. NCLEX® Connection: Management of Care, Referrals 5. A. CORRECT: It is within the range of function for a CNA to provide basic care to clients (bathing). B. CORRECT: It is within the range of function for a CNA to provide basic care to clients, (assisting with ambulation). C. CORRECT: It is within the range of function for a CNA to provide basic care to clients (assisting with toileting). D. Determining pain level is a task that requires the assessment skills of licensed personnel (nurses). It is outside the range of function for a CNA. E. CORRECT: It is within the range of function for a CNA to provide basic care to clients (measuring and recording vital signs). NCLEX® Connection: Management of Care, Assignment, Delegation and Supervision 10 CHAPTER 2 The Interprofessional Team CONTENT MASTERY SERIES CHAPTER 3 UNIT 1 SAFE, EFFECTIVE CARE ENVIRONMENT SECTION: MANAGEMENT OF CARE CHAPTER 3 Ethical Responsibilities ETHICAL DILEMMAS ● ● Ethics is the study of conduct and character, and a code of ethics is a guide for the expectations and standards of a profession. Ethical theories examine principles, ideas, systems, and philosophies that affect judgments about what is right and wrong, and good and bad. Common ethical theories are utilitarianism, deontology, consensus in bioethics, and ethics of care. Ethical principles for individuals, groups of individuals, and societies are standards of what is right or wrong with regard to important social values and norms. Values are personal beliefs about ideas that determine standards that shape behavior. Morals are personal values and beliefs about behavior and decision‑making. ETHICAL DECISION‑MAKING IN NURSING Bioethics refers to the application of ethics to health and life. It addresses dilemmas (stem cell research, organ transplantation, gender reassignment, and reproductive technologies [in vitro fertilization, surrogate parenting]). Other ethical dilemmas include abortion and acquired immunodeficiency syndrome. BASIC PRINCIPLES OF ETHICS ● ● ● ● Advocacy: support and defend clients’ health, wellness, safety, wishes, and personal rights, including privacy. Responsibility: willingness to respect obligations and follow through on promises. Accountability: ability to answer for one’s own actions. Confidentiality: protection of privacy without diminishing access to high‑quality care. ETHICAL PRINCIPLES FOR CLIENT CARE ● ● ● ● ● ● Autonomy: the right to make one’s own personal decisions, even when those decisions might not be in that person’s own best interest. Beneficence: action that promotes good for others, without any self‑interest. Fidelity: fulfillment of promises. Justice: fairness in care delivery and use of resources. Nonmaleficence: a commitment to do no harm. Veracity: a commitment to tell the truth. FUNDAMENTALS FOR NURSING Ethical dilemmas are problems that involve more than one choice and stem from differences in the values and beliefs of the decision makers. These are common in health care, and nurses must apply ethical theory and decision‑making to ethical problems. A problem is an ethical dilemma when: ◯ A review of scientific data is not enough to solve it. ◯ It involves a conflict between two moral imperatives. ◯ The answer will have a profound effect on the situation and the client. ETHICAL DECISION‑MAKING Ethical decision‑making is a process that requires striking a balance between science and morality. When making an ethical decision: ● Identify whether the issue is indeed an ethical dilemma. ● Gather as much relevant information as possible about the dilemma. ● Reflect on your own values as they relate to the dilemma. ● State the ethical dilemma, including all surrounding issues and the individuals it involves. ● List and analyze all possible options for resolving the dilemma, and review the implications of each option. ● Select the option that is in concert with the ethical principle that applies to this situation, the decision maker’s values and beliefs, and the profession’s values for client care. Justify selecting that one option in light of the relevant variables. ● Apply this decision to the dilemma, and evaluate the outcomes. Ethics committeesgenerally address unusual or complex ethical issues. Examples of ethical guidelinesfor nurses are the American Nurses Association’s Code of Ethics for Nurses With Interpretive Statements (2015) and the International Council of Nurses’ The ICN Code of Ethics for Nurses (2012). Moral distressoccurs when the nurse is placed in a difficult situation where the actions taken are different from what the nurse feels is ethically correct. 3.1 Nursing’s roles in ethical decision‑making An agent for clients facing an ethical decision. Examples: Caring for an adolescent client who has to decide whether to undergo an abortion even though her parents believe it is wrong Discussing options with a parent who has to decide whether to consent to a blood transfusion for a child when his religion prohibits such treatment A decision maker for health care delivery. Examples: Assigning staff nurses a higher client load than previously because administration has reduced the number of nurses per shift Witnessing a surgeon discussing only surgical options with a client without mentioning more conservative measures ● ● ● ● CHAPTER 3 Ethical Responsibilities 11 Application Exercises 1. A nurse is caring for a client who decides not to have surgery despite significant blockages of the coronary arteries. The nurse understands that this client’s choice is an example of which of the following ethical