NUR 185 / NUR185 Final Exam | Hondros College of Nursing 2026 | Questions with Correct Answers & Detailed Rationales | Latest Update | Guaranteed Pass | Grade A | Fundamentals of Nursing & NCLEX-RN® Prep PDF

INSTANT PDF DOWNLOAD—This is the comprehensive final exam preparation guide for NUR 185 / NUR185 at Hondros College of Nursing (2026 Update) , featuring questions with correct answers and detailed rationales. Designed for nursing students in their foundational nursing courses at Hondros College of Nursing, this resource consolidates the critical nursing concepts required to master the NUR185 final exam and excel in the nursing program. The guide is meticulously aligned with the Hondros College curriculum, the NCLEX-RN® test plan, and current evidence-based practice standards. This verified resource provides comprehensive coverage of key NUR185 nursing exam topics, including: Foundations of Nursing Practice (nursing history—Florence Nightingale, Clara Barton, Dorothea Dix, Lillian Wald, Mary Mahoney, Virginia Henderson; nursing theories—Nightingale's Environmental Theory, Henderson's Need Theory, Orem's Self-Care Deficit Theory, Roy's Adaptation Model, Watson's Theory of Human Caring, Benner's Novice to Expert; nursing process—ADPIE: assessment, diagnosis, planning, implementation, evaluation; critical thinking and clinical judgment; Tanner's Clinical Judgment Model; NCSBN Clinical Judgment Measurement Model—recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action, evaluate outcomes); Patient Safety and Infection Control (National Patient Safety Goals; hand hygiene—alcohol-based hand rub, soap and water; standard precautions; transmission-based precautions—contact precautions, droplet precautions, airborne precautions; personal protective equipment (PPE)—gloves, gown, mask, eye protection, face shield, N95 respirator; medical asepsis (clean technique) vs surgical asepsis (sterile technique); sterile field setup; sterile gloving; surgical scrub; infection prevention; healthcare-associated infections (HAIs)—catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), surgical site infection (SSI); multidrug-resistant organisms (MDROs)—MRSA, VRE, CRE, ESBL, carbapenem-resistant Enterobacteriaceae, C. difficile; isolation precautions; patient placement; cohorting; dedicated equipment; environmental cleaning; linens and waste management); Vital Signs and Physical Assessment (temperature—normal range 96.8°F-100.4°F (36°C-38°C), fever (pyrexia), hyperthermia, hypothermia, sites—oral, rectal, axillary, tympanic, temporal, skin; pulse—rate (60-100 bpm), rhythm, quality (amplitude), peripheral pulses, apical pulse, pulse deficit; respirations—rate (12-20 breaths/min), depth, pattern, eupnea, tachypnea, bradypnea, apnea, Cheyne-Stokes, Kussmaul, Biot's, hypoventilation, hyperventilation; blood pressure—systolic, diastolic, Korotkoff sounds (Phase I-V), hypertension (SBP ≥130 or DBP ≥80), hypotension (SBP 90 or DBP 60), orthostatic hypotension (drop ≥20 mmHg systolic or ≥10 mmHg diastolic upon standing); pain assessment—PQRST (Provocation/Palliation, Quality, Region/Radiation, Severity, Timing), pain scales (numeric 0-10, Wong-Baker FACES, FLACC for children, CRIES for neonates, PAINAD for older adults, CPOT for critically ill); pulse oximetry (SpO₂) - normal 95-100%, limitations (dark nail polish, poor perfusion, motion artifact, carbon monoxide poisoning), supplemental oxygen; Health Assessment (health history—biographical data, chief complaint, history of present illness (HPI), past medical history (PMH), family history (FH), social history (SH), review of systems (ROS); physical examination techniques—inspection (visual examination), palpation (touch—light, deep, bimanual), percussion (tapping—direct, indirect, blunt), auscultation (listening—bell for low-frequency sounds, diaphragm for high-frequency sounds); head-to-toe assessment sequence; documentation—SOAP notes (Subjective, Objective, Assessment, Plan), DAR notes (Data, Action, Response), narrative charting, flow sheets, electronic health record (EHR); focused assessment vs comprehensive assessment; Medication Administration (medication safety—five rights of medication administration: right patient (two patient identifiers—name, date of birth, medical record number), right drug (medication label check—three times, compare to MAR), right dose (dosage calculation, unit dose, liquid measure), right route (PO, SL, buccal, topical, transdermal, ophthalmic, otic, nasal, inhaled, rectal, vaginal, subQ, IM, ID, IV), right time (scheduled time, PRN, now, stat, frequency—daily, BID, TID, QID, Q4H, Q6H, Q8H, Q12H, AC, PC, HS); additional rights—right documentation, right reason, right response, right to refuse, right education; medication reconciliation—admission, transfer, discharge; medication administration record (MAR); routes of administration—oral (PO) - tablets, capsules, liquids; sublingual (SL); buccal; topical—creams, ointments, lotions, patches, powders; transdermal—patch application, rotation sites, patch removal; ophthalmic—eye drops, eye ointment; otic—ear drops; nasal—spray, drops; inhaled—metered-dose inhaler (MDI), dry powder inhaler (DPI), nebulizer; rectal—suppository, enema; vaginal—cream, suppository, tablet; subcutaneous (subQ)—injection sites (abdomen, upper arm, anterior thigh), needle gauge 25-31, volume ≤1 mL, angle 45-90 degrees; intramuscular (IM)—injection sites (deltoid—1-2 mL, vastus lateralis—up to 3 mL, ventrogluteal—up to 3 mL, dorsogluteal—no longer recommended due to sciatic nerve), needle gauge 20-23, volume up to 3 mL, angle 90 degrees, Z-track technique; intradermal (ID)—injection sites (forearm, upper back), needle gauge 26-27, volume 0.01-0.1 mL, angle 10-15 degrees, bleb formation; intravenous (IV)—peripheral IV insertion, site selection (cephalic, basilic, median cubital veins), catheter gauge (14-26, 18-20 most common), dressing, securement, flushing, IV push, intermittent