NURS 110 Final Exam Study Guide: Comprehensive Review 25

NURS 110 FINAL EXAM STUDY GUIDE Comprehensive Review: Weeks 1-8 Disclaimer: This study guide is designed to complement, not replace, your required coursework, textbooks, lecture materials, and ATI modules. Use this as a tool to deepen understanding and develop critical thinking skills essential for both exam success and professional nursing practice. Prof. Thakur NURSING AS A PROFESSION & HEALTHCARE SYSTEMS Understanding Professional Nursing Identity What It Is: Nursing is a profession characterized by autonomy, specialized knowledge, ethical standards, and a commitment to service. Professional identity reflects how nurses internalize the values, beliefs, and standards of the profession, shaping their practice and decision-making. Why It Matters: Strong professional identity: Guides ethical decision-making in complex situations Builds public trust and respect for nursing Supports advocacy for patients and the profession Prevents burnout and moral distress Promotes excellence in practice Key Concepts: Defining Characteristics of a Profession: Specialized body of knowledge - Evidence-based practice grounded in nursing science Autonomy in practice - Independent decision-making within scope of practice Service to society - Commitment to public good over personal gain Code of ethics - ANA Code of Ethics guides professional behavior Continuing competence - Lifelong learning and skill development Historical Foundations: Florence Nightingale revolutionized nursing by emphasizing environmental factors (clean air, proper ventilation, hygiene) affecting patient outcomes. She promoted nursing education and published influential works on healthcare Other pioneers advanced nursing theory, research, and specialized practice areas Educational Pathways: LPN/LVN - Technical skills, works under supervision ADN/Diploma RN - Entry-level registered nursing BSN - Professional nursing with emphasis on leadership, research, evidence-based practice MSN/Graduate degrees - Advanced practice (NP, CNS, CRNA, CNM) or nursing leadership/education Doctoral degrees (DNP, PhD) - Clinical expertise or research focus Patricia Benner's Novice-to-Expert Model: Novice - Rule-governed, inflexible, lacks experience and context Advanced Beginner - Recognizes recurring patterns but needs guidance Competent - Organized, efficient, can prioritize Proficient - Sees situations holistically, anticipates problems Expert - Intuitive grasp of situations, exceptional clinical judgment Nursing Roles and Competencies Essential Nursing Roles: Caregiver - Direct patient care and comfort Educator - Teaching patients and families for health promotion and disease management Advocate - Protecting patient rights and speaking up for patient needs Leader/Manager - Coordinating care and guiding healthcare teams Researcher - Contributing to evidence-based practice Change Agent - Promoting improvements in healthcare delivery Core Competencies: Communication - Therapeutic interaction, documentation, interprofessional collaboration Clinical judgment - Using nursing process and critical thinking Patient-centered care - Respecting preferences, values, and needs Safety - Minimizing risk and preventing harm Quality improvement - Monitoring and enhancing care outcomes Informatics - Using technology effectively and safely Healthcare Delivery System Current Healthcare Focus: Modern healthcare emphasizes wellness, health promotion, disease prevention, and health maintenance rather than solely treating illness. This shift reflects understanding that preventing disease is more effective and cost-efficient than treating it. Levels of Care: Primary care - First point of contact, preventive services, routine care Secondary care - Specialist consultations and hospital care Tertiary care - Highly specialized treatment (trauma centers, transplant units) Healthcare Settings: Acute care - Hospitals for immediate/short-term treatment Long-term care - Nursing homes, rehabilitation facilities Community-based care - Clinics, home health, public health departments Ambulatory care - Outpatient services Interprofessional Healthcare Team: Understanding roles promotes effective collaboration: Physicians/Providers - Diagnose and prescribe treatment Advanced Practice Nurses (APRNs) - NPs, CNSs, CRNAs, CNMs with expanded scope Pharmacists - Medication management and education Physical/Occupational/Speech Therapists - Rehabilitation and functional restoration Social Workers - Psychosocial support and resource coordination Dietitians - Nutritional assessment and planning Case Managers - Care coordination across settings Unlicensed Assistive Personnel (UAP/CNA) - Basic care under RN supervision Healthcare Disparities and Social Determinants: Social determinants of health (SDOH) are non-medical factors significantly affecting health outcomes: Economic stability - Income, employment, food security Education - Literacy, health literacy Healthcare access - Insurance, transportation, culturally competent providers Neighborhood environment - Safe housing, clean water, environmental hazards Social/community context - Support systems, discrimination, community engagement Example: A patient living in poverty may delay seeking care due to cost concerns, lack transportation to appointments, live in housing with lead exposure, and experience chronic stress—all contributing to worse health outcomes. LEGAL AND ETHICAL FOUNDATIONS Legal Framework for Nursing Practice State Nurse Practice Act: The foundational legal document that: Defines scope of practice for RNs, LPNs, and APRNs in that state Establishes requirements for licensure and renewal Outlines grounds for disciplinary action Protects public safety by ensuring competent nursing care Why it matters: Practicing outside your scope of practice can result in disciplinary action, license suspension, and legal liability. Standard of Care: The level of care that a reasonable, prudent nurse with similar education and experience would provide in a similar situation. Standards come from: State Nurse Practice Acts Professional organization standards (ANA Standards of Practice) Facility policies and procedures Evidence-based practice guidelines Joint Commission requirements Legal Concepts: Malpractice - Professional negligence where a nurse fails to meet the standard of care, resulting in patient harm. Four elements must be proven: 1. Duty - Nurse-patient relationship existed 2. Breach of duty - Nurse failed to meet standard of care 3. Causation - Breach directly caused harm 4. Damages - Patient suffered actual injury Example: A nurse fails to notify the physician about a significant change in patient condition (breach), leading to delayed treatment and patient deterioration (causation and damages). Negligence - Unintentional failure to exercise reasonable care Example: Leaving bed rails down, resulting in a patient fall Intentional Torts: Battery - Unwanted physical contact (giving treatment without consent) Assault - Threat of harmful contact (threatening to restrain a patient) False imprisonment - Unjustified restraint or confinement Invasion of privacy - Unauthorized disclosure of patient information Defamation - Damaging someone's reputation (libel = written, slander = spoken) Fraud - Intentional deception (misrepresenting credentials) HIPAA and Patient Confidentiality Health Insurance Portability and Accountability Act (HIPAA): Federal law protecting privacy and security of patient health information in all forms—verbal, written, and electronic. Common HIPAA Violations: Accessing patient records without legitimate need (even out of curiosity) Discussing patients in public areas (elevators, cafeteria) Sharing identifiable information on social media Leaving records visible to unauthorized individuals Improper disposal of patient information Using family members as interpreters when discussing sensitive information Sharing patient information with family without patient permission Critical point: Patient phone numbers, names, diagnoses, and any identifiable information are protected. You cannot share this information with family or friends without patient authorization. Documentation Requirements Legal Principles: Documentation serves as a legal record of care provided. If it wasn't documented, legally it didn't happen. Requirements for Effective Documentation: Accurate - Factual, objective observations Complete - All relevant information included Timely - Documented as soon as possible after care Legible - Clear, readable (applies to handwritten notes) Objective - Facts, not opinions or judgments Example of objective documentation: "Patient states 'I fell in the shower and was able to get back into my chair'" rather than "Patient is confused" or subjective interpretations. What to Document: Patient assessments and vital signs Medications administered and patient response Procedures performed Patient teaching and understanding Provider notifications and responses Changes in patient condition Patient statements (use quotes) What NOT to document: Incident reports in medical record (document the facts of what happened, not that a report was filed) Opinions or blame Conflicts with staff Defensive statements Informed Consent Key Roles: Physician/Provider - Explains procedure, risks, benefits, and alternatives in understandable terms Nurse - Witnesses signature, ensures patient understands and is signing voluntarily, assesses if patient is competent to consent Patient - Asks questions and makes informed decision Who Can Give Consent: Competent adults (alert, oriented, understands information) Parents/legal guardians for minors Healthcare proxy/power of attorney if patient is incapacitated The patient themselves if currently competent, even if they have dementia or history of cognitive impairment Critical point: If a patient with advance directives is currently alert and competent, the patient makes their own decisions, not the family or proxy. Mandatory Reporting Nurses are legally required to report: Child abuse or neglect - To Child Protective Services Elder or dependent adult abuse - To Adult Protective Services Certain communicable diseases - To public health authorities (e.g., tuberculosis, certain STIs) Unsafe practices or conditions - Within the facility (medication errors, safety concerns) Example: Seeing unexplained bruises on a child or signs of neglect in an elderly patient requires immediate reporting, even if only suspicious. Ethical Principles in Nursing ANA Code of Ethics: Provides moral framework for nursing practice, emphasizing: Respect for human dignity Primary commitment to the patient Advocacy for health and safety Responsibility and accountability Professional growth and integrity Core Ethical Principles: Autonomy - Respecting patient's right to make their own healthcare decisions Beneficence - Acting in the patient's best interest, promoting good Nonmaleficence - "Do no harm" - avoiding or minimizing harm Justice - Fair and equitable treatment for all patients Fidelity - Keeping promises and being faithful to commitments Veracity - Truthfulness and honesty Application example: When a child needs immunization, there's temporary discomfort (nonmaleficence concern), but the protection from serious disease for the child and community (beneficence and justice) outweighs the minor harm. Advanced Directives Legal documents allowing individuals to express end-of-life wishes: Types: Living Will/Advance Healthcare Directive (AHCD) - Specifies desired treatments if unable to communicate Durable Power of Attorney for Healthcare (DPAHC) - Designates someone to make healthcare decisions if incapacitated POLST (Physician Orders for Life-Sustaining Treatment) - Medical orders specifying preferences for CPR, ventilation, feeding tubes Values underlying advance directives: Informed consent - Making choices based on understanding Autonomy - Self-determination Truth-telling - Honest information about prognosis Control over dying process - Maintaining dignity Good Samaritan Laws Protect healthcare providers who voluntarily give emergency care outside their employment setting from liability, provided there is no gross negligence. Example: A nurse stops to help at a car accident. If sued, Good Samaritan laws would likely provide legal protection if care was reasonable given the circumstances. NURSING PROCESS AND CLINICAL JUDGMENT Understanding the Nursing Process What It Is: A systematic, organized approach to patient care consisting of five interconnected steps: Assessment, Diagnosis/Analysis, Planning, Implementation, and Evaluation (ADPIE or AAPIE). It provides structure while allowing flexibility for individualized care. Why It Matters: Ensures comprehensive, organized care Promotes critical thinking and clinical reasoning Provides framework for documentation and communication Facilitates evaluation of care effectiveness Meets professional standards of practice The Five Steps 1. Assessment - Data Collection Purpose: Gather comprehensive patient information to identify health status, needs, and concerns. Types of data: Subjective - What patient reports (symptoms, feelings, perceptions) Example: "I have sharp pain in my chest" Objective - Observable, measurable data (vital signs, lab results, physical findings) Example: Blood pressure 180/95, respiratory rate 28, diaphoresis present Assessment skills: Interviewing and therapeutic communication Physical examination (inspection, palpation, percussion, auscultation) Reviewing medical records and diagnostic tests Consulting with interprofessional team Clinical example: When a patient reports shortness of breath (subjective), the nurse assesses respiratory rate, oxygen saturation, lung sounds, and presence of cyanosis (objective) to fully understand the situation. 2. Analysis/Diagnosis - Data Interpretation Purpose: Analyze assessment data to identify patient problems, needs, and responses to health conditions. Nursing diagnosis describes: The patient's problem or need Related factors (what's contributing to the problem) Defining characteristics (signs and symptoms) Example: "Risk for falls related to orthostatic hypotension, left-sided weakness, and fear of falling as evidenced by patient statement 'I'm afraid I'll fall' and documented fall last week." 3. Planning - Setting Goals and Identifying Interventions Purpose: Establish patient-centered goals and identify nursing interventions to achieve desired outcomes. SMART Goals: Specific - Clear and focused Measurable - Can assess achievement objectively Achievable/Attainable - Realistic given patient's condition Relevant - Important to patient's health Time-bound - Has a target timeframe Example: "Patient will ambulate 30 feet with walker within 3 days" is SMART. "Patient will feel better" is not. Planning considerations: Patient preferences and priorities Available resources Safety concerns Evidence-based best practices 4. Implementation - Taking Action Purpose: Carry out the planned interventions and document care provided. Types of nursing interventions: Independent - Within nursing scope, no order needed (positioning, patient teaching, hygiene) Dependent - Require provider order (medications, certain treatments) Collaborative - Performed with other healthcare team members Example: A nurse independently repositions a patient every 2 hours to prevent pressure ulcers, administers ordered pain medication (dependent), and coordinates with physical therapy for mobility assessment (collaborative). 5. Evaluation - Determining Effectiveness Purpose: Assess whether goals were met and interventions were effective. Ongoing process, not just at end of care. Evaluation involves: Reassessing patient status Comparing current status to expected outcomes Determining goal achievement Identifying need for plan modification Example: After administering pain medication, the nurse reassesses pain level 30 minutes later. If pain decreased from 8/10 to 3/10, the intervention was effective. If still 7/10, the plan needs revision. Clinical Judgment Model Connection to NCLEX: The NCLEX now incorporates clinical judgment through the Clinical Judgment Measurement Model (CJMM), which emphasizes cognitive processes nurses use to make decisions. Six Steps of Clinical Judgment: 1. Recognize Cues - Notice relevant patient information Example: Patient is short of breath, has decreased oxygen saturation, and appears anxious 2. Analyze Cues - Determine meaning and relationships Example: These findings suggest respiratory distress possibly due to fluid overload or infection 3. Prioritize Hypotheses - Rank possible explanations Example: Most likely: heart failure exacerbation; also consider: pneumonia or pulmonary embolism 4. Generate Solutions - Identify appropriate interventions Example: Elevate head of bed, apply oxygen, notify provider, prepare for possible diuretic administration 5. Take Action - Implement interventions Example: Immediately elevate HOB to 45 degrees, apply 2L oxygen via nasal cannula, call provider 6. Evaluate Outcomes - Assess effectiveness Example: Recheck oxygen saturation, respiratory rate, and patient's subjective breathing comfort Critical Thinking in Nursing What It Is: Purposeful, goal-directed thinking that questions assumptions, evaluates evidence, and considers alternatives before making decisions. Why It's Essential: Critical thinking is the foundation for clinical decision-making. It incorporates nursing knowledge, scientific principles, and ethical reasoning to make sound clinical judgments. Critical Thinking Attitudes: Confidence - Trust in your knowledge and abilities while recognizing limitations Independence - Thinking for yourself while collaborating with others Intellectual curiosity - Asking "why" and seeking deeper understanding Open-mindedness - Considering multiple perspectives Perseverance - Not giving up when solutions aren't immediately apparent Responsibility - Accountability for decisions and actions Application example: A nurse receives an antibiotic order for a patient with a documented penicillin allergy. Rather than automatically administering it, the nurse uses critical thinking to recognize the potential error, checks if the antibiotic is penicillin-based, and contacts the provider for clarification. PRIORITIZATION AND DELEGATION Priority-Setting Frameworks Maslow's Hierarchy of Needs: Prioritize physiological needs first, then safety, then psychosocial needs: 1. Physiological - Oxygen, circulation, food, water, elimination 2. Safety - Physical and psychological security 3. Love and belonging - Relationships, social connections 4. Self-esteem - Confidence, respect, achievement 5. Self-actualization - Reaching full potential Clinical application: A patient with ineffective airway clearance (physiological) takes priority over a patient with disturbed body image (self-esteem), even though both are important. ABC/ABCDE Framework: A - Airway - Is it patent? B - Breathing - Is ventilation adequate? C - Circulation - Is perfusion adequate? D - Disability - Neurological status E - Exposure - Identify other injuries/concerns Use when: Multiple body systems are affected or emergency situations Acute vs. Chronic: Acute, new-onset problems typically take priority over chronic, stable conditions. Example: New-onset abdominal pain is more urgent than chronic migraines. Stable vs. Unstable: Unstable patients showing signs of deterioration require immediate attention over stable patients. Urgent vs. Non-urgent: Urgent - Requires prompt attention (new symptoms, potential complications) Non-urgent - Can wait without risk (routine medication, hygiene needs) Survival Potential: In disaster/triage situations: Immediate/Red - Life-threatening but survivable with prompt treatment Delayed/Yellow - Serious but stable, can wait Minimal/Green - Minor injuries, "walking wounded" Expectant/Black - Unlikely to survive even with treatment Effective Delegation What It Is: Transferring responsibility for performing a task while retaining accountability for the outcome. Why It Matters: Proper delegation allows RNs to manage time effectively, ensures appropriate use of team members' skills, and promotes safe, efficient patient care. The 5 Rights of Delegation: 1. Right Task - Is it appropriate to delegate for this patient? Routine, stable tasks can be delegated; complex assessment and unstable patients cannot 2. Right Circumstance - Is the patient stable enough for delegation? First ambulation post-surgery? Needs RN supervision Routine hygiene for stable patient? Can delegate to UAP 3. Right Person - Does the delegate have the competence and within their scope? UAP can do vital signs, hygiene, feeding, I&O documentation LPN can give medications (some states), wound care, data collection RN must do assessment, teaching, care planning, evaluation, complex procedures 4. Right Direction/Communication - Clear instructions provided? Specify what to do, when, how, and what to report back Example: "Take Mr. Smith's vital signs now and let me know immediately if BP is over 160/90 or under 90/60" 5. Right Supervision/Evaluation - Monitor performance and provide feedback Follow up to ensure task was completed correctly Evaluate patient outcomes What Cannot Be Delegated (RN Responsibilities): Assessment - Initial and ongoing nursing assessment Analysis - Interpreting data and formulating nursing diagnoses Planning - Developing care plans and setting goals Teaching - Patient and family education Evaluation - Determining if goals were met Unstable patients - Care of patients with changing conditions Complex procedures - Requires specialized nursing judgment Priority Consideration: The State Nurse Practice Act is the ultimate authority on what can be delegated in your state, taking precedence over agency policies. COMMUNICATION AND COLLABORATION Therapeutic Communication What It Is: Purposeful, goal-directed communication techniques that facilitate patient-centered interactions and promote trust, understanding, and healing. Why It Matters: Effective communication is essential for: Building therapeutic relationships Gathering accurate assessment data Providing emotional support Teaching and counseling Preventing errors through clear handoffs Therapeutic Techniques Active Listening: Maintain appropriate eye contact Use attentive body language (lean forward slightly, open posture) Avoid interrupting Provide feedback showing understanding Open-ended Questions: Encourage elaboration and exploration Example: "Tell me about your pain" rather than "Does it hurt?" Clarification: Ensuring understanding of what the patient means Example: "What would you say is the main point of what you're saying?" Reflection: Directing feelings back to encourage further expression Example: Patient: "I'm so worried." Nurse: "You're feeling worried about..." Silence: Providing time for patient to organize thoughts and process emotions Particularly therapeutic during difficult discussions Focusing: Directing conversation to important topics Example: "You mentioned chest pain. Let's talk more about that." Summarizing: Reviewing main points to ensure shared understanding Example: "So you've been having pain for 3 days, it's worse with movement, and it's not relieved by your medication. Is that correct?" Nontherapeutic Communication (What to Avoid) False reassurance - "Everything will be fine" (dismisses patient's concerns) Giving advice - "You should..." (removes patient autonomy) Asking "why" - Can sound judgmental and make patient defensive Changing the subject - Avoiding uncomfortable topics Minimizing feelings - "It's not that bad" (invalidates emotions) Defensive responses - Protecting yourself rather than focusing on patient Nonverbal Communication Personal Space and Proximity: Intimate distance (0-18 inches) - Reserved for close personal care Personal distance (18 inches-4 feet) - Most nursing interactions Social distance (4-12 feet) - Group teaching, formal interactions Cultural consideration: Personal space preferences vary by culture. Some cultures are comfortable with closer proximity, while others prefer more distance. Body Language: Facial expressions convey emotions Posture shows engagement (leaning in) or disinterest (turned away) Gestures can have different meanings across cultures Eye contact norms vary (direct eye contact may be seen as respectful or confrontational depending on culture) Communication Barriers Language Differences: Always use certified medical interpreters, never family members (especially children) for medical discussions Provide written materials in patient's primary language Use pictures and demonstrations when possible Health Literacy: Use plain language at 5th-6th grade reading level Avoid medical jargon Teach-back method - Ask patient to explain in their own words Environmental Barriers: Noise, lack of privacy, interruptions Poor lighting affecting lip reading or written materials Physiological Barriers: Hearing or vision impairment Cognitive impairment Pain or fatigue affecting concentration Altered mental status Emotional Barriers: Anxiety, fear, or anger interfering with processing information Cultural beliefs affecting willingness to communicate Interprofessional Communication SBAR (Situation-Background-Assessment-Recommendation): Standardized framework for communicating critical information: S - Situation: "What is happening right now?" Example: "Mr. Jones in Room 215 is having chest pain" B - Background: "What is the relevant context?" Example: "He's a 68-year-old with history of MI, admitted yesterday for heart failure" A - Assessment: "What do I think the problem is?" Example: "His pain is 7/10, crushing, radiating to left arm. BP 160/95, HR 110, O2 sat 92%" R - Recommendation: "What do I think should be done?" Example: "I think he needs a 12-lead EKG and you should assess him immediately" Handoff Reports: Communicate essential information when transferring care responsibility: Patient identification and location Current condition and recent changes Background (diagnosis, medical history) Current treatments and medications Upcoming needs (pending tests, due medications) Safety concerns (fall risk, allergies) Interdisciplinary Collaboration: Working effectively with the healthcare team requires: Respecting each discipline's expertise Clear, professional communication Shared goals for patient outcomes Timely information sharing DOCUMENTATION AND INFORMATICS Purpose of Documentation Legal record - Proof of care provided Communication - Informs other healthcare team members Quality improvement - Data for evaluating care Reimbursement - Justifies charges and services Research - Contributes to evidence-based practice Continuity of care - Ensures seamless transitions Principles of Effective Documentation Characteristics: Factual - Objective observations, not opinions Accurate - Correct information, no errors Complete - All relevant information included Timely - Documented promptly after care Organized - Logical, easy to follow Confidential - Maintains HIPAA privacy Documentation Guidelines: Use approved abbreviations only (avoid error-prone abbreviations like "U" for units, "QD" for daily) Record in chronological order Use patient's own words in quotes when relevant Document patient responses to interventions Never chart in advance Do not alter records - Draw single line through errors, write "error," initial and date Types of Documentation Systems Narrative Charting: Chronological story format describing care SOAP/SOAPIE: S - Subjective (patient report) O - Objective (observable data) A - Assessment/Analysis (nursing interpretation) P - Plan (interventions) I - Implementation (what was done) E - Evaluation (patient response) PIE (Problem-Intervention-Evaluation): Focused on specific problems identified Focus/DAR Charting: D - Data (subjective and objective) A - Action (interventions) R - Response (patient outcome) Charting by Exception: Documents only abnormal findings and interventions, assumes normalcy for nondocumented items Electronic Health Records (EHR): Digital documentation with advantages: Accessibility from multiple locations Integration of data (labs, imaging, medications) Clinical decision support Improved legibility EHR Best Practices: Secure passwords - Never share login credentials Log off when leaving workstation Access only relevant records - Don't look up celebrities or acquaintances Incident Reports Purpose: Document unexpected events or potential safety concerns for quality improvement, not to assign blame. When to Complete: Patient falls or injuries Medication errors Equipment malfunction Missing belongings Any near-miss or adverse event Important Points: Document facts in medical record, not opinions Do not mention in patient chart that incident report was completed Report filed separately to risk management HUMAN DEVELOPMENT ACROSS THE LIFESPAN Why Development Matters in Nursing Understanding development enables nurses to: Provide age-appropriate care and communication Recognize developmental delays or concerns Anticipate age-specific health risks Support healthy transitions through life stages Tailor patient teaching to cognitive and emotional level Principles of Human Development Development follows predictable patterns but individual timing varies Development is continuous throughout lifespan Development is multidimensional - physical, cognitive, emotional, social, moral Genetics and environment both influence development Each stage has characteristic tasks or milestones Major Developmental Theories Erik Erikson's Psychosocial Development: Each stage presents a developmental crisis or challenge to resolve: Life Stage Framework: Age Stage Infancy (0-1 year) Trust vs. Mistrust Central Task Nursing Implications Developing confidence Consistent caregiving, meet basic needs promptly, that needs will be met encourage parent bonding Toddler (1-3 Autonomy vs. Gaining independence Toilet training readiness, allow choices, praise efforts, years) Shame/Doubt and self-control set safe limits Taking initiative in Encourage play, answer questions, support activities imagination, set appropriate boundaries Preschool (3-5 years) Initiative vs. Guilt School Age (6-12 Industry vs. Developing competence Support academic success, recognize achievements, years) Inferiority in skills manage chronic illness effects on self-esteem Adolescence (12- Identity vs. Role Forming personal 18 years) Confusion identity and values Young Adult (18- Intimacy vs. Forming intimate Support relationship concerns, sexual health, family 40 years) Isolation relationships planning, career development Middle Adult Generativity vs. Contributing to society Address chronic disease management, career/family (40-65 years) Stagnation and next generation balance, "sandwich generation" stresses Older Adult (65+ Integrity vs. Reflecting on life with Support reminiscence, address loss/grief, maintain years) Despair satisfaction dignity and independence, end-of-life planning Respect privacy, involve in decisions, address body image concerns, recognize that challenging authority is developmentally normal Piaget's Cognitive Development: Stage Age Characteristics Health Teaching Approach 0-2 Learning through senses and actions, Use distraction, simple explanations to parents, years object permanence develops consistency in care 2-7 Symbolic thinking, egocentric, Use simple language, pictures, play, avoid years magical thinking abstract concepts, address fears about procedures Concrete 7-12 Logical thinking about concrete Explain procedures with concrete examples, Operational years objects, understands cause-effect allow questions, encourage participation Formal 12+ Abstract reasoning, hypothetical Provide detailed explanations, discuss long-term Operational years thinking consequences, involve in care decisions Sensorimotor Preoperational Kohlberg's Moral Development: Moral reasoning progresses from fear of punishment → seeking approval → internalized ethical principles Application: Understanding moral development helps nurses recognize that children's "dishonesty" about symptoms may reflect developmental stage rather than intentional deception. GRIEF, LOSS, AND END-OF-LIFE CARE Understanding Grief What It Is: The emotional, psychological, and physical response to loss—not just death, but any significant loss (health, function, relationships, roles, independence). Why It Matters: Nurses encounter grieving patients and families regularly. Understanding grief helps provide compassionate, appropriate support during vulnerable times. Types of Grief Normal/Uncomplicated Grief: Expected grief response to loss, characterized by sadness, crying, difficulty concentrating, changes in sleep and appetite. Gradually improves over time. Anticipatory Grief: Grief experienced before actual loss occurs Example: Family members grieving as loved one declines with terminal illness, allowing time to prepare emotionally and say goodbye Complicated/Prolonged Grief Disorder: Grief lasting >6 months for children/adolescents Grief lasting >12 months for adults Intense yearning, preoccupation with deceased, difficulty accepting loss Significantly impairs daily functioning Disenfranchised Grief: Grief for losses not socially recognized or validated Examples: Miscarriage, death of ex-spouse, loss of pet, death of someone from stigmatized illness, loss when relationship was secret Stages/Patterns of Grief Kübler-Ross Five Stages: Not linear, not universal—framework for understanding common responses: 1. Denial - "This can't be happening" Cues: Avoidance, refusal to believe reality, acting as if nothing happened 2. Anger - "Why me?" Frustration, resentment Cues: Irritability, blaming others, hostility toward caregivers 3. Bargaining - "If only..." Attempting to negotiate Cues: Seeking meaning, making deals with higher power, "what if" thinking 4. Depression - Reality sets in, profound sadness Cues: Withdrawal, crying, numbness, despair 5. Acceptance - Coming to terms with loss Cues: Renewed interest in life, integrating loss into identity, making plans Important Understanding: Grief is not linear - people move back and forth between stages Not everyone experiences all stages No "right way" or "timeline" for grief Cultural and individual variation is normal Dual Process Model: People oscillate between: Loss-oriented - Focusing on grief, emotions, missing the person Restoration-oriented - Focusing on rebuilding life, new roles, moving forward Healthy grief involves both processes, not getting stuck in one. Manifestations of Grief Emotional: Sadness, anxiety, anger, guilt, relief, numbness Mood swings, difficulty concentrating Physical: Fatigue, changes in appetite and sleep Headaches, muscle tension Shortness of breath, tightness in chest Gastrointestinal upset Cognitive: Disbelief, confusion, preoccupation with deceased Sense of presence, hallucinations of deceased (can be normal) Behavioral: Crying spells, social withdrawal Restlessness, searching behaviors Changes in productivity Factors Affecting Grief Individual Factors: Previous loss experiences and coping patterns Relationship with deceased (ambivalent relationships can complicate grief) Personality and mental health history Spiritual/religious beliefs Available support systems Situational Factors: Circumstances of death (sudden vs. expected, traumatic, stigmatized) Unfinished business with deceased Multiple losses occurring together Secondary losses resulting from death Cultural Factors: Mourning rituals and practices vary widely by culture Expression of grief differs (some cultures encourage emotional expression, others value restraint) Beliefs about death and afterlife influence grief experience Age-Related Considerations: Children - Understanding of death develops with age, may show grief through behavior changes or play Adolescents - May struggle with identity issues, peer support important Adults - May suppress grief due to responsibilities Older adults - May experience multiple losses, complicated by own health concerns Nursing Role in Grief Support Assessment: Identify type and stage of grief Assess coping mechanisms and support systems Screen for complicated grief or safety concerns (suicidal ideation) Recognize cultural and spiritual needs Interventions: Presence - Being with the person, active listening Normalize grief - Reassure varied responses are normal Encourage expression - Create safe space for feelings Avoid clichés - "They're in a better place" can minimize pain Support rituals - Facilitate culturally appropriate mourning practices Connect with resources - Grief counseling, support groups, spiritual care Monitor for complications - Refer for professional help if needed What NOT to do: Rush the process or impose timelines Compare griefs ("At least you have other children") Share your own grief stories unless truly therapeutic Tell them "I know how you feel" Try to "fix" their grief Physical Signs of Approaching Death Understanding these helps nurses prepare families and provide appropriate comfort care: Respiratory Changes: Dyspnea (shortness of breath) - Elevate head of bed, use fan for air circulation Cheyne-Stokes respirations - Irregular pattern with periods of apnea Death rattle - Gurgling sound from secretions; reposition, avoid suctioning which may cause more distress Circulatory Changes: Mottling - Purple/gray/pale marbling of skin, especially extremities Cool extremities - Circulation prioritizes vital organs Decreased blood pressure and weak pulse Neurological Changes: Decreased consciousness - May be unresponsive but hearing often remains Restlessness or agitation Hallucinations - May see deceased loved ones (can be comforting) Other Changes: Temperature instability - Fever or hypothermia Decreased intake - Loss of interest in food/fluids Incontinence - Loss of sphincter control Pain - Requires continued assessment and management Family Teaching: These changes are normal and expected Patient may still hear - encourage talking to them Touch and presence provide comfort It's okay to give "permission" to let go Palliative Care vs. Hospice Care Palliative Care: Holistic care focusing on comfort and quality of life for patients with serious illness Can be provided alongside curative treatments No time restrictions - can start at diagnosis Addresses physical symptoms, emotional distress, spiritual concerns Available in any setting - hospital, home, outpatient clinic Hospice Care: Specialized palliative care for terminally ill patients (typically ≤6 months life expectancy) Focus on comfort, not cure - no aggressive treatments Interdisciplinary team approach (nurses, physicians, social workers, chaplains, volunteers) Family-centered - supports patient and family as unit of care Usually home-based but can be in facility Includes bereavement support for family after death Key Difference: Palliative care can include curative treatment; hospice focuses only on comfort. Post-Mortem Care Nursing Responsibilities: Verify death - Physician or RN pronounces death (per state law) Document - Time of death, who was notified, location of belongings Prepare body: Close eyes and mouth Remove tubes and medical devices (unless autopsy - then leave in place) Clean body and change linens Place identification tags - Minimum two locations (toe/ankle and outside of body bag/shroud) Position naturally with arms at sides Provide privacy - If family wishes to view, allow time alone with body Respect cultural practices - Some cultures have specific requirements for body handling Account for belongings - Document and return personal items to family Arrange transport - Notify funeral home or morgue Support family - Provide tissues, quiet space, contact information for grief resources Special Considerations: Autopsy cases - Leave all tubes, lines, medical devices in place; inform family this is standard procedure Organ donation - Follow facility protocol, contact organ procurement organization Religious practices - Some require body not be left alone, specific handling by same gender, no embalming HEALTH PROMOTION AND DISEASE PREVENTION Shifting Healthcare Focus Modern healthcare emphasizes wellness, health maintenance, health promotion, and disease prevention rather than only treating illness. This shift reflects understanding that: Prevention is more effective than treatment Chronic diseases are largely preventable through lifestyle Quality of life matters as much as length of life Healthcare costs decrease when disease is prevented Levels of Prevention Primary Prevention - Stop Disease Before It Starts Goal: Prevent disease occurrence by addressing risk factors Interventions: Immunizations - Vaccines for preventable diseases Health education - Smoking cessation, nutrition, exercise, safe sex Safety measures - Seatbelts, helmets, childproofing homes Environmental improvements - Clean water, air quality, lead paint removal Policy advocacy - Supporting laws that promote health (smoking bans, menu labeling) Nurse's Role: Provide vaccinations and education about importance Teach about healthy lifestyle choices Conduct prenatal education Advocate for safe environments and health-promoting policies Lead community wellness programs Example: A school nurse teaching elementary students about handwashing prevents spread of infectious diseases. Secondary Prevention - Catch Disease Early Goal: Detect disease early when treatment is most effective Interventions: Screenings - Mammograms, colonoscopies, blood pressure checks, depression screening, glucose monitoring Health fairs - Community-based screening events Case finding - Identifying at-risk individuals for targeted screening Nurse's Role: Conduct screenings in various settings Educate about importance of routine screening Identify high-risk populations needing screening Refer for diagnostic follow-up when abnormalities found Track and follow up on screening results Example: A nurse performs Pap smears at a community clinic, detecting cervical changes before cancer develops. Tertiary Prevention - Manage Disease to Prevent Complications Goal: Minimize impact of established disease and prevent disability Interventions: Chronic disease management - Diabetes control, heart failure management, asthma care Rehabilitation - Physical therapy after stroke, cardiac rehabilitation Support groups - Helping patients adapt to chronic conditions Complication prevention - Diabetic foot care to prevent amputation, turning to prevent pressure ulcers Nurse's Role: Teach self-management skills Monitor disease progression Coordinate care among specialists Facilitate rehabilitation services Provide palliative care when appropriate Support adaptation to limitations Example: A nurse teaches a diabetic patient proper foot care, blood glucose monitoring, and dietary management to prevent complications like neuropathy and amputation. Health Promotion Strategies Individual Approaches: One-on-one counseling and education Motivational interviewing to support behavior change Goal setting and self-monitoring Teach-back to ensure understanding Community-Based Approaches: Health fairs and screening events Group education classes Partnership with community organizations (schools, faith communities, senior centers) Mobile health clinics for underserved areas Social media and health campaigns Population-Level Approaches: Policy advocacy and legislation Environmental changes (bike lanes, smoke-free zones, healthy food access) Media campaigns School-based programs Cultural Considerations in Health Promotion Cultural Humility Approach: Lifelong learning about diverse cultures Self-reflection on own biases and assumptions Power imbalance recognition - Patient is expert on their own culture Institutional accountability - Systems support culturally responsive care Strategies for Diverse Populations: Adapt materials - Translate to primary language, use appropriate images and examples Use community health workers - Build trust through shared background Respect health beliefs - Integrate traditional healing when safe Address barriers - Transportation, childcare, work schedules, cost Faith-based partnerships - Deliver health messages through trusted religious leaders Avoid assumptions - Assess individual beliefs rather than stereotyping Example: When providing diabetes education to Latinx community, use Spanish materials, incorporate culturally familiar foods (beans, rice, tortillas) into meal planning, and consider family-centered approach reflecting collectivist values. Social Determinants of Health (SDOH) Non-medical factors significantly influencing health outcomes: Economic Stability: Income level affects ability to afford healthcare, healthy food, safe housing Employment provides insurance and financial security Food insecurity leads to poor nutrition and chronic disease Education: Health literacy affects understanding of medical information Educational attainment correlates with better health outcomes Schools provide health education and services Healthcare Access: Insurance coverage determines care access Geographic barriers in rural areas Provider shortages and long wait times Culturally competent care availability Neighborhood and Built Environment: Housing quality affects safety and health (lead paint, mold, heating/cooling) Access to parks and recreational facilities Transportation to healthcare and healthy food Air and water quality Violence and crime affecting safety Social and Community Context: Social support and connection Discrimination and racism causing chronic stress Community cohesion and civic participation Nursing Response: Screen for unmet social needs during assessment Connect patients with community resources (housing assistance, food banks, transportation) Advocate for policies addressing health inequities Collaborate with social workers and community organizations Example: A patient with uncontrolled diabetes may struggle not due to lack of understanding, but because they live in a food desert with no access to fresh produce, work two jobs leaving no time for meal preparation, and lack transportation to medical appointments. CLIENT EDUCATION AND TEACHING Why Patient Education Matters Patient education is a legal and professional responsibility of nursing that: Improves health outcomes and self-management Reduces hospital readmissions and complications Increases patient satisfaction and engagement Promotes informed decision-making Supports health promotion and disease prevention Domains of Learning Cognitive Domain - Knowledge Acquisition What it involves: Understanding information, recalling facts, applying knowledge Teaching strategies: Lectures and discussions Written materials and handouts Videos and demonstrations Question-and-answer sessions Evaluation: Ask patient to explain information in own words Example: Teaching a diabetic patient about relationship between carbohydrate intake and blood glucose levels Affective Domain - Attitudes and Values What it involves: Feelings, emotions, values, beliefs about health Teaching strategies: Role-playing Values clarification exercises Storytelling Motivational interviewing Support groups Evaluation: Observe willingness to participate in care, statements about importance of treatment Example: Counseling a new parent hesitant about vaccines, exploring concerns and providing accurate information respectfully Psychomotor Domain - Physical Skills What it involves: Motor skills, coordination, performing procedures Teaching strategies: Demonstration - Nurse shows skill Return demonstration - Patient performs with supervision Practice - Repeated performance to build confidence Evaluation: Patient successfully performs skill independently Example: Teaching insulin injection technique, wound dressing changes, using walker Principles of Effective Learning Readiness to Learn: Patient must be physically, emotionally, and cognitively ready Assess readiness: Is patient alert and free from acute pain? Are they emotionally stable (not in crisis)? Do they perceive learning as relevant to their needs? Example: A patient in severe pain cannot focus on discharge teaching - manage pain first, then teach. Motivation and Relevance: People learn best when information is personally meaningful Strategies: Connect teaching to patient's goals and concerns Use motivational interviewing - "What matters to you about managing this condition?" Explain benefits and consequences Support intrinsic motivation (personal values) over extrinsic (external rewards) Health Literacy: Ability to obtain, understand, and use health information Statistics: Nearly 90% of adults struggle with health literacy Strategies for low literacy: Use plain language (5th-6th grade reading level) Avoid medical jargon Use short sentences and simple words Provide visual aids - pictures, diagrams, models Limit information - Focus on 3 key points per session Use teach-back method Language Barriers: Always use certified medical interpreters - Never family members or children Speak directly to patient, not interpreter Provide translated written materials Ensure cultural appropriateness of content Age and Developmental Appropriateness: Match teaching to cognitive and emotional development Children - Use play, simple language, involve parents, use dolls/models Adolescents - Respect privacy, involve in decisions, use digital resources, peer influence Young adults - Goal-oriented, time-efficient, relate to career/family plans Middle adults - Practical application, managing multiple responsibilities Older adults - May need more time, consider sensory changes, build on life experience Learning Styles Visual Learners: Prefer seeing information Use: Pictures, diagrams, videos, written instructions, color coding Example: Providing illustrated medication chart Auditory Learners: Prefer hearing information Use: Verbal explanations, discussions, recordings, reading aloud Example: Explaining procedure step-by-step while patient listens Kinesthetic/Tactile Learners: Prefer hands-on learning Use: Demonstration, practice, simulation, manipulation of objects Example: Allowing patient to practice with wound dressing supplies Reading/Writing Learners: Prefer text-based information Use: Handouts, lists, note-taking, written instructions Best practice: Use multiple modalities to reach all learners - combine verbal explanation with written handout and demonstration. Teaching Strategies Teach-Back Method: Ask patient to explain in their own words what they learned Script: "I want to make sure I explained this clearly. Can you tell me how you'll take your medication at home?" Why it works: Verifies understanding, not just agreement Identifies knowledge gaps Improves retention and adherence No shame - frames as checking the nurse's teaching ability Return Demonstration: Patient performs skill while nurse observes Critical for: Insulin injections, inhaler use, wound care, equipment operation Benefits: Identifies technique errors to correct Builds confidence through practice Ensures safety before discharge SMART Goals: Effective teaching includes setting goals that are: Specific - Clear, focused Measurable - Can assess achievement Achievable - Realistic given patient ability Relevant - Important to patient Time-bound - Has target date Example: "Patient will demonstrate proper inhaler technique before discharge tomorrow" (SMART) vs. "Patient will understand breathing treatment" (vague) ADPIE Framework for Teaching Assessment: What does patient already know? What is their learning style? What is their literacy level and primary language? Are they ready and motivated to learn? What are cultural factors and health beliefs? Analysis/Diagnosis: Identify learning needs Example: "Knowledge deficit related to new diabetes diagnosis as evidenced by inability to explain insulin administration" Planning: Set SMART learning objectives Choose appropriate teaching methods Gather materials Schedule teaching at optimal time Implementation: Use selected teaching strategies Provide information in manageable chunks Check understanding frequently Adapt based on patient response Evaluation: Did patient meet learning objectives? Can they demonstrate understanding (teach-back) or skill (return demonstration)? Do they express confidence in self-management? Is reteaching needed? STRESS AND COPING Understanding Stress What It Is: The body's psychological and physical response to perceived challenges or threats. Stress can be positive (eustress - motivating) or negative (distress - harmful). Stress Response (Fight-or-Flight): When stressed, the body activates sympathetic nervous system: Increased heart rate, blood pressure, cardiac output Faster breathing, bronchodilation Pupil dilation for better vision Increased blood glucose for energy Muscle tension for action Decreased digestion Enhanced alertness Why It Matters: Chronic stress (prolonged, unrelieved) has serious health consequences: Immune suppression - Increased infections and slower healing Cardiovascular effects - Hypertension, increased risk of heart disease and stroke Mental health impact - Depression, anxiety, cognitive impairment Gastrointestinal problems - IBS, ulcers Sleep disturbances Decreased quality of life Types of Stressors Situational: Personal, family, or work-related issues Examples: Chronic illness diagnosis, financial problems, job loss, relationship conflict Adventitious: Rare, unexpected disasters or traumatic events Examples: Natural disasters, accidents, violence, war Socioeconomic: Related to poverty, homelessness, unemployment, discrimination Cultural: Conflicts between personal values and societal expectations, living where cultural beliefs aren't respected Factors Affecting Stress and Coping Individual Factors: Previous coping experiences and success Personality and temperament Physical health status Mental health history Perception of control over situation Support Systems: Family and friend relationships Community connections Access to counseling or support groups Spiritual/religious community Resources: Financial stability Access