principles? A. Fidelity B. Autonomy C. Justice Active Learning Scenario A nurse is teaching a group of newly licensed nurses about the process of resolving ethical dilemmas. Use the ATI Active Learning Template: Basic Concept to complete this item. UNDERLYING PRINCIPLES: Define the ethical decision‑making process. NURSING INTERVENTIONS: List the steps of making an ethical decision. D. Nonmaleficence 2. A nurse offers pain medication to a client who is postoperative prior to ambulation. The nurse understands that this aspect of care delivery is an example of which of the following ethical principles? A. Fidelity B. Autonomy C. Justice D. Beneficence 3. A nurse is instructing a group of newly licensed nurses about the responsibilities organ donation and procurement involve. When the nurse explains that all clients waiting for a kidney transplant have to meet the same qualifications, the newly licensed nurses should understand that this aspect of care delivery is an example of which of the following ethical principles? A. Fidelity B. Autonomy C. Justice D. Nonmaleficence 4. A nurse questions a medication prescription as too extreme in light of the client’s advanced age and unstable status. The nurse understands that this action is an example of which of the following ethical principles? A. Fidelity B. Autonomy C. Justice D. Nonmaleficence 5. A nurse is instructing a group of newly licensed nurses about how to know and what to expect when ethical dilemmas arise. Which of the following situations should the newly licensed nurses identify as an ethical dilemma? A. A nurse on a medical‑surgical unit demonstrates signs of chemical impairment. B. A nurse overhears another nurse telling an older adult client that if he doesn’t stay in bed, she will have to apply restraints. C. A family has conflicting feelings about the initiation of enteral tube feedings for their father, who is terminally ill. D. A client who is terminally ill hesitates to name their partner on their durable power of attorney form. 12 CHAPTER 3 Ethical Responsibilities CONTENT MASTERY SERIES Application Exercises Key 1. A. Fidelity is the fulfillment of promises. The nurse has not made any promises; this is the client’s decision. B. CORRECT: In this situation, the client is exercising their right to make their own personal decision about surgery, regardless of others’ opinions of what is “best” for them. This is an example of autonomy. C. Justice is fairness in care delivery and in the use of resources. Because the client has chosen not to use them, this principle does not apply. D. Nonmaleficence is a commitment to do no harm. In this situation, harm can occur whether or not the client has surgery. However, because they choose not to, this principle does not apply. NCLEX® Connection: Management of Care, Ethical Practice 2. A. Fidelity is the fulfillment of promises. Unless the nurse has specifically promised the client a pain‑free recovery, which is unlikely, this principle does not apply to this action. B. Autonomy is the right to make personal decisions, even when they are not necessarily in the person’s best interest. In this situation, the nurse is delivering responsible client care. This principle does not apply. C. Justice is fairness in care delivery and in the use of resources. Pain management is available for all clients who are postoperative, so this principle does not apply. D. CORRECT: Beneficence is action that promotes good for others, without any self‑interest. By administering pain medication before the client attempts a potentially painful exercise like ambulation, the nurse is taking a specific and positive action to help the client. NCLEX® Connection: Management of Care, Ethical Practice 3. A. Fidelity is the fulfillment of promises. Because donor organs are a scarce resource compared with the numbers of potential recipients who need them, no one can promise anyone an organ. Thus, this principle does not apply. B. Autonomy is the right to make personal decisions, even when they are not necessarily in the person’s best interest. No personal decision is involved with the qualifications for organ recipients. C. CORRECT: Justice is fairness in care delivery and in the use of resources. By applying the same qualifications to all potential kidney transplant recipients, organ procurement organizations demonstrate this ethical principle in determining the allocation of these scarce resources. D. Nonmaleficence is a commitment to do no harm. In this situation, harm can occur to organ donors and to recipients. The requirements of the organ procurement organizations are standard procedures and do not address avoidance of harm or injury. NCLEX® Connection: Management of Care, Ethical Practice 4. A. Fidelity is the fulfillment of promises. The nurse is not addressing a specific promise when they determine the appropriateness of a prescription for the client. Thus, this principle does not apply. B. Autonomy is the right to make personal decisions, even when they are not necessarily in the person’s best interest. No personal decision is involved when the nurse questions the client’s prescription. C. Justice is fairness in care delivery and in the use of resources. In this situation, the nurse is delivering responsible client care and is not assessing available resources. This principle does not apply. D. CORRECT: Nonmaleficence is a commitment to do no harm. In this situation, administering the medication could harm the client. By questioning it, the nurse is demonstrating this ethical principle. NCLEX® Connection: