Basic Nursing Skills

Course Overview

Basic Nursing Skills (D442) introduces foundational principles of the nursing process and the clinical judgment model, health assessment techniques, and communication skills needed to care for diverse adult patients across the lifespan. Skills focus on the concepts of vital signs, medication administration, infection control, nutrition, elimination, mobility, oxygenation, and skin integrity.

This course was started March 3, 2026 and is delivered through WGU’s module-based learning platform, which incorporates textbook access, videos, and interactive learning components. Students are encouraged to use the interactive components — including embedded questions and quizzes — to reinforce learning.

Students are required to be successful on lab assessments to progress to Adult Health 1 clinical.

Co-requisites: D443 and D444

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Learning Objectives

By the end of this course, students will be able to:

1. Perform systematic health assessment strategies and techniques on diverse adult patients to gather objective and subjective data. (Bloom’s: Apply)
2. Develop a prioritized plan of care for diverse adult patients using the nursing process (ADPIE) and the NCSBN clinical judgment model. (Bloom’s: Create)
3. Demonstrate appropriate sterile and aseptic techniques and select correct equipment to support infection control. (Bloom’s: Apply)
4. Demonstrate proper personal hygiene practices supporting activities of daily living for diverse adult patients. (Bloom’s: Apply)
5. Perform appropriate techniques to support diverse adult patient mobility needs, including safe patient handling, positioning, and fall prevention. (Bloom’s: Apply)
6. Assess nutritional requirements and perform techniques supporting diverse adult patient nutritional needs, including enteral nutrition. (Bloom’s: Analyze)
7. Perform appropriate techniques to support oxygenation, ventilation, and gas exchange needs of diverse adult patients. (Bloom’s: Apply)
8. Perform safe medication administration using the rights of medication administration across routes. (Bloom’s: Apply)
9. Perform appropriate techniques to support diverse adult patient urinary and bowel elimination needs. (Bloom’s: Apply)
10. Describe appropriate health care strategies and techniques for diverse adult patient specimen collection. (Bloom’s: Understand)
11. Apply the steps of the nursing process and clinical judgment model to plan, implement, and evaluate care. (Bloom’s: Evaluate)

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Course Competencies

Performs Health Assessments

The learner performs health assessment strategies and techniques on diverse adult patients to gather information. This competency encompasses systematic head-to-toe assessment, focused assessments, use of assessment tools, and accurate documentation of objective and subjective findings.

Develops a Care Plan

The learner develops a plan of care for diverse adult patients using the nursing process and clinical judgment model. Care planning integrates assessment data, prioritized nursing diagnoses, measurable patient-centered outcomes, evidence-based interventions, and ongoing evaluation.

Demonstrates Sterile Techniques for Infection Control

The learner demonstrates the use of appropriate sterile techniques and equipment to support infection control. This includes surgical asepsis, sterile field maintenance, sterile gloving, wound care, urinary catheterization, and understanding of standard and transmission-based precautions.

Demonstrates Daily Personal Hygiene Practices

The learner demonstrates proper personal hygiene practices for diverse adult patient activities of daily living. This includes bed bathing, oral care, hair and nail care, perineal care, back massage, and assisting with grooming while promoting patient dignity and independence.

Performs Supportive Assistance for Mobility Needs

The learner performs the appropriate health care strategies and techniques to support diverse adult patient mobility needs. This includes safe patient handling and mobility (SPHM), positioning techniques, range-of-motion exercises, transfer techniques, ambulation assistance, and fall prevention strategies.

Assesses Nutritional Requirements

The learner assesses the appropriate health care strategies and techniques to support diverse adult patient nutritional needs. This includes nutritional screening, caloric and hydration needs assessment, feeding assistance, and management of enteral nutrition via nasogastric and gastric tubes.

Performs Respiratory Requirements

The learner performs the appropriate health care strategies and techniques to support diverse adult patient oxygenation, ventilation, and gas exchange needs. This includes oxygen therapy, positioning for respiratory optimization, incentive spirometry, suctioning, and early recognition of respiratory compromise.

Performs Medication Administration

The learner performs the appropriate health care strategies and techniques to support diverse adult patient medication administration needs. This includes the rights of medication administration, oral, topical, subcutaneous, intramuscular, and IV medication routes, medication reconciliation, and adverse effect monitoring.

Performs Elimination Requirements

The learner performs the appropriate health care strategies and techniques to support diverse adult patient elimination needs. This includes urinary catheter insertion and care, management of urinary incontinence, bowel elimination promotion, enema administration, and ostomy care fundamentals.

Describes Specimen Collection Requirements

The learner describes the appropriate health care strategies and techniques for diverse adult patient specimen collection. This includes urine, stool, sputum, wound, and blood specimen collection, proper labeling and transport, and patient education related to specimen collection.

Performs Medical Processes and Judgement

The learner performs the steps of the nursing process and clinical judgment model to support diverse adult patient needs. This includes recognizing cues, analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

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Assessments

This course has three performance assessments that must be completed successfully to progress to Adult Health 1 clinical.

Code	Assessment	Type
KEA1	Basic Nursing Skills Pre-Lab HESI Patient Review	Performance Assessment
WKA1	Basic Nursing Skills Pre-Lab Shadow Health Digital Clinical Experience (DCE) — Ticket to Ride	Performance Assessment
LRA1	Basic Nursing Skills On Ground Lab	Performance Assessment

KEA1 — Pre-Lab HESI Patient Review

The HESI Patient Review is a pre-lab knowledge assessment that evaluates readiness for simulation lab. Students must demonstrate understanding of the clinical concepts, safety principles, and procedural knowledge covered in the course modules before progressing to the on-ground lab experience.

WKA1 — Shadow Health Digital Clinical Experience (DCE): Ticket to Ride

The Shadow Health DCE “Ticket to Ride” scenario is a virtual clinical simulation in which students perform a complete patient handoff assessment, apply the clinical judgment model, and demonstrate competency in health assessment and care planning skills. This pre-lab activity serves as a “ticket” to participate in the on-ground lab.

LRA1 — On Ground Lab

The On Ground Lab is a faculty-supervised, hands-on skills assessment conducted in the nursing simulation lab. Students must successfully demonstrate competency in selected fundamental nursing skills. Successful completion of LRA1 is required to progress to Adult Health 1 clinical.

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Course Structure

Week	Focus Area	Key Skills
1	Nursing Process, Clinical Judgment & Health Assessment	ADPIE, NCSBN model, head-to-toe assessment, vital signs
2	Infection Control, Hygiene & Skin Integrity	Sterile technique, hygiene care, wound care, pressure injury prevention
3	Mobility, Nutrition & Elimination	Safe patient handling, enteral nutrition, catheterization, bowel care
4	Oxygenation, Medication Administration & Integration	Oxygen therapy, medication routes, specimen collection, NCLEX prep

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Week 1: Nursing Process, Clinical Judgment, and Health Assessment

Week 1 Overview

The first week establishes the conceptual and procedural foundations of nursing practice. Students learn to apply the nursing process (ADPIE) and the NCSBN Clinical Judgment Measurement Model (CJMM) as frameworks for all clinical decision-making. Health assessment skills — from systematic head-to-toe examination to focused assessment — are introduced and practiced in a structured skills lab environment alongside vital signs measurement.

Session 1.1: The Nursing Process — ADPIE

Learning Objectives:

• Describe each phase of the nursing process: Assessment, Diagnosis, Planning, Implementation, Evaluation
• Distinguish between medical diagnosis and nursing diagnosis
• Explain how the nursing process guides individualized, patient-centered care

Key Concepts:

• Assessment: Collecting subjective data (symptoms, history) and objective data (signs, measurements)
• Diagnosis: Analyzing data to identify actual and risk nursing diagnoses using NANDA-I taxonomy
• Planning: Setting measurable, patient-centered outcomes (SMART goals) and selecting evidence-based interventions
• Implementation: Performing nursing actions safely and documenting care
• Evaluation: Comparing patient outcomes to expected goals; modifying the plan as needed

NCLEX-Style Practice Questions:

1. A nurse is completing an initial assessment on a newly admitted patient. Which action best represents the assessment phase of the nursing process?

   • A) Administering prescribed antibiotics on schedule
   • B) Measuring vital signs and asking about current symptoms ✓
   • C) Writing a nursing diagnosis of Impaired Gas Exchange
   • D) Teaching the patient about deep-breathing exercises

2. A patient’s nursing diagnosis states: “Acute Pain related to surgical incision as evidenced by patient rating pain 8/10 and guarding behavior.” Which component represents the defining characteristics (evidence)?

   • A) Acute Pain
   • B) Surgical incision
   • C) Patient rating pain 8/10 and guarding behavior ✓
   • D) The entire statement equally

Session 1.2: NCSBN Clinical Judgment Measurement Model

Learning Objectives:

• Identify the six cognitive skills of the NCSBN Clinical Judgment Measurement Model (CJMM)
• Apply the CJMM to a patient scenario to generate a nursing response
• Differentiate between the CJMM and the traditional nursing process

Key Concepts:

The NCSBN CJMM reflects how expert nurses actually think in clinical practice. The six cognitive skills are:

Cognitive Skill	Definition	Example
Recognize Cues	Identify relevant patient information	Noting SpO₂ of 88% in a post-op patient
Analyze Cues	Determine the meaning and significance	Recognizing this indicates hypoxemia
Prioritize Hypotheses	Rank possible explanations by urgency	Atelectasis vs. pulmonary embolism
Generate Solutions	Identify interventions for each hypothesis	Reposition, incentive spirometry, notify provider
Take Action	Implement selected interventions	Apply supplemental O₂, reposition, call provider
Evaluate Outcomes	Determine if actions were effective	SpO₂ returns to 95%; reassess in 15 min

NCLEX-Style Practice Questions:

1. A nurse notes that a patient’s blood pressure has dropped from 128/78 to 88/52 mmHg in the past hour. Using the NCSBN CJMM, which cognitive skill does the nurse use when determining that this change is likely related to the patient’s recent gastrointestinal bleeding?
   • A) Recognize Cues
   • B) Analyze Cues ✓
   • C) Prioritize Hypotheses
   • D) Generate Solutions

Session 1.3: Head-to-Toe Health Assessment

Learning Objectives:

• Perform a systematic head-to-toe physical assessment using inspection, palpation, percussion, and auscultation
• Document assessment findings accurately and objectively
• Identify normal versus abnormal findings requiring follow-up

Key Concepts:

Assessment Techniques (in order of use):

1. Inspection — Visual examination; used first for every body system
2. Auscultation — Listening with stethoscope; performed before palpation/percussion for abdominal assessment
3. Palpation — Touch to assess texture, temperature, moisture, organ size, pulsations, tenderness
4. Percussion — Tapping to assess underlying tissue density (tympany, dullness, resonance)

Head-to-Toe Sequence:

• General appearance, mental status, communication
• Head, eyes, ears, nose, throat (HEENT)
• Neck: lymph nodes, trachea, thyroid, carotid pulses, jugular veins
• Chest: respiratory assessment (anterior and posterior), cardiovascular assessment
• Abdomen: bowel sounds, palpation for organomegaly and tenderness
• Extremities: skin integrity, peripheral pulses, edema, range of motion
• Neurological: level of consciousness, orientation, reflexes

NCLEX-Style Practice Questions:

1. The nurse is performing an abdominal assessment. In which order should the nurse use assessment techniques?

   • A) Inspection, palpation, percussion, auscultation
   • B) Inspection, auscultation, percussion, palpation ✓
   • C) Auscultation, inspection, palpation, percussion
   • D) Palpation, inspection, auscultation, percussion

2. During assessment, the nurse documents that the patient’s breath sounds are “decreased at bilateral bases.” This finding is best classified as:

   • A) Subjective data
   • B) Objective data ✓
   • C) A nursing diagnosis
   • D) A medical diagnosis

Session 1.4: Vital Signs — Measurement and Clinical Significance

Learning Objectives:

• Measure temperature, pulse, blood pressure, respirations, and SpO₂ using correct technique
• State normal adult values for each vital sign
• Identify critical values requiring immediate nursing action

Key Concepts:

Vital Sign	Normal Adult Range	Critical Values
Temperature (oral)	36.0–37.5°C (96.8–99.5°F)	> 40°C or < 35°C
Pulse	60–100 bpm	< 40 or > 150 bpm
Blood Pressure	< 120/< 80 mmHg (normal)	SBP < 90 or > 180; DBP > 120
Respirations	12–20 breaths/min	< 8 or > 30 breaths/min
SpO₂	95–100%	< 90% (notify provider immediately)
Pain	0 (no pain)	≥ 7/10 unmanaged pain

Technique Highlights:

• Temperature: Document route; wait 15 min after hot/cold intake for oral route
• Pulse: Count for full 60 seconds if irregular; assess rate, rhythm, volume
• Blood Pressure: Correct cuff size; arm at heart level; no talking during measurement
• Respirations: Count without patient awareness; observe for depth and pattern
• SpO₂: Assess probe site, nail polish, and perfusion; correlate with clinical presentation

NCLEX-Style Practice Questions:

1. The nurse obtains a blood pressure of 186/112 mmHg on a patient with no history of hypertension. What is the nurse’s priority action?
   • A) Document the finding and reassess in 4 hours
   • B) Administer an antihypertensive from the PRN medication list
   • C) Reposition the patient and obtain a repeat reading, then notify the provider ✓
   • D) Instruct the patient to rest and reduce fluid intake

Session 1.5: Documentation and Communication — SBAR and EHR

Learning Objectives:

• Document assessment findings accurately using objective language in the electronic health record (EHR)
• Apply the SBAR framework to communicate clinical concerns to providers
• Identify legal and ethical principles of nursing documentation

Key Concepts:

SBAR Communication Framework:

• S — Situation: What is happening right now? (“Mr. Jones in Room 412 has a blood pressure of 186/112.”)
• B — Background: What is the clinical context? (“He was admitted for elective knee replacement; no prior hypertension history.”)
• A — Assessment: What do you think is happening? (“He appears to be experiencing acute hypertension, possibly pain-related.”)
• R — Recommendation: What do you need? (“I am requesting an order for additional antihypertensive medication and reassessment.”)

Documentation Principles:

• Record facts, not interpretations (“patient states pain is 8/10” not “patient is in a lot of pain”)
• Document in real time; never pre-chart or back-chart
• Use approved abbreviations only
• Late entries must be labeled as such with timestamp and reason
• Never alter or delete documentation

NCLEX-Style Practice Questions:

1. A nurse needs to report a patient’s new onset confusion to the provider. Which SBAR statement best represents the “Assessment” component?
   • A) “Mr. Torres in Room 208 is confused.”
   • B) “He was admitted yesterday for a UTI and is 82 years old.”
   • C) “I believe he may be developing sepsis-associated encephalopathy given his elevated temperature and altered mental status.” ✓
   • D) “I would like you to order a complete metabolic panel and blood cultures.”

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Week 2: Infection Control, Hygiene, and Skin Integrity

Week 2 Overview

Week 2 focuses on preventing harm through asepsis and protecting skin integrity. Students learn to differentiate medical asepsis from surgical asepsis, perform sterile procedures, and implement standard and transmission-based precautions. The week also covers comprehensive hygiene care techniques and introduces the principles of wound assessment and pressure injury prevention — critical competencies for safe nursing practice.

Session 2.1: Infection Control — Standard and Transmission-Based Precautions

Learning Objectives:

• Explain the chain of infection and identify nursing strategies to break each link
• Differentiate standard precautions from transmission-based precautions
• Perform correct hand hygiene using CDC guidelines

Key Concepts:

Chain of Infection:

1. Infectious agent (pathogen)
2. Reservoir (host, environment, equipment)
3. Portal of exit (respiratory secretions, blood, feces)
4. Mode of transmission (contact, droplet, airborne, vehicle, vector)
5. Portal of entry (mucous membranes, non-intact skin, GI/respiratory tracts)
6. Susceptible host

Standard Precautions (used with ALL patients):

• Hand hygiene (before/after patient contact, before clean procedures, after body fluid exposure, after touching patient surroundings)
• Personal protective equipment (PPE): gloves, gown, mask, eye protection as indicated
• Safe injection practices
• Respiratory hygiene/cough etiquette
• Environmental cleaning

Transmission-Based Precautions:

Type	Pathogens	PPE	Room
Contact	MRSA, C. diff, VRE, scabies	Gown + gloves	Private
Droplet	Influenza, meningitis, pertussis	Surgical mask	Private (or > 3 ft)
Airborne	TB, measles, varicella	N95 respirator	Negative-pressure

NCLEX-Style Practice Questions:

1. A patient is admitted with confirmed pulmonary tuberculosis. Which precaution type and room assignment does the nurse implement?