IV infusion (piggyback), continuous IV infusion, IV pump, IV tubing (primary, secondary), IV solution compatibility, IV site assessment, complications—infiltration (coolness, swelling, pallor), extravasation (vesicant medications), phlebitis (redness, warmth, tenderness, palpable venous cord), infection (purulence, fever, chills, tachycardia), hematoma, air embolism, speed shock, fluid overload; dosage calculations—desired over have method, ratio and proportion, dimensional analysis, formula method; high-alert medications—insulin, heparin, warfarin, opioids, potassium chloride, neuromuscular blocking agents, chemotherapy agents; look-alike sound-alike medications (LASA)—INSULIN (Humalog vs Humulin), HYDROmorphone vs MORPHine, Lortab vs Lorazepam, Celebrex vs Celexa vs Cerebyx; tall man lettering—HYDROmorphone, MORPHine, DOPamine, DOBUTamine, vinBLAStine, vinCRIStine; medication error prevention—independent double check, barcode medication administration (BCMA), automated dispensing cabinet (ADC) - Pyxis, Omnicell, medication reconciliation, patient education; medication error reporting—root cause analysis, near miss, just culture, incident report, state board of nursing reporting); Basic Care and Comfort (hygiene—bathing (complete bed bath, partial bed bath, tub bath, shower), perineal care (pericare), oral hygiene (toothbrushing, flossing, denture care), foot care (diabetic foot care, nail care), hair care (shampooing, combing, styling), shaving (electric razor, safety razor), bed-making (closed bed, open bed, occupied bed, surgical bed); mobility—body mechanics (wide base of support, low center of gravity, facing direction of movement, use of large muscles), safe patient handling (transfer belt/gait belt, slide board, mechanical lift (Hoyer lift), ceiling lift, sit-to-stand lift), positioning—supine, prone, lateral (side-lying), Sims' (semi-prone), Fowler's (semi-sitting—low, semi, high), Trendelenburg (feet elevated, head down), reverse Trendelenburg (head elevated, feet down), lithotomy, knee-chest, jackknife; range of motion (ROM)—active (patient performs), passive (nurse performs), active-assistive (patient performs with assistance); turning and repositioning schedule (every 2 hours); transfer techniques—transfer belt, slide board, mechanical lift, pivot transfer; ambulation—gait belt, cane (standard, quad), walker (standard, wheeled), crutches (axillary, forearm/Lofstrand), tripod position, swing-to gait, swing-through gait, four-point gait, two-point gait, three-point gait; fall prevention—fall risk assessment (Morse Scale, Hendrich II Fall Risk Model, Johns Hopkins Fall Risk Assessment Tool), fall precautions (bed alarm, chair alarm, bed in low position, side rails up (partial, full), non-skid footwear, night light, call light within reach, clutter-free environment); restraint use—physical restraints (vest, wrist, ankle, belt, mitt), chemical restraints (sedating medications), alternatives (sitter, diversion, environmental modifications, family presence, orientation, pain management, toileting schedule), ethical and legal considerations, documentation, monitoring every 15-30 minutes, order renewal every 24 hours, face-to-face evaluation by physician within 1 hour); Skin Integrity and Wound Care (pressure injury staging—NPUAP/EPUAP/PPPIA: Stage 1 (non-blanchable erythema), Stage 2 (partial-thickness skin loss with exposed dermis), Stage 3 (full-thickness skin loss, subcutaneous fat visible), Stage 4 (full-thickness tissue loss with exposed bone, tendon, muscle), Unstageable (obscured full-thickness skin and tissue loss), Deep Tissue Pressure Injury (DTPI) - persistent non-blanchable deep red, maroon, purple discoloration; pressure injury risk assessment—Braden Scale (sensory perception, moisture, activity, mobility, nutrition, friction/shear), Norton Scale, Waterlow Scale; pressure injury prevention—turning schedule (every 2 hours), support surfaces (alternating pressure mattress, low-air-loss mattress, air-fluidized bed, gel overlay, foam overlay), pressure redistribution (heel offloading, pillows, foam wedges, positioning devices), skin assessment (daily inspection, temperature, moisture management, incontinence care, cleansing, moisturizing, barrier creams); wound assessment—size (length × width × depth), tunneling (sinus tract), undermining (area of tissue destruction under wound edges), exudate (serous, sanguineous, serosanguineous, purulent), odor, wound bed appearance (granulation tissue—red, moist; slough—yellow, tan, gray, devitalized tissue; eschar—black, brown, necrotic tissue), periwound skin (maceration, erythema, induration, edema); wound healing—primary intention (surgical incision, edges approximated), secondary intention (wound left open, healing from base up), tertiary intention (delayed primary closure, wound left open then closed); wound healing phases—hemostasis (platelets, clotting factors), inflammatory (vasodilation, phagocytosis, neutrophils, macrophages), proliferative (granulation tissue, angiogenesis, collagen deposition, epithelialization), maturation/remodeling (collagen reorganization, scar formation); wound care—cleansing (normal saline, sterile water, commercial wound cleanser), debridement (sharp/surgical, mechanical (wet-to-dry), autolytic (occlusive dressing), enzymatic (collagenase, papain), biosurgical (maggot therapy)), dressing selection—gauze (wet-to-dry, wet-to-moist, dry), transparent film (Tegaderm), hydrocolloid (DuoDerm), hydrogel (IntraSite, SoloSite), foam (Mepilex, Allevyn), alginate (Sorbsan, Kalginate), collagen, silver (silver sulfadiazine, silver-impregnated dressing), iodine (cadexomer iodine), negative pressure wound therapy (NPWT) - V.A.C. (Vacuum Assisted Closure) device, foam dressing, suction, pressure settings; Nutrition and Hydration (nutritional assessment—body mass index (BMI) = weight (kg) / height (m²), underweight 18.5, normal 18.5-24.9, overweight 25-29.9, obesity ≥30; weight history (unintentional weight loss 5% in 1 month or 10% in 6 months); dietary intake (24-hour recall, food diary, calorie count); laboratory values—albumin (3.5-5.0 g/dL, half-life 20 days), prealbumin (15-36 mg/dL, half-life 2-3 days, acute malnutrition), transferrin (200-360 mg/dL), total lymphocyte count, nitrogen balance; enteral nutrition—nasogastric (NG) tube (Salem sump, Levin), percutaneous endoscopic gastrostomy (PEG) tube, percutaneous endoscopic jejunostomy (PEJ) tube; tube feeding administration—continuous (pump), intermittent (gravity), bolus (syringe); tube feeding formula—standard (1-2 kcal/mL), fiber-containing, elemental/semi-elemental, disease-specific (diabetes, renal, pulmonary, immune-modulating), blenderized (real food); tube feeding complications—aspiration (elevate head of bed 30-45°, check residual volumes every 4-6 hours, prokinetic agents), diarrhea (rate, formula, medication, infection), constipation (fiber, hydration, mobility), tube dislodgement (secure tube, verify placement, marking), tube clogging (water flushes before and after medication/feeding, use liquid medications, avoid crushing medications), refeeding syndrome (hypophosphatemia, hypokalemia, hypomagnesemia, thiamine deficiency)—monitor electrolytes, slow initiation, vitamin supplementation; parenteral nutrition—total parenteral nutrition (TPN) - hypertonic, central line (PICC, CVC), peripheral parenteral nutrition (PPN) - isotonic, peripheral IV; IV fluid therapy—crystalloids (normal saline 0.9% NaCl, lactated Ringer's (LR), D5W (5% dextrose in water), D5 ½ NS, D5LR), colloids (albumin 5%, 25%, hetastarch, dextran); fluid balance—intake and output (I&O) - oral fluids, IV fluids, tube feeding, urine output, emesis, diarrhea, wound drainage, nasogastric output, chest tube output, drain output; fluid volume deficit (hypovolemia)—causes (vomiting, diarrhea, hemorrhage, burns, diuretics, diabetes insipidus), signs/symptoms (thirst, dry mucous membranes, decreased skin turgor, oliguria, tachycardia, hypotension, orthostatic hypotension, flat neck veins, weight loss, confusion, sunken fontanelles in infants), nursing interventions (oral fluids, IV fluids, monitor I&O, daily weight, vital signs); fluid volume excess (hypervolemia)—causes (heart failure, renal failure, cirrhosis, excessive IV fluids), signs/symptoms (edema (pitting, peripheral, pulmonary), crackles, dyspnea, orthopnea, tachycardia, hypertension, distended neck veins, weight gain, S3 gallop), nursing interventions (restrict fluids, sodium restriction, diuretics, monitor I&O, daily weight, lung sounds, oxygen, positioning (high Fowler's)); Elimination (urinary elimination—urinary assessment (frequency, urgency, dysuria, nocturia, hematuria, incontinence, retention); urinary incontinence—stress (coughing, sneezing, laughing, physical activity), urge (sudden, intense urge), overflow (incomplete emptying, dribbling), functional (cognitive/physical impairment preventing toileting), reflex (spinal cord injury, no sensation), mixed (combination of types); urinary retention—acute (sudden inability to void, painful, palpable bladder), chronic (gradual onset, overflow incontinence); urinary catheterization—indwelling (Foley) catheter (balloon inflated in bladder, continuous drainage), intermittent (straight) catheter (in and out, single use), external (condom) catheter (non-invasive, male only), suprapubic catheter (surgically placed through abdominal wall); catheter care—perineal hygiene, secure catheter, maintain closed drainage system, keep drainage bag below level of bladder, empty bag before transport, monitor urine output, color, clarity, odor; CAUTI prevention—aseptic insertion, maintain sterility, secure catheter, unobstructed flow, daily necessity assessment, remove as soon as possible, avoid routine irrigation, avoid routine replacement; bowel elimination—bowel assessment (frequency, consistency (Bristol Stool Chart: Type 1-2 constipation, Type 3-4 normal, Type 5-7 diarrhea), color (brown normal, black/tarry upper GI bleed, red lower GI bleed, clay-colored biliary obstruction), shape, odor); constipation—causes (decreased fiber, decreased fluids, immobility, medications (opioids, anticholinergics, calcium channel blockers, iron), ignoring urge, colorectal disorders), prevention (high-fiber diet, adequate hydration, regular exercise, respond to urge), treatment (stool softeners (docusate), osmotic laxatives (polyethylene glycol, lactulose, magnesium hydroxide), stimulant laxatives (bisacodyl, senna), bulk-forming laxatives (psyllium), suppositories, enemas); impaction—hardened stool in rectum, unable to pass, overflow incontinence (liquid stool around impaction), digital disimpaction; diarrhea—causes (infection, medications (antibiotics, laxatives), inflammatory bowel disease, malabsorption, enteral feeding), complications (dehydration, electrolyte imbalance, skin breakdown), management (fluid/electrolyte replacement, antidiarrheals (loperamide, diphenoxylate/atropine), probiotics, dietary modifications (BRAT diet: bananas, rice, applesauce, toast)); fecal incontinence—causes (sphincter damage, nerve damage, diarrhea, impacted stool), management (bowel training program, scheduled toileting, pelvic floor exercises, perineal skin care, incontinence briefs, fecal containment device); ostomy—colostomy (large intestine, stool formed), ileostomy (small intestine, stool liquid), urostomy (urinary diversion, urine); ostomy care—pouching system (one-piece, two-piece), skin barrier (wafer), stoma assessment (color (pink/red healthy, purple/black ischemia), size, edema, bleeding), pouching (measure opening, cut 1/8 inch larger, warm barrier, apply, empty when 1/3-1/2 full), skin care (clean with water, pat dry, skin barrier powder, paste, ring), dietary modifications (avoid gas-forming foods, odors, blockages), psychosocial support; enema administration—cleansing (soap suds, tap water, normal saline), retention (oil