to healthcare Safe housing Transportation Coping Strategies Adaptive (Healthy) Coping: Problem-focused - Addressing the stressor directly (e.g., creating budget to address financial stress) Emotion-focused - Managing emotional response (e.g., talking with friends, journaling) Exercise and physical activity - Reduces stress hormones Relaxation techniques - Deep breathing, meditation, progressive muscle relaxation Social support - Connecting with others Spiritual practices - Prayer, mindfulness, finding meaning Time management - Prioritizing and organizing Healthy lifestyle - Sleep, nutrition, avoiding substances Maladaptive (Unhealthy) Coping: Substance use/abuse Social isolation and withdrawal Aggressive behavior Avoidance and denial Overeating or restricting food Excessive sleeping or insomnia Nursing Role in Stress Management Assessment: Identify current stressors Evaluate coping patterns (healthy vs. unhealthy) Assess support systems and resources Screen for anxiety, depression Recognize physical manifestations of stress Interventions: Teach stress management - Relaxation techniques, time management, problem-solving Encourage healthy coping - Exercise, social connection, adequate sleep Provide resources - Counseling referrals, support groups, community services Normalize stress responses - Validate feelings Help identify and modify stressors when possible Support self-compassion - Encourage realistic expectations Nurse Self-Care: Nurses experience significant occupational stress. Self-care is essential, not selfish: Set boundaries Take breaks during shifts Practice mindfulness Maintain work-life balance Use employee assistance programs Build peer support Recognize signs of burnout early PROFESSIONAL VALUES AND NURSING ETHICS Core Nursing Values Altruism: Selfless concern for others' welfare Manifestation: Staying late to ensure patient comfort, advocating for vulnerable populations Autonomy: Recognizing individuals' right to self-determination Manifestation: Respecting patient's right to refuse treatment, involving patients in care decisions Human Dignity: Inherent worth and uniqueness of every person Manifestation: Providing care with respect regardless of patient's background, condition, or behavior Integrity: Acting in accordance with ethical standards and being honest Manifestation: Admitting errors, documenting accurately, maintaining professional boundaries Social Justice: Fair and equitable treatment, addressing health disparities Manifestation: Advocating for policies that improve access to care, providing quality care to all patients ANA Code of Ethics - Key Provisions The Code guides ethical nursing practice through 9 provisions (know key concepts): 1. Practice with compassion and respect for dignity and worth of all individuals 2. Primary commitment is to the patient - patient's interests above other considerations 3. Advocate for and protect patient rights, health, and safety 4. Authority, accountability, and responsibility for nursing practice 5. Duty to self - preserve integrity, maintain competence, ensure personal health 6. Establish and maintain ethical environment in practice settings 7. Advance profession through research, scholarship, and practice standards 8. Collaborate with other professions to promote health 9. Articulate nursing values and maintain integrity of profession Professional Identity Development What It Is: How one perceives themselves as a professional, internalizing the values, beliefs, and standards of nursing Components: Technical competence and knowledge Ethical behavior and decision-making Commitment to lifelong learning Professional appearance and behavior Interpersonal and communication skills Concern for others' welfare Avoiding Unprofessional Behavior: Horizontal violence - Nurse-to-nurse bullying, blame, undermining (creates toxic environment) Vertical violence - Abuse of power by those in authority positions Incivility - Rude, disrespectful behavior Boundary violations - Inappropriate relationships with patients SPECIAL TOPICS AND INTEGRATION Medication Calculations Dosage Calculation Formula: Desired Dose ÷ Available Dose × Vehicle (quantity) = Amount to Administer Metric Conversions to Know: 1 gram (g) = 1000 milligrams (mg) 1 milligram (mg) = 1000 micrograms (mcg) 1 liter (L) = 1000 milliliters (mL) Example Problem: Order: 0.1 gram PO daily. Available: 100 mg tablets. How many tablets? Convert: 0.1 g = 100 mg Calculate: 100 mg (desired) ÷ 100 mg (available) × 1 tablet = 1 tablet Example Problem: Order: 15 mg PO. Available: 30 mg/3mL. How many mL? Calculate: 15 mg ÷ 30 mg × 3 mL = 1.5 mL Safety and Risk Reduction Fall Prevention: Falls are the leading cause of trauma in older adults Risk Factors: History of falls Gait/balance problems Orthostatic hypotension Medications (sedatives, antihypertensives) Environmental hazards Cognitive impairment Fear of falling (leads to reduced activity and deconditioning) Prevention Strategies: Declutter environment - remove tripping hazards Ensure adequate lighting Use assistive devices - walkers, canes, grab bars Non-skid footwear Bed/chair alarms for high-risk patients Frequent toileting - many falls occur going to bathroom Regular exercise - strength and balance training Medication review - minimize sedating medications Implicit Bias and Healthcare Disparities Implicit Bias: Unconscious attitudes and stereotypes affecting understanding, actions, and decisions Impact on Healthcare: Affects treatment recommendations Influences communication and rapport Contributes to health disparities Undermines patient-centered care Strategies to Address: Self-awareness - Recognize own biases through reflection and assessment Education - Learn about different cultures and populations Standardized protocols - Reduce variability in care decisions Diverse healthcare workforce - Reflects patient population Cultural humility - Lifelong learning and self-reflection Ask, don't assume - Inquire about individual preferences and beliefs Quality Improvement and Safety Culture QSEN Competencies: Patient-centered care - Respect for patient preferences and values Teamwork and collaboration - Effective interprofessional communication Evidence-based practice - Integrating research into practice Quality improvement - Using data to improve care processes Safety - Minimizing risk of harm Informatics - Using technology effectively Incident Reporting: Purpose is quality improvement, not punishment. Promotes a culture of safety where errors are reported and systems are improved to prevent recurrence. FINAL EXAM SUCCESS STRATEGIES Study Approach Understand Concepts, Don't Just Memorize: Focus on WHY things matter, not just WHAT they are Connect concepts across topics Apply to clinical scenarios Think Like a Professional Nurse: What would be safest? What respects patient autonomy? What addresses the highest priority need? What reflects evidence-based practice? Use Critical Thinking: Consider all options before choosing Eliminate obviously wrong answers Watch for absolutes ("always," "never") - usually incorrect Look for best answer, not just correct answer Test-Taking Tips Priority Questions: Use ABC (airway, breathing, circulation) - physiological needs first Apply Maslow's hierarchy Acute, unstable patients before chronic, stable Assessment before intervention (in most cases) Delegation Questions: Can only delegate to within scope of practice State Nurse Practice Act is ultimate authority RN must do assessment, teaching, planning, evaluation Stable, routine tasks can be delegated to UAP Communication Questions: Therapeutic responses are open-ended, non-judgmental, patient-focused Avoid advice-giving, false reassurance, "why" questions Best answers facilitate further communication Teaching Questions: Teach-back is gold standard for verifying understanding Match teaching to developmental level and learning style Address literacy and language barriers Use certified interpreters, not family Legal/Ethical Questions: Patient autonomy is paramount (competent adults make own decisions) Document facts, not opinions Follow chain of command Report mandatory situations (abuse, communicable diseases) Content Areas to Review Make sure you understand: Nursing process and clinical judgment steps Developmental theories and stages Levels of prevention (primary, secondary, tertiary) Grief stages and types Palliative vs. hospice care Ethical principles and how to apply them Legal concepts (malpractice, negligence, informed consent, advance directives) HIPAA violations Delegation principles and 5 rights Communication techniques (therapeutic and nontherapeutic) Documentation requirements Priority-setting frameworks Domains of learning (cognitive, affective, psychomotor) Teaching strategies and health literacy considerations Social determinants of health Professional nursing roles and competencies Healthcare delivery system components Patricia Benner's stages (novice to expert) KEY TAKEAWAYS FOR EXAM SUCCESS Recurring Themes Across All Topics