ATI EXIT/NCLEX (PN) EXAM STUDY GUIDE
Coordinated Care
Advanced Directives
(Legal responsibilities: Reinforcing teaching about advance directives)
What is the purpose of Advance Directives?
- To communicate a client's wishes regarding end-of-life care should the client become
unable to do so.
Life saving measures?
- Resuscitation, intubation, artificial hydration, and nutrition
Who can prescribe a DNR?
- Only the doctor
Living will?
- A written statement detailing a person’s desires regarding their medical treatment in
circumstances in which they are no longer able to express informed consent.
What is the durable power of attorney is the same as?
- Health care proxy/surrogate: people who can make clients decisions when client is unable
to
Advocacy
(Legal responsibilities: Client advocacy)
Main goal: protect clients rights and advocate on behalf of the client.
- Self-actualization: highest level of Maslow’s hierarchy of needs, representing the
fulfillment of one’s full potential
Nurses Role:
- Nurses' role in supporting clients by ensuring that they are properly informed, that their
rights are respected, and that they are receiving the proper level of care and developing
and growing towards self-actualization.
- Nurses are accountable for actions even if they are carrying out providers orders.
Situations:
(In which nurses might need to advocate for clients or assist them to advocate for themselves)
- End-of-life decisions.
- Access to health care
- Protection of client privacy
- Informed consent
- Substandard practice
,Assignments/Delegations
(Managing client care: Delegating client care task to an AP)
(Managing client care: Delegating task to an Ap)
- Delegating care/task to an AP
o Working within the scope of practice
§ ADL’s, bathing, grooming, toileting, ambulating, vitals, feeding (w/o
swallowing precautions), specimen collection, I+O’s.
Assignment Factors:
- Client factors
o Complexity of care needed.
o Specific care needs (cardiac monitoring, mechanical vent)
o Need for special precautions (private room w/ negative pressure, fall precautions,
seizure precautions, isolation precautions
- Healthcare team factors
o Skills
o Experience
o Nurse-to-client ratio
Client Rights
(Cancer treatment options: therapeutic response for a client who is receiving chemotherapy)
Goal: Focuses on managing side effects, ensuring treatment efficiency, and promoting overall well-being
Types of cancer treatment options:
- Chemotherapy
- Surgical interventions
- Hormone therapy
- Radiation therapy
- Immunotherapy
Key considerations:
- Monitoring treatment response
o Assess for signs of tumor reduction, symptom improvement, and lab values (CBC,
kidney/liver function test, and tumor markers)
o Monitor for adverse effects
§ Bone marrow suppression
§ Nausea/Vomiting
§ Stomatitis
§ Peripheral Neuropathy
- Managing side effects
o Bone marrow suppression (neutropenia, anemia, thrombocytopenia)
§ Monitor CBC regularly
§ Infection prevention
• Avoiding crowds, hand hygiene, neutropenic precautions
o Nausea/Vomiting
§ Antiemetics (e.g., ondansetron, metoclopramide) before and after treatments
§ Encourage small frequent meals and hydration
, o Stomatitis
§ Provide oral care with a soft toothbrush
§ Avoid acidic, spicy foods
§ Use gravies a food softener
§ Rinse mouth with saline solution
o Peripheral Neuropathy
§ Monitor for numbness, tingling, and weakness
§ Implement fall precautions
o Emotional/Psychosocial
§ Encourage open communication (talk about feelings/concerns)
§ Provide counseling and encourage support groups
§ Educate on managing changes in body image and fatigue
o Client Education
§ Reinforce proper nutrition and hydration
§ Reinforce teaching on take medications as prescribed
(Professional responsibilities: reinforcing teaching about informed consent)
Informed consent
- a legal document that clients must sign for an invasive procedure stating that they
understand their medical treatment options, risk, and benefits and voluntarily agree to the
procedure/treatment.
Elements of informed consent:
- Explanation of procedure/treatment à purpose, expected outcomes.
- Potential risk and benefits
- Alternative treatment options à including no treatment.
- Right to refuse or withdraw consent at any time.
Who can give informed consent?
