1
ATI CMS Fundamentals, 2026–2027 Edition,
Verified Study Set with Questions & Notes (A+
Graded Preparation Resource)
PART 1: QUICK REVIEW NOTES
DOMAIN 1: SAFE, EFFECTIVE CARE ENVIRONMENT
Advance Directives
• Living Will: Written statement of client's end-of-life wishes; activated when client is
terminally ill or permanently unconscious.
• Durable Power of Attorney for Health Care (DPOA): Designates a surrogate decision-
maker; remains valid if client becomes incapacitated.
• DNR/DNI: Provider order; RN ensures provider order is current, signed, and visible in
chart/emergency documents.
• Nursing Role: Verify existence, document in record, ensure copies are accessible, honor
client wishes; do not witness if family member or if there is conflict of interest.
• Client must be competent to establish or revoke; revocation can be verbal.
• HIPAA: Advance directive information may be shared with relevant treatment team
members.
HIPAA
• Protected Health Information (PHI): Any information that identifies the client and relates
to health status, provision of care, or payment.
• Minimum Necessary Standard: Only access/use/disclose the minimum necessary PHI to
perform job duties.
, 2
• Permitted Disclosures: TPO (Treatment, Payment, Operations); public health authorities;
abuse/neglect reporting; court orders/subpoenas; law enforcement (limited
circumstances); client authorization.
• Violations: Discussing clients in public areas, leaving charts open, accessing records not
needed for job, throwing PHI in regular trash.
• Client Rights: Access their own medical record, request amendments, accounting of
disclosures.
Informed Consent
• Provider Responsibility: Explain procedure, risks, benefits, alternatives, consequences of
refusal.
• RN Responsibility: Verify consent is signed, witness signature (if required by facility),
confirm client understands what was explained, ensure client is competent and voluntary.
• RN does NOT explain the procedure (that is practicing medicine without a license if scope
is exceeded).
• Emergency Exception: Life or limb threatened, unable to obtain consent, reasonable
person would consent; document thoroughly.
• Minors/Guardians: Parent/guardian consents except emancipated minors, mature minor
laws (varies by state), emergency.
• Competency: Client must understand information and consequences; impaired clients
(sedation, psychosis, dementia) cannot consent.
Incident Reports
• Purpose: Quality improvement and risk management; not part of the medical record.
• Documentation in Chart: Document factual observations, assessments, interventions,
client response; do not mention "incident report" in the chart.
• Do not place incident report in client chart or reference it.
• Who completes: Usually the nurse involved or supervisor per facility policy.
Torts
• Negligence: Failure to act as a reasonably prudent person would under similar
circumstances.
, 3
• Malpractice: Professional negligence; breach of duty that causes injury (4 elements: duty,
breach, causation, damages).
• Assault: Threat to touch without consent.
• Battery: Actual unauthorized touching or procedure performed without consent.
• False Imprisonment: Unjustified restraint of client without legal warrant (e.g.,
inappropriate use of restraints, threats to keep client).
• Defamation: Libel (written) or slander (spoken) false statements that injure reputation.
• Invasion of Privacy: Disclosing private information, intrusion into client's affairs.
Delegation & Scope of Practice
• RN: Assessment, planning, evaluation, teaching, complex procedures, IV push meds (varies
by state), initial assessments, discharge teaching.
• LPN/LVN: Data collection, medication administration (PO, IM, subQ, some IV piggybacks
per facility), wound care, stable clients, reinforce teaching (cannot do initial teaching).
• UAP/AP: ADLs, vital signs on stable clients, ambulation, feeding, bathing, bed making, I&O,
specimen collection (non-invasive), glucose monitoring (if trained and delegated).
• 5 Rights of Delegation: Right task, right circumstance, right person, right
direction/communication, right supervision/evaluation.
• Do not delegate: Assessment, planning, evaluation, teaching, judgment, unstable clients,
invasive procedures.
Triage & Emergency Response
• Emergency Triage Categories (3-tier): Emergent (life-threatening, immediate), Urgent
(potential to become life-threatening, 30-60 min), Non-urgent (non-life-threatening, >1 hr).
• START Triage (Disaster): Simple Triage and Rapid Treatment; evaluate Respirations,
Perfusion (radial pulse), Mental Status (RPM).
o Black (Deceased/Expectant): Not breathing after airway opened.
o Red (Immediate): Breathing but immediate threat to life.
o Yellow (Delayed): Serious but can wait for transport.
o Green (Minor/Walking Wounded): Ambulatory.
