ATI CMS FUNDAMENTALS EXAM STUDY GUIDE 2023/2024

ATI CMS FUNDAMENTALS EXAM STUDY GUIDE Stage 1 Sleep - ANSWER - Very light sleep - Only a few minutes long - Awaken easily - Feels relaxed and drowsy Stage 2 Sleep - ANSWER - Deeper sleep - 10-20 min long - Increased relaxation Stage 3 Sleep - ANSWER - Beginning of deep sleep - 15-30 min long - Difficult to awaken Stage 4 Sleep - ANSWER - "Delta Sleep" - Deepest sleep - 15-30 min long - Very difficult to awaken - Sleep walking, sleep talking, enuresis REM - ANSWER - vivid dreaming - 90 min after falling asleep - Very difficult to awaken - cognitive restoration Insomnia - ANSWER inability to sleep Sleep apnea - ANSWER More than five breathing cessations lasting longer than 10 seconds per hour during sleep = decreased arterial oxygen saturation Nursing consideration for Rest and Sleep - ANSWER - Bed time routine - Limit clients walking at night - Help with personal hygiene and back rubs - Medication: benzodiazepine: sedative-hypnotics, zolpidem, eszopiclone, zaleplon Client education for rest and sleep - ANSWER - exercise regular (2 hours) before bedtime - bedtime routine - comfort environment - limit alcohol, caffeine, nicotine at least 4 hrs before bed - engage muscle relaxation Carbohydrates - ANSWER - provides most of the body's energy and fiber - 4 kcal - whole grains, breads, baked potato, brown rice Fats - ANSWER - energy and vitamins - 9 kcal - olive oil, salmon, egg yolks Protein - ANSWER - growth, maintenance and repair of body tissue - 4 kcal - beef, whole milk, poultry Fat soluble vitamins - ANSWER A, D, E, K Water soluble Vitamins - ANSWER C, B Minerals - ANSWER - complete essential biochemical reactions - calcium, potassium, sodium, iron Newborns starting to eat solid foods - ANSWER - 4-6 months - No cow's milk or honey for the first year Anorexia Nervosa - ANSWER - eating disorder - low body weight - self perception of being far - consistent restriction of food intake bulimia nervosa - ANSWER - eating disorder - binge eating followed by purging Healthy BMI - ANSWER 18.5-25 Preventing aspiration - ANSWER - Position in high fowlers - tuck chin when swallowing - keep client in semi fowlers at least 1 hr after meals Nutrition of Older adults (over 65) - ANSWER - slower metabolic rate require fewer calories - thirst sensation diminish - need same amount of vitamins and minerals as younger adults - calcium intake - need carbohydrates for fiber/bulk Cane instructions - ANSWER - maintain two points of support - keep cane on stronger side - support body weight on both sides - move weaker leg forward toward cane - position crutches on unaffected side when sitting or rising from chair Giving bed bath - ANSWER - wash face first - lock wheels on bed - long firm strokes Foot care for diabetics - ANSWER - do not soak feet - do not cut nails - file nails using nail filer - can apply lotion BUT do not apply lotion IN BETWEEN fingers or toes Living will - ANSWER directive documents for medical treatment per the client's wishes Advance directives - ANSWER legal documents that direct end of life issues denial - ANSWER difficult believing a terminal diagnosis or loss anger - ANSWER lashes out at other people or things bargaining - ANSWER negotiates for more time or a cure depression - ANSWER saddened by the inability to change the situation acceptance - ANSWER acknowledges what is happening and plans for the future by moving forward Palliative Care - ANSWER - relief of pain, spiritual, emotional, and psychosocial aspects of the clients life - improves quality of life of clients facing end of life issues Hospice Care - ANSWER - not expected to live longer than 6 months - enhancing quality of life and supporting the client toward a peaceful and dignified death integrity vs despair (65 years and older) - ANSWER - adjust to lifestyle changes related to retirement - adapt to changes in family structure - adapt to changing in living environment - deal with multiple loss - face death Decreased physical development on 65 years and older - ANSWER - decreased skin turgor - thickening of fingernails/toenails - increased blood pressure - decrease production of saliva - decreased bladder capacity Middle Adult (35-65) - ANSWER - generativity vs. stagnation - use life as an opportunity for creativity and productivity - concern for others - well-being for next generation - whole grans, fresh fruits, veggies - increase vitamin D Physical development for Middle Adult (35-65) - ANSWER - Skin turgor - visual acuity, especially for near vision - sense of taste - height - gastric secretions - decreased glomerular filtration rate Preventative Health Care - ANSWER focuses on educating and equipping clients to reduce and control risk factors for disease Primary Health Care - ANSWER Emphasizes health promotion and includes prenatal and well baby care, family planning, nutrition counseling, and disease control ex. office or clinic, community health centers Secondary Health Care - ANSWER includes the diagnosis and treatment of acute illness and injury ex. inpatient and emergency departments Tertiary Health Care - ANSWER acute care, involves the provision of specialized and highly technical care ex. intensive care, oncology centers, burn centers Restorative health care - ANSWER involves intermediate follow up care for restoring health and promoting self care ex. home health care, rehabilitation centers, skilled nursing Continuing health care - ANSWER addresses long term or chronic health care needs over a period of time ex. end of life care, palliative care, hospice, adult day care, assisted living, in home respite care Advocacy - ANSWER support of clients health, wellness, safety, and personal rights, including privacy Responsibility - ANSWER willingness to respect obligations and follow through on promises Accountability - ANSWER ability to answer for one's own actions Confidentiality - ANSWER protection of privacy without diminishing access to high quality care Autonomy - ANSWER the right to make own's own personal decisions, even when those decisions might now be in that person's own best interest Beneficence - ANSWER action that promotes good for others, without any self interest Fidelity - ANSWER fulfillment of promises