Patient Safety is Paramount: Always consider what action prevents harm Falls, medication errors, infections are common safety concerns Documentation protects both patient and nurse Proper delegation ensures safe care Patient Autonomy Must Be Respected: Competent adults make their own healthcare decisions Family cannot override competent patient's wishes Informed consent requires understanding, not just signature Advance directives express patient's values Professional Nursing Identity: Defined by autonomy, specialized knowledge, ethical standards Requires critical thinking and clinical judgment, not just task completion Involves advocacy, education, and coordination, not just physical care Demands lifelong learning and professional growth Communication is Fundamental: Therapeutic communication builds trust and gathers information Documentation serves as legal record and communication tool Interprofessional collaboration requires clear, respectful communication Cultural humility improves patient relationships and outcomes Holistic, Patient-Centered Care: Consider physical, emotional, social, spiritual, cultural factors Social determinants significantly affect health outcomes Development stage influences how patients experience and cope with illness Individualized care is more effective than one-size-fits-all approaches Evidence-Based Practice: Nursing practice should be grounded in research and best practices Standards of care come from multiple sources (Nurse Practice Act, ANA Standards, facility policies, evidence-based guidelines) Quality improvement uses data to enhance care Critical thinking evaluates evidence and applies it appropriately Common Question Patterns to Recognize "What should the nurse do FIRST?" Assess before acting (usually) Address physiological needs before psychosocial Use ABC or Maslow's hierarchy Stabilize emergencies before routine care "Which statement indicates understanding?" Look for accurate, complete information in patient's own words Correct statements reflect key concepts taught Misunderstandings may be subtle (watch for reversed information) "Which action requires intervention?" or "What indicates need for further teaching?" Identify the WRONG or unsafe action Recognize violations of principles (sterile technique, scope of practice, safety protocols) "What is the priority?" Unstable, acute conditions before stable, chronic Life-threatening before non-life-threatening Unexpected changes require immediate attention "Which statement by the nurse is most therapeutic?" Open-ended, encourages expression Non-judgmental, patient-focused Avoids advice-giving or false reassurance Facilitates continued communication "What demonstrates the ethical principle of [autonomy/beneficence/etc.]?" Match the action to the principle's definition Autonomy = respecting patient choice Beneficence = doing good for patient Nonmaleficence = avoiding harm Justice = fair treatment Fidelity = keeping promises Veracity = truthfulness Common Mistakes to Avoid Overgeneralizing: Not all older adults have dementia Not all members of a culture share identical beliefs Developmental stages are guidelines, not rigid rules Confusing Similar Concepts: Palliative care ≠ only end-of-life (can be provided with curative treatment) Hospice = specialized palliative care for terminal illness LPN/LVN scope differs from RN scope Assessment (gathering data) ≠ Analysis (interpreting data) Grief stages are not linear or universal Assuming Rather Than Assessing: Always assess patient's individual situation Don't assume family speaks for competent patient Don't assume pain level without asking Verify understanding rather than assuming patient "got it" Ignoring Legal Requirements: Mandatory reporting laws require action, not just documentation Informed consent has specific requirements HIPAA protections apply to all patient information Scope of practice limits what can be delegated Choosing Ineffective Communication: Avoid "why" questions (sound judgmental) Don't offer false reassurance ("Everything will be fine") Don't give advice ("You should...") Don't change subject when patient brings up concerns How to Approach Complex Scenarios Read Carefully: Identify the key issue or problem Note relevant patient information (age, diagnosis, symptoms, vital signs) Recognize what the question is really asking Apply Frameworks: Use nursing process: What step am I in? Use priority frameworks: What's most urgent? Use ethical principles: What respects patient rights? Consider Context: Developmental stage affects appropriate interventions Cultural factors may influence patient responses Setting matters (home vs. hospital vs. clinic) Think "Nursing Judgment": What would a reasonable, prudent nurse do? What promotes safety and positive outcomes? What reflects professional nursing values? FINAL THOUGHTS Beyond the Exam The concepts in this guide aren't just for passing tests—they form the foundation of professional nursing practice. Understanding why things matter, not just memorizing facts, will serve you throughout your nursing career. Remember: Critical thinking is more valuable than memorization Patient safety is always the priority Therapeutic communication builds trust and improves outcomes Cultural humility enhances care for diverse patients Ethical practice defines nursing professionalism Lifelong learning is essential for competent practice Self-care enables you to care for others Study Plan Recommendations 1-2 Weeks Before Exam: Review this guide thoroughly Focus on areas of weakness Complete practice questions Review ATI modules and course materials Attend any review sessions Few Days Before: Summarize key concepts in your own words Review priority-setting frameworks Practice medication calculations Quiz yourself on key terms and definitions Day Before: Light review only—avoid cramming Get adequate sleep (crucial for memory and critical thinking) Prepare materials needed for exam Practice stress management techniques Day of Exam: Eat a good breakfast Arrive early to reduce stress Read questions carefully Trust your preparation Remember: You've learned this material! You've Got This! You've worked hard throughout the semester, engaged with complex material, and developed critical thinking skills. Trust your knowledge, apply the frameworks you've learned, and think like the professional nurse you're becoming. This guide complements your course materials—use both together for comprehensive preparation. Good luck on your final exam! QUICK REFERENCE CHARTS Nursing Process Quick Reference Step Purpose Assessment Gather data Analysis Identify problems Planning Implementation Key Activities Interview, physical exam, review records Documentation Subjective and objective findings Interpret data, formulate nursing Problem statements with related diagnoses factors Set goals and Establish SMART goals, identify Expected outcomes and planned interventions actions interventions Take action Carry out interventions What was done, patient response Step Evaluation Purpose Key Activities Documentation Determine Compare actual to expected Goal achievement, plan modifications effectiveness outcomes needed Delegation Quick Reference CAN Delegate to UAP/CNA CANNOT Delegate (RN Only) Vital signs (stable patients) Initial assessment Basic hygiene care Nursing diagnosis/analysis Feeding (non-aspiration risk) Care planning Ambulation assistance Patient teaching I&O documentation Medication administration* Positioning IV management Simple dressing changes (non-sterile) Sterile procedures Unstable patients Evaluation of outcomes *Some states allow LPN/LVN medication administration under RN supervision Priority Setting Quick Guide Use This Framework When...: ABC/ABCDE → Multiple body systems affected or emergency Maslow's Hierarchy → Deciding between physiological and psychosocial needs Acute vs. Chronic → Prioritizing between new and ongoing problems Stable vs. Unstable → Determining which patient to see first Nursing Process → Generally assess before implementing Therapeutic Communication Quick Tips ✓ DO: Use open-ended questions Sit at eye level Allow silence for processing Reflect feelings back Clarify unclear statements Summarize key points Show empathy ✗ DON'T: Ask "why" (sounds judgmental) Give advice Offer false reassurance Share your own stories Minimize feelings Change subject abruptly Rush the conversation Documentation Principles Remember: FACTUAL Factual - objective observations Accurate - correct information Complete - all relevant details Timely - documented promptly Understandable - clear, legible Appropriate - relevant to care Legal - serves as legal record Remember: This guide is a tool for understanding, not a replacement for your required readings, lectures, and ATI materials. Use it to synthesize information and develop critical thinking for both exam success and clinical excellence. Study smart, think critically, and trust your nursing judgment. You're preparing to enter a noble profession—embrace the challenge!