retention, medicated), hypertonic (Fleets), administration steps (position patient left side-lying (Sims'), lubricate tip, insert 3-4 inches (adult), instill slowly, hold 5-15 minutes, assist to bathroom); Comfort and Pain Management (pain physiology—nociceptive pain (somatic—musculoskeletal, visceral—organ), neuropathic pain (nerve damage, burning, shooting), acute pain (sudden onset, 3 months, sympathetic response—tachycardia, hypertension, diaphoresis), chronic pain (persistent, 3 months, no sympathetic response, depression, fatigue, sleep disturbance); pain assessment—PQRST (P: provocation/palliation (what makes it better/worse?), Q: quality (sharp, dull, burning, aching, throbbing?), R: region/radiation (where is it? does it radiate?), S: severity (0-10 scale, FACES scale), T: timing (when did it start? constant or intermittent?)); pain scales—numeric rating scale (0-10), Wong-Baker FACES (children, adults with cognitive impairment), FLACC (Face, Legs, Activity, Cry, Consolability) for children 2 months-7 years, CRIES (Crying, Requires O2, Increased vital signs, Expression, Sleeplessness) for neonates, PAINAD (Pain Assessment in Advanced Dementia) for older adults with dementia, CPOT (Critical Care Pain Observation Tool) for critically ill intubated patients; nonpharmacologic pain management—distraction (music, TV, conversation, deep breathing, guided imagery), relaxation (progressive muscle relaxation, meditation, mindfulness, yoga), heat/cold therapy (heat for muscle spasms, stiffness; cold for acute inflammation, swelling), massage (effleurage, petrissage), positioning (support pillows, elevating limbs), transcutaneous electrical nerve stimulation (TENS), acupuncture, acupressure, hypnosis, biofeedback, music therapy, art therapy, pet therapy, aromatherapy; pharmacologic pain management—WHO Analgesic Ladder: Step 1 (nonopioid ± adjuvant): acetaminophen (Tylenol) - max dose 4 g/day, hepatotoxicity risk, no anti-inflammatory effect; NSAIDs (ibuprofen (Motrin, Advil), naproxen (Aleve), ketorolac (Toradol), celecoxib (Celebrex)) - anti-inflammatory, analgesic, antipyretic, adverse effects (GI bleeding, renal impairment, cardiovascular risk); Step 2 (weak opioid ± nonopioid ± adjuvant): codeine, tramadol (Ultram), hydrocodone combinations (Vicodin, Norco), oxycodone combinations (Percocet); Step 3 (strong opioid ± nonopioid ± adjuvant): morphine, hydromorphone (Dilaudid), oxycodone (OxyContin, Roxicodone), fentanyl (Duragesic patch, IV, transmucosal), methadone, meperidine (Demerol - avoid due to neurotoxicity metabolite normeperidine), adverse effects (respiratory depression, sedation, nausea/vomiting, constipation, pruritus, urinary retention, tolerance, physical dependence, addiction); adjuvant analgesics—antidepressants (amitriptyline, nortriptyline, duloxetine (Cymbalta), venlafaxine (Effexor)) for neuropathic pain, anticonvulsants (gabapentin (Neurontin), pregabalin (Lyrica), carbamazepine (Tegretol)) for neuropathic pain, muscle relaxants (cyclobenzaprine (Flexeril), baclofen, tizanidine (Zanaflex)) for muscle spasm, topical agents (lidocaine patch, capsaicin cream, diclofenac gel (Voltaren)); patient-controlled analgesia (PCA)—prescribed loading dose, demand dose, lockout interval (5-10 minutes), 1-hour limit, pump, patient education (only patient presses button, not family), monitoring (respiratory rate, sedation level (Pasero Opioid-Induced Sedation Scale), pain score, side effects); epidural analgesia—epidural catheter, local anesthetic (bupivacaine, ropivacaine) + opioid (fentanyl, hydromorphone, morphine), continuous infusion, PCA epidural, monitoring (blood pressure (hypotension), respiratory rate, motor/sensory blockade, catheter site, urinary retention), emergency equipment (resuscitation, naloxone); Sleep and Rest (sleep physiology—circadian rhythm (24-hour cycle, suprachiasmatic nucleus, melatonin), sleep stages—NREM (N1 light sleep, N2 deeper sleep, N3 deep sleep/slow wave sleep, restorative, growth hormone release), REM (rapid eye movement, dreaming, memory consolidation); sleep requirements—newborns (14-17 hours), infants (12-15 hours), toddlers (11-14 hours), preschoolers (10-13 hours), school-age (9-11 hours), adolescents (8-10 hours), adults (7-9 hours), older adults (7-8 hours); factors affecting sleep—illness (pain, dyspnea, nocturia, fever), environment (noise, light, temperature, unfamiliar bed, alarms, monitors), lifestyle (shift work, caffeine, alcohol, nicotine, exercise, screen time), medications (diuretics, bronchodilators, corticosteroids, antidepressants, decongestants, sedatives, hypnotics), psychological (stress, anxiety, depression, worry); common sleep disorders—insomnia (difficulty falling asleep, staying asleep, early awakening), sleep apnea (obstructive (OSA) - airway collapse, central (CSA) - lack of respiratory effort, complex/mixed), narcolepsy (excessive daytime sleepiness, cataplexy, sleep paralysis, hypnagogic hallucinations), restless legs syndrome (RLS) - urge to move legs, worse at rest, relieved by movement, periodic limb movement disorder (PLMD) - repetitive leg movements during sleep; sleep hygiene—consistent bedtime/wake time, relaxing bedtime routine (warm bath, reading, music), comfortable environment (cool, dark, quiet), comfortable mattress and pillows, avoid caffeine, nicotine, alcohol before bed, avoid large meals before bed, regular exercise (not close to bedtime), limit daytime naps, use bed only for sleep and sex, turn clocks away, get sunlight exposure during day; promoting sleep in hospitalized patients—cluster care (minimize interruptions), reduce noise (quiet hours, soft closing doors, dim lights), pain management, toileting before bed, relaxation techniques, back rub, warm drink (decaffeinated, no sugar), music, white noise, eye mask, earplugs, familiar objects from home); Psychosocial Integrity (therapeutic communication—verbal (words, tone, pitch, volume), nonverbal (body language, eye contact, facial