- A competent adult (18+)
- A parent or legal guardian
- A durable power of attorney/health care proxy
Nurses Role
- Ensure that provider explained the procedure (Risk/Benefits/ Alternative options)
- Assess the clients understanding à reinforce teaching if needed
- Witness signature of consent form
- Document the process.
- Notify provider if client has additional questions
Example scenarios
1. Client is unsure or has questions à Notify provider to clarify before signing
2. Client is sedated or confused à consent should not be obtained until client is fully
alert/oriented
3. Client refuses treatment à Respect clients decision and document refusal
4. Emergency situations and no consent available à treat patient with implied consent (life
saving intervention)
, Collaboration with interdisciplinary team
(Coordinating client care: client to recommend for a interprofessional conference)
Interprofessional conference
- Involves a team of healthcare professionals collaborating to develop a care plan for a
client.
Who should nurse recommend?
- Clients who have complex needs requiring coordination between multiple disciplines
o Clients with complex medical conditions
§ Chronic illnesses (diabetes, heart failure, COPD, cancer) àclients who
require input from specialist
§ Clients with multiple comorbidities affecting care and treatment decisions
o Need for rehabilitation or therapy
§ Stroke clients needing PT, OT, and speech therapy
§ Clients with TBI’s or spinal cord injuries needing long term rehab
o Clients with discharge planning and home care needs
§ Home health services, medical equipment, fall risk, limited family
support, need for caregiver
o Clients with psychosocial and mental health needs
• Substance abuse disorders, schizophrenia, bipolar disorder,
neglect, abuse, homelessness
o Clients with end of life or palliative care
§ Terminally ill clients (hospice care, pain management, emotional support)
§ Clients and families needing ethical decision-making assistance regarding
life sustain treatments
Healthcare team members involved in the conference?
- Primary care provider: oversees medical treatment
- Nurse: coordinates care, assess needs, provides client education and treatment, advocate
- Case manager/ social worker: assist with discharge planning, community resources
- PT/OT/Speech therapy: address mobility, self-care, and communication deficits
- Dietician: provides nutritional guidance and special diets
- Pharmacist: assess medication interactions and adherence strategies
- Psychologist/counselor: provides mental/emotional support
Coordinated Care
Advanced Directives
(Legal responsibilities: Reinforcing teaching about advance directives)
What is the purpose of Advance Directives?
- To communicate a client's wishes regarding end-of-life care should the client become
unable to do so.
Life saving measures?
- Resuscitation, intubation, artificial hydration, and nutrition
Who can prescribe a DNR?
- Only the doctor
Living will?
- A written statement detailing a person’s desires regarding their medical treatment in
circumstances in which they are no longer able to express informed consent.
What is the durable power of attorney is the same as?
- Health care proxy/surrogate: people who can make clients decisions when client is unable
to
Advocacy
(Legal responsibilities: Client advocacy)
Main goal: protect clients rights and advocate on behalf of the client.
- Self-actualization: highest level of Maslow’s hierarchy of needs, representing the
fulfillment of one’s full potential
Nurses Role:
- Nurses' role in supporting clients by ensuring that they are properly informed, that their
rights are respected, and that they are receiving the proper level of care and developing
and growing towards self-actualization.
- Nurses are accountable for actions even if they are carrying out providers orders.
Situations:
(In which nurses might need to advocate for clients or assist them to advocate for themselves)
- End-of-life decisions.
- Access to health care
- Protection of client privacy
- Informed consent
- Substandard practice
,Assignments/Delegations
(Managing client care: Delegating client care task to an AP)
(Managing client care: Delegating task to an Ap)
- Delegating care/task to an AP
o Working within the scope of practice
§ ADL’s, bathing, grooming, toileting, ambulating, vitals, feeding (w/o
swallowing precautions), specimen collection, I+O’s.