• Internal Disasters: Fire (RACE: Rescue, Alarm, Confine, Extinguish/Evacuate), Code (client
emergency), Bomb threat, Severe weather.
, 4
DOMAIN 2: HEALTH PROMOTION & MAINTENANCE
Developmental Stages (Erikson)
• Infant (0-1): Trust vs. Mistrust; meet needs consistently.
• Toddler (1-3): Autonomy vs. Shame/Doubt; offer choices, allow independence.
• Preschool (3-6): Initiative vs. Guilt; answer questions, allow imaginative play.
• School Age (6-12): Industry vs. Inferiority; praise accomplishments, encourage peer
interaction.
• Adolescent (12-18): Identity vs. Role Confusion; support identity exploration, peer
acceptance.
• Young Adult (18-40): Intimacy vs. Isolation; develop relationships, career.
• Middle Adult (40-65): Generativity vs. Stagnation; mentor, contribute to community.
• Older Adult (65+): Integrity vs. Despair; life review, acceptance of mortality.
Health Screening Guidelines
• Mammography: Every 2 years for women 40-74 (USPSTF biennial starting 40).
• Cervical Cancer (Pap): Every 3 years (21-29); HPV co-testing every 5 years (30-65) or Pap
alone every 3 years.
• Colorectal Cancer: 45+ years (stool-based tests, colonoscopy every 10 years, CT
colonography every 5 years).
• Blood Pressure: All adults ≥18 at every health care visit; annually if normal.
• Lipids: Every 4-6 years for adults 20+; more frequently with risk factors.
• Diabetes (T2DM): Screen adults 35-70 who are overweight/obese; earlier with risk
factors.
• Osteoporosis: Women 65+; men 70+; earlier with risk factors (DEXA scan).
• Prostate (PSA): Shared decision-making for men 55-69.
• Lung Cancer (Low-dose CT): Annual for adults 50-80 with 20 pack-year history who
currently smoke or quit within 15 years.
Lifestyle & Prevention
ATI CMS Fundamentals, 2026–2027 Edition,
Verified Study Set with Questions & Notes (A+
Graded Preparation Resource)
PART 1: QUICK REVIEW NOTES
DOMAIN 1: SAFE, EFFECTIVE CARE ENVIRONMENT
Advance Directives
• Living Will: Written statement of client's end-of-life wishes; activated when client is
terminally ill or permanently unconscious.
• Durable Power of Attorney for Health Care (DPOA): Designates a surrogate decision-
maker; remains valid if client becomes incapacitated.
• DNR/DNI: Provider order; RN ensures provider order is current, signed, and visible in
chart/emergency documents.
• Nursing Role: Verify existence, document in record, ensure copies are accessible, honor
client wishes; do not witness if family member or if there is conflict of interest.
• Client must be competent to establish or revoke; revocation can be verbal.
• HIPAA: Advance directive information may be shared with relevant treatment team
members.
HIPAA
• Protected Health Information (PHI): Any information that identifies the client and relates
to health status, provision of care, or payment.
• Minimum Necessary Standard: Only access/use/disclose the minimum necessary PHI to
perform job duties.
, 2
• Permitted Disclosures: TPO (Treatment, Payment, Operations); public health authorities;
abuse/neglect reporting; court orders/subpoenas; law enforcement (limited
circumstances); client authorization.
• Violations: Discussing clients in public areas, leaving charts open, accessing records not
needed for job, throwing PHI in regular trash.
• Client Rights: Access their own medical record, request amendments, accounting of
disclosures.
Informed Consent
• Provider Responsibility: Explain procedure, risks, benefits, alternatives, consequences of
refusal.
• RN Responsibility: Verify consent is signed, witness signature (if required by facility),
confirm client understands what was explained, ensure client is competent and voluntary.
• RN does NOT explain the procedure (that is practicing medicine without a license if scope
is exceeded).
• Emergency Exception: Life or limb threatened, unable to obtain consent, reasonable
person would consent; document thoroughly.
• Minors/Guardians: Parent/guardian consents except emancipated minors, mature minor
laws (varies by state), emergency.