expression, posture, touch, personal space (intimate 0-18 inches, personal 18 inches-4 feet, social 4-12 feet, public 12 feet)); therapeutic communication techniques—active listening (SOLER: Sit facing patient, Open posture, Lean toward patient, Eye contact, Relax), empathy (understanding patient's feelings), clarification ("I'm not sure I understand, can you tell me more?"), reflection ("You seem upset"), restatement ("You said you're feeling anxious"), summarizing (brief review of discussion), focusing (directing to a specific topic), exploring (asking for more detail), silence (allowing patient time to process), humor (if appropriate, lighten mood), offering self ("I will sit with you for a while"), giving information (education, explanation), providing hope (realistic optimism), touch (therapeutic if appropriate, cultural considerations); nontherapeutic communication techniques—false reassurance ("everything will be fine"), automatic responses ("that's nice"), giving advice ("you should..."), asking "why" questions (feels accusatory), changing the subject (avoiding sensitive topics), defensive responses (arguing, justifying), judgmental responses ("that was wrong"), clichés ("time heals all wounds"), stereotyping (labeling), belittling ("it's not that bad"), passive/aggressive responses; therapeutic relationship—phases: preinteraction (preparing before meeting patient), orientation (introduction, establishing trust, setting goals, boundaries), working (active problem-solving, addressing issues, implementing plan), termination (ending relationship, summarizing progress, discussing feelings, referral); boundaries—professional boundaries (nurse-patient relationship, avoid dual relationships, self-disclosure (limited, therapeutic purpose), gift-giving policies, social media policies, physical boundaries, time boundaries, content boundaries); transference (patient projects feelings onto nurse), countertransference (nurse projects feelings onto patient); stress and coping—stress response (Selye's General Adaptation Syndrome: alarm (fight-or-flight), resistance (adaptation), exhaustion (resource depletion)); coping mechanisms—adaptive (problem-solving, seeking support, exercise, relaxation, humor), maladaptive (substance use, denial, avoidance, self-harm, aggression); defense mechanisms—denial (refusing to accept reality), repression (unconsciously blocking thoughts), suppression (consciously blocking thoughts), projection (attributing own feelings to others), displacement (redirecting emotions to safer target), rationalization (creating logical explanations for irrational behavior), intellectualization (focusing on facts to avoid emotions), sublimation (channeling unacceptable impulses into acceptable behavior), compensation (making up for perceived weakness), reaction formation (acting opposite to true feelings), regression (returning to earlier developmental stage), undoing (attempting to make up for unacceptable behavior), isolation (separating feelings from thoughts), dissociation (temporary detachment from reality); anxiety—mild (restlessness, increased alertness, motivated), moderate (trembling, voice changes, narrowed perception), severe (confusion, hyperventilation, tachycardia, sense of impending doom), panic (immobility, irrationality, hallucinations, violence); anxiety management—therapeutic communication, deep breathing, relaxation, grounding techniques, guided imagery, distraction, medication (SSRIs, SNRIs, benzodiazepines PRN); crisis intervention—crisis (temporary state of disequilibrium, overwhelmed coping), crisis intervention model (Roberts' Seven-Stage Crisis Intervention Model), psychological first aid (PFA), crisis hotline (988 Suicide and Crisis Lifeline), crisis stabilization, safety planning; grief and loss—Kübler-Ross stages of grief (denial, anger, bargaining, depression, acceptance)—not linear, may revisit stages; types of grief—normal (expected reaction), anticipatory (grieving before loss), complicated (prolonged, intense, impaired functioning), disenfranchised (unrecognized by society), ambiguous (loss without closure); end-of-life care—palliative care (symptom management, quality of life, any stage of illness), hospice care (terminal prognosis ≤6 months, comfort-focused, no curative treatment, Medicare hospice benefit); advance directives—living will (written document specifying treatment preferences), durable power of attorney for health care (DPOAHC) / health care proxy (appoints decision-maker), Do Not Resuscitate (DNR) / Allow Natural Death (AND), Do Not Intubate (DNI), Physician Orders for Life-Sustaining Treatment (POLST), Medical Orders for Life-Sustaining Treatment (MOLST), MOST (Medical Orders for Scope of Treatment); comfort care—pain and symptom management (pain, dyspnea, nausea, anxiety, delirium, constipation), positioning, oral care, skin care, hydration/nutrition (patient preference), spiritual support (chaplain, clergy, rituals), family support (presence, information, grief support), bereavement support; postmortem care—pronouncement of death (varies by state, physician or nurse), family notification (private, compassionate), organ/tissue donation (consent, donor registry), autopsy (consent, medical examiner cases), postmortem care (cleaning, positioning (supine, arms at sides, head elevated), dentures in place, closing eyes and mouth, incontinence care, removing tubes/lines (unless autopsy), personal belongings, labeling, transport to morgue), cultural and religious considerations (rituals, bathing, viewing, burial/cremation, mourning practices); Ethical and Legal Issues (ethical principles—autonomy (patient's right to make own decisions, informed consent, refusal of treatment), beneficence (acting in patient's best interest), nonmaleficence (do no harm), justice (fair distribution of resources, equitable care), fidelity (keeping promises, loyalty, advocacy), veracity (truthfulness, honesty); ethical dilemmas—situations