Assignment Factors:
- Client factors
o Complexity of care needed.
o Specific care needs (cardiac monitoring, mechanical vent)
o Need for special precautions (private room w/ negative pressure, fall precautions,
seizure precautions, isolation precautions
- Healthcare team factors
o Skills
o Experience
o Nurse-to-client ratio
Client Rights
(Cancer treatment options: therapeutic response for a client who is receiving chemotherapy)
Goal: Focuses on managing side effects, ensuring treatment efficiency, and promoting overall well-being
Types of cancer treatment options:
- Chemotherapy
- Surgical interventions
- Hormone therapy
- Radiation therapy
- Immunotherapy
Key considerations:
- Monitoring treatment response
o Assess for signs of tumor reduction, symptom improvement, and lab values (CBC,
kidney/liver function test, and tumor markers)
o Monitor for adverse effects
§ Bone marrow suppression
§ Nausea/Vomiting
§ Stomatitis
§ Peripheral Neuropathy
- Managing side effects
o Bone marrow suppression (neutropenia, anemia, thrombocytopenia)
§ Monitor CBC regularly
§ Infection prevention
• Avoiding crowds, hand hygiene, neutropenic precautions
o Nausea/Vomiting
§ Antiemetics (e.g., ondansetron, metoclopramide) before and after treatments
§ Encourage small frequent meals and hydration
, o Stomatitis
§ Provide oral care with a soft toothbrush
§ Avoid acidic, spicy foods
§ Use gravies a food softener
§ Rinse mouth with saline solution
o Peripheral Neuropathy
§ Monitor for numbness, tingling, and weakness
§ Implement fall precautions
o Emotional/Psychosocial
§ Encourage open communication (talk about feelings/concerns)
§ Provide counseling and encourage support groups
§ Educate on managing changes in body image and fatigue
o Client Education
§ Reinforce proper nutrition and hydration
§ Reinforce teaching on take medications as prescribed
(Professional responsibilities: reinforcing teaching about informed consent)
Informed consent
- a legal document that clients must sign for an invasive procedure stating that they
understand their medical treatment options, risk, and benefits and voluntarily agree to the
procedure/treatment.
Elements of informed consent:
- Explanation of procedure/treatment à purpose, expected outcomes.
- Potential risk and benefits
- Alternative treatment options à including no treatment.
- Right to refuse or withdraw consent at any time.
Who can give informed consent?
- A competent adult (18+)
- A parent or legal guardian
- A durable power of attorney/health care proxy
Nurses Role
- Ensure that provider explained the procedure (Risk/Benefits/ Alternative options)
- Assess the clients understanding à reinforce teaching if needed
- Witness signature of consent form
- Document the process.
- Notify provider if client has additional questions
Example scenarios
1. Client is unsure or has questions à Notify provider to clarify before signing
2. Client is sedated or confused à consent should not be obtained until client is fully
alert/oriented
3. Client refuses treatment à Respect clients decision and document refusal
4. Emergency situations and no consent available à treat patient with implied consent (life
saving intervention)
, Collaboration with interdisciplinary team
(Coordinating client care: client to recommend for a interprofessional conference)
Interprofessional conference
- Involves a team of healthcare professionals collaborating to develop a care plan for a
client.
Who should nurse recommend?
- Clients who have complex needs requiring coordination between multiple disciplines
o Clients with complex medical conditions
§ Chronic illnesses (diabetes, heart failure, COPD, cancer) àclients who
require input from specialist
§ Clients with multiple comorbidities affecting care and treatment decisions
o Need for rehabilitation or therapy
§ Stroke clients needing PT, OT, and speech therapy
§ Clients with TBI’s or spinal cord injuries needing long term rehab
o Clients with discharge planning and home care needs
§ Home health services, medical equipment, fall risk, limited family
support, need for caregiver
o Clients with psychosocial and mental health needs
• Substance abuse disorders, schizophrenia, bipolar disorder,
neglect, abuse, homelessness
o Clients with end of life or palliative care
§ Terminally ill clients (hospice care, pain management, emotional support)
§ Clients and families needing ethical decision-making assistance regarding
life sustain treatments
Healthcare team members involved in the conference?
- Primary care provider: oversees medical treatment
- Nurse: coordinates care, assess needs, provides client education and treatment, advocate
- Case manager/ social worker: assist with discharge planning, community resources
- PT/OT/Speech therapy: address mobility, self-care, and communication deficits
- Dietician: provides nutritional guidance and special diets
- Pharmacist: assess medication interactions and adherence strategies
- Psychologist/counselor: provides mental/emotional support
