Summary RN Adult Medical Surgical Nursing ATI Study Guide

ATI RN Adult Medical-Surgical 12.0 –CRAM GUIDE



Foundations & Clinical Judgment

Core Concepts
 Nursing Process = ADPIE (Assess → Diagnose → Plan → Implement → Evaluate). Never skip
assessment unless CPR.
 Clinical Judgment Model (NCJMM): Recognize cues → Analyze cues → Prioritize hypotheses →
Generate solutions → Act → Evaluate outcomes.
 Prioritization frameworks: ABCDE, Maslow, Acute vs Chronic, Unstable vs Stable,
Systemic vs Localized.
 Delegation – 5 Rights: Task, Circumstance, Person, Direction/Communication,
Supervision/Evaluation.
 Cannot delegate: assessment, nursing diagnosis, patient education, evaluation, or any unstable
patient.

High-Yield Numbers
 Glasgow Coma Scale <8 = intubate.
 Respiratory isolation spacing: Droplet ≥3 ft, Airborne negative-pressure with ≥12 ACH.

Nursing Concepts and Clinical Judgment

Key Concepts:

 The nursing process (ADPIE) guides systematic client care: Assess → Diagnose → Plan →
Implement → Evaluate.
o A – Assess: Collect objective & subjective data (e.g., vitals, symptoms, history).
o D – Diagnose: Use NANDA-approved nursing diagnoses (e.g., Risk for Falls).
o P – Plan: Set SMART goals (Specific, Measurable, Achievable, Relevant, Time-bound).
o I – Implement: Execute interventions (e.g., administer meds, educate).
o E – Evaluate: Reassess if goals were met; revise plan if needed.

Never skip assessment unless in a code situation (e.g., CPR).



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,  Clinical judgment is applying knowledge, critical thinking, and clinical reasoning to patient care
decisions.

o Example: A patient has new-onset dyspnea and crackles → Recognize cue → Analyze →
Prioritize hypothesis (fluid overload) → Act (e.g., furosemide).

 Prioritization frameworks ensure safe decisions in time-sensitive environments.
 Nurses must synthesize data, predict complications, and respond to changes in real-time.

Clinical Judgment Model (NCJMM):

1. Recognize cues: Identify relevant patient data. (Gather relevant clinical info (labs, vitals, patient
behavior).
2. Analyze cues: Interpret and cluster findings. (Interpret what data means; compare trends).
3. Prioritize hypotheses: Determine most urgent issues.
4. Generate solutions: Identify nursing interventions based on priority.
5. Take action: Implement nursing care (safest, most appropriate actions).
6. Evaluate outcomes: Reassess and adapt plan as needed.

Nursing Applications:

 Use Maslow’s Hierarchy and ABCDE
o Airway, Breathing, Circulation, Disability (neuro status, e.g., GCS), Exposure (bleeding,
burns, etc.)) when planning care.

 Glasgow Coma Scale (GCS):
 Score <8 = intubate (protect airway).
 3 = deep coma, 15 = alert and oriented.

 Maslow’s =
o Physiological (air, water, food, sleep)
o Safety (security, stability)
o Love/belonging
o Esteem
o Self-actualization

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,  Prioritize unstable or acute conditions over chronic/stable ones.
o Acute conditions take precedence unless chronic is life-threatening.
o Treat unstable first (e.g., new onset chest pain vs chronic HTN)
 Recognize the impact of systemic vs. localized symptoms.
o Treat systemic concerns (e.g., sepsis, anaphylaxis) before localized (e.g., sprained ankle)

Managing Client Care

Key Concepts:

 Safe and effective care requires collaboration with interdisciplinary teams.
 Leadership styles:
o Autocratic: decisions made with little staff input (useful in crisis).
 Leader makes decisions alone
o Democratic: encourages input and participation.
 Best for teamwork
o Laissez-faire: minimal guidance/oversight; assumes staff are experienced/self-directed.

Delegation Principles:

 Delegation transfers task responsibility but not accountability.
 The Five Rights of Delegation:
1. Right Task – Is it appropriate for this level of staff (e.g., UAPs take vitals, not assess)?
2. Right Circumstance – Is the patient stable? If not → RN must handle it.
3. Right Person – Is the person trained, licensed, and competent?
4. Right Direction/Communication – Give clear, specific instructions (what, when, how,
report back).
5. Right Supervision/Evaluation – Follow-up & monitor task completion.

Assignment vs. Delegation:

 Assignment: transferring responsibility within the same scope of practice (e.g., RN to RN).
 Delegation: giving tasks to lower-credentialed staff (e.g., RN to CNA).

What RNs Cannot Delegate:

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,  Initial assessments
 Nursing diagnoses or care plans
 Evaluation of interventions
 Patient education
 Tasks requiring critical thinking
 Any unstable or newly admitted patient

Infection Control

Standard Precautions (Apply to all clients):

 Hand hygiene: wash with soap and water for at least 40–60 seconds when visibly soiled or caring
for C. difficile.
 Use gloves, gowns, masks, eye protection when risk of fluid exposure exists.

Transmission-Based Precautions:

 Contact (e.g., MRSA, VRE, C. diff): Gloves, gown, dedicated equipment.
 Droplet (e.g., influenza, pertussis): Surgical mask, gown, goggles within 3 feet.
o ≥3 feet (e.g., influenza, pertussis, rubella). Mask + gown + goggles.

 Airborne (e.g., TB, measles, varicella): N95 respirator, negative pressure room.
o Negative-pressure room with ≥12 air exchanges/hour (e.g., TB, measles, varicella). Use
N95.

Infection Control Techniques:

 Donning PPE: gown → mask → goggles → gloves.
 Doffing PPE: gloves → goggles → gown → mask.
 Dispose of sharps in puncture-proof containers.

Special Considerations:

 Reportable diseases: TB, varicella, COVID-19, measles.
 Use single-use disposable equipment for immunocompromised patients.


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