where ethical principles conflict (e.g., patient refusal of life-saving treatment (autonomy) vs nurse's duty to preserve life (beneficence)), ethical decision-making framework (identify problem, gather information, explore options, decide, act, evaluate); ANA Code of Ethics—9 provisions, guides nursing practice, includes commitment to patient, advocacy, professional boundaries, collaboration, self-care, social justice; legal issues—Nurse Practice Act (state law defining scope of practice, standards, licensure requirements, grounds for discipline), scope of practice (what nurse can legally do based on education, licensure, competency), standards of care (guidelines for nursing practice, ANA standards, specialty standards, institutional policies); malpractice (professional negligence)—4 elements: duty (nurse-patient relationship established), breach (failure to meet standard of care), causation (breach caused injury), damages (harm suffered); negligence—failure to act as reasonably prudent nurse (e.g., fall prevention, medication errors, misdiagnosis, failure to monitor, documentation errors); informed consent—patient's right to know risks, benefits, alternatives before treatment or procedure; required elements (diagnosis, nature/purpose of procedure, risks/benefits, alternatives, prognosis if declined), nurse's role (witness signature, verify understanding, ensure consent obtained before sedation, not responsible for explaining procedure), exceptions (emergency, patient incapacitated, waiver, therapeutic privilege); implied consent—situation where consent assumed (e.g., patient extends arm for blood draw, emergency care if unconscious); minor consent—parent/guardian usually required, exceptions (emancipated minor, mature minor, pregnancy/STI treatment, substance abuse, mental health); confidentiality—HIPAA (Health Insurance Portability and Accountability Act) Privacy Rule, Security Rule, Breach Notification Rule; protected health information (PHI)—identifiable health information (name, date of birth, medical record number, SSN, address, phone number, email, photos, diagnosis, treatment, payment); minimum necessary standard (access only PHI needed for job), patient rights (access records, amend records, accounting of disclosures, restrictions, confidential communications); mandatory reporting—child abuse (physical, sexual, emotional, neglect), elder abuse (physical, sexual, emotional, financial, neglect, abandonment), domestic violence (intimate partner violence), gunshot wounds, stab wounds, certain communicable diseases (TB, STIs, foodborne illnesses), impaired healthcare provider (state board of nursing); advance directives—patient self-determination, Patient Self-Determination Act (PSDA) requires healthcare facilities to provide information about advance directives; patient rights—right to respectful care, right to information, right to informed consent/refusal, right to privacy/confidentiality, right to advance directives, right to complaint/grievance process; patient advocacy—supporting patient's rights, speaking up for patient, ensuring safety, respecting preferences, facilitating communication, reporting concerns; Healthcare Delivery Systems (types of healthcare facilities—hospitals (acute care, critical access, teaching, community, specialty, psychiatric, rehabilitation), ambulatory care centers (outpatient surgery, diagnostic testing, urgent care, primary care), clinics (specialty, community health, retail, school-based, employee health), physician offices, urgent care centers, long-term care facilities (skilled nursing facilities (SNF), nursing homes, assisted living facilities (ALF), independent living, continuing care retirement communities (CCRC)), rehabilitation centers (inpatient, outpatient), home health agencies, hospice, palliative care, adult day care, respite care; levels of care—primary care (first contact, prevention, health maintenance, common illnesses), secondary care (specialist consultation, hospitalization, surgery, acute care), tertiary care (highly specialized, intensive care, burn center, trauma center, transplant center), quaternary care (highly experimental, specialized procedures, research); healthcare team members—nurses (LPN/LVN, RN, APRN—NP, CNS, CNM, CRNA), physicians (MD, DO), advanced practice providers (NP, PA), physical therapists (PT), physical therapist assistants (PTA), occupational therapists (OT), certified occupational therapy assistants (COTA), speech-language pathologists (SLP), respiratory therapists (RT), pharmacists (RPh, PharmD), pharmacy technicians, social workers (BSW, MSW, LCSW), case managers (RN, MSW), dieticians (RD, RDN), nutritionists, chaplains/spiritual care, child life specialists, art therapists, music therapists, recreational therapists, therapeutic recreation specialists, patient advocates, patient navigators, medical assistants (MA, CMA, RMA), phlebotomists, EKG technicians, radiology technicians, sonographers, MRI technologists, CT technologists, nuclear medicine technologists, radiation therapists, surgical technologists, anesthesia assistants, perfusionists, orthotists, prosthetists, audiologists, optometrists, ophthalmologists, dentists, dental hygienists, dental assistants, podiatrists, chiropractors, acupuncturists, massage therapists, athletic trainers, exercise physiologists, health coaches, community health workers, peer support specialists, recovery coaches; healthcare financing—Medicare (federal, age ≥65 or disability, ESRD, ALS: Part A hospital insurance (inpatient, skilled nursing facility (up to 100 days), hospice, home health), Part B medical insurance (outpatient, physician services, durable medical equipment, preventive services), Part C Medicare Advantage (private insurance plans), Part D prescription drug coverage); Medicaid (federal/state, low-income, children, pregnant women, parents, older adults, disabled, blind), CHIP (Children's Health Insurance Program), TRICARE (military members, retirees, dependents), VA (Veterans Health Administration), IHS (Indian Health Service); private insurance (employer-sponsored, individual marketplace, ACA plans); managed care—HMO (Health Maintenance Organization - primary care gatekeeper, referrals, in-network), PPO (Preferred Provider Organization - no gatekeeper, out-of-network coverage, higher cost), POS (Point of Service - gatekeeper, some out-of-network coverage), EPO (Exclusive Provider Organization - no gatekeeper, in-network only); accountable care organizations (ACOs) - groups of providers coordinating care for Medicare patients, shared savings; value-based purchasing (VBP) - reimbursement based on quality measures, patient satisfaction, outcomes; prospective payment system (PPS) - fixed payment based on diagnosis (DRG for hospitals, RUG for SNF, HHRG for home health, APC for outpatient); diagnosis-related groups (DRGs) - payment classification for hospital inpatient stays; resource utilization groups (RUGs) - payment classification for skilled nursing facilities; home health resource groups (HHRG) - payment classification for home health agencies; ambulatory payment classifications (APCs) - payment classification for outpatient services; healthcare reform—Affordable Care Act (ACA) (2010) - individual mandate (tax penalty repealed 2019), health insurance marketplace (exchange), subsidies (premium tax credits, cost-sharing reductions), Medicaid expansion (optional for states), essential health benefits (10 categories), preventive services without cost-sharing, dependent coverage up to age 26, pre-existing condition coverage, lifetime/annual limit removal); Quality and Safety (quality improvement—PDSA cycle (Plan, Do, Study, Act), Six Sigma (DMAIC: Define, Measure, Analyze, Improve, Control), Lean methodology (waste reduction, value stream mapping), total quality management (TQM), continuous quality improvement (CQI); quality indicators—National Database of Nursing Quality Indicators (NDNQI) - nurse-sensitive indicators (falls, pressure injuries, CAUTI, CLABSI, VAP, restraint use, patient falls with injury, nursing hours per patient day, turnover, vacancy, patient satisfaction (HCAHPS)); nurse-sensitive outcomes—falls (rate, fall-related injury), pressure injury (community-acquired, hospital-acquired, unit-acquired), CAUTI (catheter-associated urinary tract infection), CLABSI (central line-associated bloodstream infection), VAP (ventilator-associated pneumonia), SSI (surgical site infection), restraint use (physical, chemical), patient satisfaction (HCAHPS - Hospital Consumer Assessment of Healthcare Providers and Systems), nurse satisfaction, nurse burnout, nurse turnover; patient safety—National Patient Safety Goals (NPSG) - TJC (The Joint Commission) - identify patients correctly (two identifiers), improve staff communication (verbal orders read-back, critical results reporting), use medicines safely (medication reconciliation, labeled medications, high-alert medications), prevent infection (hand hygiene, CAUTI, CLABSI, SSI prevention), identify patient safety risks (suicide risk screening, fall risk assessment), prevent mistakes in surgery (Universal Protocol: time-out, site marking, correct patient/procedure/site); just culture—balanced accountability (systems errors vs behavioral choices), distinguish human error (unintentional, slips/lapses), at-risk behavior (risk not recognized, risky choices), reckless behavior (conscious disregard for safety), incident reporting (non-punitive reporting of errors, near misses), root cause analysis (RCA) - systematic process to identify underlying causes of adverse events, sentinel event (unexpected death/serious injury, TJC review), failure mode and effects analysis (FMEA) - proactive risk assessment; Professional Development (professional nursing organizations—American Nurses Association (ANA), National League for Nursing (NLN), Sigma Theta Tau International (STTI) Honor Society of Nursing, American Association of Colleges of Nursing (AACN), National Student Nurses' Association (NSNA), National Black Nurses Association (NBNA), National Association of Hispanic Nurses (NAHN), Philippine Nurses Association of America (PNAA), Asian American Pacific Islander Nurses Association (AAPINA), National Alaska Native American Indian Nurses Association (NANAINA), National Association of Indian Nurses of America (NAINA), National Council of State Boards of Nursing (NCSBN); career planning—self-assessment (strengths, interests, values), exploring nursing specialties (medical-surgical, critical care, emergency, pediatrics, obstetrics, neonatal, psychiatric-mental health, community health, home health, hospice, perioperative, perianesthesia, interventional radiology, cardiology, oncology, nephrology, transplant, rehabilitation, long-term care, informatics, education, administration, research, quality, safety, infection prevention, case management, utilization review, legal nurse consulting, forensic nursing, flight nursing, school nursing, occupational health nursing, public health nursing, military nursing, travel nursing, telenursing, nurse coaching, aesthetics nursing, correctional nursing, faith community nursing); resume writing—format (chronological, functional, combination), components (contact information, professional summary, education, licensure/certifications, clinical experience, work experience, skills, volunteer experience, professional memberships, honors/awards, references), keywords (NCLEX, BLS, ACLS, PALS, NRP, EKG, IV, phlebotomy, medication administration, wound care, EMR/EHR, Epic, Cerner, Meditech, electronic health record, patient education, care coordination, discharge planning, interdisciplinary collaboration, patient advocacy, critical thinking, clinical judgment, time management, prioritization, delegation, leadership); interviewing skills—research organization (mission, values, services, Magnet status, patient satisfaction