Justice - ANSWER fairness in care delivery and use of resources Nonmaleficence - ANSWER do no harm Veracity - ANSWER commitment to tell the truth A problem is an ethical dilemma when: - ANSWER - review of scientific data is not enough to solve it - involves a conflict between two moral imperatives - answer will have profound effect on the situation and the client Ethical decision making - ANSWER process that requires striking balance between science and morality negligence - ANSWER fails to implement safety measures for a client at risk for falls malpractice - ANSWER professional negligence ex. giving a large dose of medication due to calculation error breach of confidentiality - ANSWER release a client's medical diagnosis to a member of the press defamation of character - ANSWER nurse tells coworker that she believes the client has been unfaithful to partner assault - ANSWER conduct of one person makes another person fearful and apprehensive battery - ANSWER intentional and wrongful physical contact with a person that involves an injury or offensive contact false imprisonment - ANSWER confined or restraint against his will Nurses can avoid liability for negligence by - ANSWER - following standards of care - giving competent care - communicating with other health team members and clients - developing a caring rapport with clients - fully documenting assessments, interventions, evaluation - being familiar with/following facility's policies and procedures informed consent - ANSWER legal process by which a client or client's legally appointed designee has given written permission for a procedure or treatment Consent is informed when a provider explains and the client understands: - ANSWER - the reason the client needs treatment/procedure - how it will benefit them - risks involved - other options to treat problem Nurses role in the informed consent process is - ANSWER to witness the client's signature individuals who may grant consent for another person - ANSWER - parent of minor - legal guardian - court specified representative - an individual who has durable power of attorney authority for health care What does the patient sign when they decide to leave the facility against medical advice (without a discharge prescription) - ANSWER Against medical advice form factual documentation - ANSWER subjective and objective data Subjective data - ANSWER person tells you Objective data - ANSWER what you see What should you never do when doing assessment? - ANSWER pre-chart SOAP - ANSWER subjective, objective, assessment, plan PIE - ANSWER problem, intervention, evaluation DAR - ANSWER data, action, response Use the 5 rights of delegation to decide - ANSWER - right task - right circumstance (like getting right resource) - right person - right direction/communication - right supervision/evaluation PN - ANSWER - monitoring findings - client teaching - trach care - suctioning - checking ng tube patency - enteral feeding - urinary catheter AP - ANSWER - bathing - grooming - dressing - toileting - ambulating - positioning Confidence - ANSWER Feels sure of abilities integrity - ANSWER practice truthfully and ethically competence - ANSWER uses to make nursing judgment asepsis - ANSWER absence of illness producing micro organisms medical asepsis - ANSWER - "clean technique" - precise practices to reduce number, growth, spread of microorganisms surgical asepsis - ANSWER - "sterile technique" - use of precise practices to eliminate all micro organisms from an object or area and prevent contamination Washing hands - ANSWER - soap and water - rub hands vigorously - wash for 15 seconds, or up to 2 min when hands are soiled - alcohol based product (3-5 ml) Sterile packaging - ANSWER - arm positioned away - lift package 15 cm (6 in) above - fungi - ANSWER molds, yeasts prions - ANSWER protein particals parasites - ANSWER protozoa, helminths, flukes passive immunity - ANSWER antibodies are produced by an external source native immunity - ANSWER restricts entry or immediately responds to foreign organism through activation of phagocytic cells, complement, inflammation specific adaptive immunity - ANSWER allows body to make antibodies in response to foreign organism Active immunity - ANSWER antibodies are produced in response to an antigen causitive agent - ANSWER bacteria, virus, fungus, etc. reservoir - ANSWER human, animal, food, organic matter, inanimate objects portal of exit - ANSWER leaving the host mode of transmission - ANSWER contact, droplet, airborne, vector borne portal of entry - ANSWER might be the same as the portal exit susceptible host - ANSWER compromised defense mechanisms leave the host more susceptible to infections incubation - ANSWER between the pathogen entering the body and the presentation of the first symptom prodromal stage - ANSWER interval from onset of general symptoms to more distinct symptoms (pathogen multiplying) illness stage - ANSWER when symptoms specific to the infection occur convalescence - ANSWER acute symptoms disappear Individuals who have compromised health or defenses against infection - ANSWER - immunocompromised - had surgery - indwelling devices - poor O2 - impaired circulation - acute or chronic disease what is more effective in removing micro organisms - ANSWER alcohol based product airborne precaution - ANSWER - private room - n95 mask for tuberculosis - negative pressure room droplet precaution - ANSWER - travel 3-6 ft from client - private room or with others who have same disease - own equipment - mask for provider/family antipyretics - ANSWER - used for fever and discomfort - acetaminophen/aspirin causes of hypovolemia - ANSWER - vomiting - nasogastric suctioning - diarrhea - diaphoresis - loss of fluids from wound - hemorrhage causes of dehydration - ANSWER - hyperventilation - prolonged fever - diabetic ketoacidosis - enteral feeding without sufficient water intake expected findings for hypovolemia - ANSWER - hypothermia - hyperthermia - tachycardia - thready pulse - dry mucous - dizziness - syncope Respiratory acidosis - ANSWER - ph = low - paco2 = high respiratory alkalosis - ANSWER - ph = high - paco2 = low metabolic acidosis - ANSWER - ph = low - hcO3 = low metabolic alkalosis - ANSWER - ph = high - hcO3 = high