• Competency: Client must understand information and consequences; impaired clients
(sedation, psychosis, dementia) cannot consent.
Incident Reports
• Purpose: Quality improvement and risk management; not part of the medical record.
• Documentation in Chart: Document factual observations, assessments, interventions,
client response; do not mention "incident report" in the chart.
• Do not place incident report in client chart or reference it.
• Who completes: Usually the nurse involved or supervisor per facility policy.
Torts
• Negligence: Failure to act as a reasonably prudent person would under similar
circumstances.
, 3
• Malpractice: Professional negligence; breach of duty that causes injury (4 elements: duty,
breach, causation, damages).
• Assault: Threat to touch without consent.
• Battery: Actual unauthorized touching or procedure performed without consent.
• False Imprisonment: Unjustified restraint of client without legal warrant (e.g.,
inappropriate use of restraints, threats to keep client).
• Defamation: Libel (written) or slander (spoken) false statements that injure reputation.
• Invasion of Privacy: Disclosing private information, intrusion into client's affairs.
Delegation & Scope of Practice
• RN: Assessment, planning, evaluation, teaching, complex procedures, IV push meds (varies
by state), initial assessments, discharge teaching.
• LPN/LVN: Data collection, medication administration (PO, IM, subQ, some IV piggybacks
per facility), wound care, stable clients, reinforce teaching (cannot do initial teaching).
• UAP/AP: ADLs, vital signs on stable clients, ambulation, feeding, bathing, bed making, I&O,
specimen collection (non-invasive), glucose monitoring (if trained and delegated).
• 5 Rights of Delegation: Right task, right circumstance, right person, right
direction/communication, right supervision/evaluation.
• Do not delegate: Assessment, planning, evaluation, teaching, judgment, unstable clients,
invasive procedures.
Triage & Emergency Response
• Emergency Triage Categories (3-tier): Emergent (life-threatening, immediate), Urgent
(potential to become life-threatening, 30-60 min), Non-urgent (non-life-threatening, >1 hr).
• START Triage (Disaster): Simple Triage and Rapid Treatment; evaluate Respirations,
Perfusion (radial pulse), Mental Status (RPM).
o Black (Deceased/Expectant): Not breathing after airway opened.
o Red (Immediate): Breathing but immediate threat to life.
o Yellow (Delayed): Serious but can wait for transport.
o Green (Minor/Walking Wounded): Ambulatory.
• Internal Disasters: Fire (RACE: Rescue, Alarm, Confine, Extinguish/Evacuate), Code (client
emergency), Bomb threat, Severe weather.
, 4
DOMAIN 2: HEALTH PROMOTION & MAINTENANCE
Developmental Stages (Erikson)
• Infant (0-1): Trust vs. Mistrust; meet needs consistently.
• Toddler (1-3): Autonomy vs. Shame/Doubt; offer choices, allow independence.
• Preschool (3-6): Initiative vs. Guilt; answer questions, allow imaginative play.
• School Age (6-12): Industry vs. Inferiority; praise accomplishments, encourage peer
interaction.
• Adolescent (12-18): Identity vs. Role Confusion; support identity exploration, peer
acceptance.
• Young Adult (18-40): Intimacy vs. Isolation; develop relationships, career.
• Middle Adult (40-65): Generativity vs. Stagnation; mentor, contribute to community.
• Older Adult (65+): Integrity vs. Despair; life review, acceptance of mortality.
Health Screening Guidelines
• Mammography: Every 2 years for women 40-74 (USPSTF biennial starting 40).
• Cervical Cancer (Pap): Every 3 years (21-29); HPV co-testing every 5 years (30-65) or Pap
alone every 3 years.
• Colorectal Cancer: 45+ years (stool-based tests, colonoscopy every 10 years, CT
colonography every 5 years).
• Blood Pressure: All adults ≥18 at every health care visit; annually if normal.
• Lipids: Every 4-6 years for adults 20+; more frequently with risk factors.
• Diabetes (T2DM): Screen adults 35-70 who are overweight/obese; earlier with risk
factors.
• Osteoporosis: Women 65+; men 70+; earlier with risk factors (DEXA scan).
• Prostate (PSA): Shared decision-making for men 55-69.
• Lung Cancer (Low-dose CT): Annual for adults 50-80 with 20 pack-year history who
currently smoke or quit within 15 years.
Lifestyle & Prevention