scores, quality ratings), prepare questions (for interviewer: orientation, preceptorship, nurse-to-patient ratios, advancement opportunities, continuing education, schedule, benefits), behavioral questions (STAR method: Situation, Task, Action, Result), dress professionally, arrive early, bring copies of resume/cover letter/references, follow-up thank you note; nursing licensure—NCLEX-RN (National Council Licensure Examination for Registered Nurses), NCLEX-PN (Practical Nurses), exam format (CAT - Computerized Adaptive Testing, minimum 75 questions, maximum 265 questions, 5-hour time limit), question types (multiple-choice, select-all-that-apply (SATA), ordered response (drag and drop), fill-in-the-blank, hot spot, bow-tie, matrix/grid), test plan (client needs categories: Safe and Effective Care Environment (Management of Care 17-23%, Safety and Infection Control 9-15%), Health Promotion and Maintenance (6-12%), Psychosocial Integrity (6-12%), Physiological Integrity (Basic Care and Comfort 6-12%, Pharmacological and Parenteral Therapies 12-18%, Reduction of Risk Potential 9-15%, Physiological Adaptation 11-17%)); licensure by endorsement (license transfer to another state), Nurse Licensure Compact (NLC) - multistate license allows practice in compact states; continuing education—CEUs (contact hours), state board requirements for license renewal, specialty certification (ANCC, AANP, PCCN, CCRN, CEN, CPEN, CFRN, CTRN, CNOR, CPAN, CAPA, CGRN, CRRN, ONC, CMSRN, RNC-OB, RNC-MNN, RNC-LRN, RNC-NIC, C-EFM, C-NPT, RN-BC, PMH-BC, FNP-BC, AGNP-BC, PNP-BC, WHNP-BC, CNM, CRNA, CNS, CNL, CENP, NE-BC, NEA-BC, CPHQ, CIC, VA-BC, WOCN, CWOCN, CWCN, COCN, CCCN, CFCN, CDE, CDCES, CHSE, CHSOS, CHPN, CHPCA, ACHPN, ACHP-SW, CPLC, CTN-B, SANE-A, SANE-P, AFN-BC, FN-CSA, LNCC, CNLCP, CNCC, CCM, CRRN, CIRS, C-AL, CDP, CADDCT); evidence-based practice (EBP)—integration of best research evidence, clinical expertise, patient preferences/values; EBP process (Ask (PICOT question), Acquire (search for evidence), Appraise (critically appraise), Apply (implement evidence), Assess (evaluate outcomes)); nursing research—quantitative (numerical data, statistical analysis), qualitative (thematic analysis, narrative, lived experience), mixed methods (combination), research utilization, knowledge translation, implementation science; lifelong learning—continuing education, graduate education (MSN, DNP, PhD), professional reading (journals: American Journal of Nursing, Nursing2024, Nursing Management, Nursing Research, Journal of Nursing Education, Journal of Professional Nursing, Journal of Nursing Administration, Nursing Economics, Journal of Continuing Education in Nursing, Journal for Nurses in Professional Development, Journal of Nursing Care Quality, Journal of Patient Safety, Clinical Simulation in Nursing, Journal of Nursing Regulation, Journal of Nursing Scholarship, Journal of Advanced Nursing, International Journal of Nursing Studies, Nurse Educator, Nursing Education Perspectives, Nurse Leader, Nursing Outlook, Journal of Nursing and Midwifery Sciences, Journal of Clinical Nursing, Journal of the American Psychiatric Nurses Association, Journal of Pediatric Nursing, Journal of Gerontological Nursing, Journal of Obstetric, Gynecologic & Neonatal Nursing, MCN: The American Journal of Maternal/Child Nursing, Journal of Midwifery & Women's Health, Journal of Transcultural Nursing, Journal of Holistic Nursing, Journal of Hospice and Palliative Nursing, Journal of Addictions Nursing, Journal of Forensic Nursing, Journal of Correctional Health Care, Journal of Emergency Nursing, Journal of Trauma Nursing, Journal of Perianesthesia Nursing, Journal of Radiology Nursing, Journal of Infusion Nursing, Journal of Wound, Ostomy and Continence Nursing, Journal of Wound Care, Journal of Burn Care & Research, Journal of the Dermatology Nurses' Association, Journal of the American Association of Nurse Practitioners, Journal for Nurse Practitioners, Clinical Nurse Specialist, Nurse Practitioner, The Nurse Practitioner, The Journal for Nurse Practitioners, Advanced Emergency Nursing Journal, Dimensions of Critical Care Nursing, Critical Care Nursing Quarterly, Critical Care Nurse, American Journal of Critical Care, Heart & Lung: The Journal of Acute and Critical Care, AACN Advanced Critical Care, Intensive and Critical Care Nursing, Australian Critical Care, British Journal of Cardiac Nursing, Journal of Cardiovascular Nursing, European Journal of Cardiovascular Nursing, Progress in Cardiovascular Nursing, Journal of the American College of Cardiology, Circulation, Circulation Research, Circulation: Cardiovascular Quality and Outcomes, Stroke, Journal of the American Heart Association, Journal of the American College of Cardiology: Heart Failure, JACC: Cardiovascular Imaging, JACC: Cardiovascular Interventions, JACC: Clinical Electrophysiology, JACC: Basic to Translational Science, JACC: CardioOncology, JACC: Asia, European Heart Journal, European Heart Journal: Cardiovascular Imaging, European Heart Journal: Cardiovascular Pharmacotherapy, European Heart Journal: Case Reports, European Heart Journal: Acute Cardiovascular Care, European Journal of Heart Failure, European Journal of Preventive Cardiology, European Journal of Cardiovascular Nursing, ESC Heart Failure, Clinical Research in Cardiology, International Journal of Cardiology, Canadian Journal of Cardiology, Journal of Cardiology, Circulation Journal, American Journal of Cardiology, American Journal of Cardiovascular Drugs, Cardiovascular Drugs and Therapy, Cardiovascular Therapeutics, Journal of Cardiovascular Pharmacology and Therapeutics, Journal of Cardiovascular Medicine, Journal of Cardiovascular Pharmacology, Journal of the Renin-Angiotensin-Aldosterone System, Journal of the American Society of Hypertension, Journal of Human Hypertension, Hypertension Research, Blood Pressure, Blood Pressure Monitoring, Clinical and Experimental Hypertension, J