   • A) Contact precautions; private room with positive-pressure ventilation
   • B) Droplet precautions; private room
   • C) Airborne precautions; negative-pressure private room ✓
   • D) Standard precautions; semi-private room is acceptable

2. The nurse is caring for a patient with Clostridioides difficile. After removing gloves, which hand hygiene agent should the nurse use?

   • A) Alcohol-based hand rub (ABHR)
   • B) Soap and water ✓
   • C) Antiseptic towelette
   • D) Either soap or ABHR are equally effective for C. diff

Session 2.2: Sterile Technique and Sterile Field Maintenance

Learning Objectives:

• Distinguish between medical asepsis (clean technique) and surgical asepsis (sterile technique)
• Open and maintain a sterile field without contamination
• Don and remove sterile gloves using the closed and open gloving methods

Key Concepts:

Principles of Surgical Asepsis:

1. Only sterile items touch the sterile field
2. The sterile field is kept in sight at all times
3. Items below the level of the sterile field are considered contaminated
4. Sterile items at the edge (< 2.5 cm / 1 inch) of the field are considered contaminated
5. Moisture contamination = contamination (strike-through)
6. When in doubt, throw it out

Sterile Field Setup Steps:

1. Select a clean, dry, flat work surface above waist height
2. Check package integrity and expiration date
3. Open outer wrap without reaching over the sterile interior
4. Place sterile items by dropping or with sterile forceps only
5. Pour liquids from a distance; avoid splashing
6. Don sterile gloves after setup

NCLEX-Style Practice Questions:

1. The nurse is setting up a sterile field for a urinary catheter insertion. Which action requires the nurse to establish a new sterile field?
   • A) The sterile drape touches the bedrail
   • B) The nurse turns away from the sterile field for 10 seconds ✓
   • C) The nurse opens a secondary sterile package and drops the item onto the field
   • D) The patient coughs while the sterile field is being set up and covers their mouth

Session 2.2b: Sterile Technique Violations — Identifying and Correcting Errors

Learning Objectives:

• Identify common sterile technique violations in clinical scenarios
• State the correct action when a sterile technique violation is detected
• Apply the “when in doubt, throw it out” principle consistently
• Recognize strike-through contamination and the one-inch border rule in practice

Key Concepts:

Common Sterile Technique Violations:

Violation	Why It Contaminates	Correct Action
Turning away from the sterile field	Field outside line of sight — unobserved contact cannot be assessed	Remain facing the field; gather all supplies before setup
Reaching across the sterile field	Non-sterile sleeve/arm passes over sterile surface	Reposition to access items from the side; never reach across
Leaving the sterile field unattended	Airborne particles or unobserved contact compromise integrity	Discard and reconstruct the field; never leave it unattended
Strike-through contamination	Moisture wicks microorganisms from an unsterile surface through packaging	Replace any wet items; sterility is not recoverable once wet
Items in the 1-inch border zone	Edges of the sterile drape (< 2.5 cm from border) are considered non-sterile	Keep all sterile items in the interior of the field
Non-sterile item placed on field	Any item below sterile integrity contaminates the entire field	Remove the item; reconstruct the field if necessary
Sterile glove touches non-sterile surface	The outside of the sterile glove is contaminated on any unsterile contact	Remove, discard, and re-glove using a new sterile pair
Opening a sterile package incorrectly	Reaching over or touching the inner packaging compromises sterility	Open away from the body; peel back flaps to the side

The “When in Doubt, Throw It Out” Principle:

This foundational principle of sterile technique means that if there is any uncertainty about whether an item or field remains sterile — for any reason — it must be treated as contaminated and replaced. There is no gray area in sterile technique. This principle protects patients from HAIs caused by uncertainty-driven shortcuts.

Clinical Application — Urinary Catheter Insertion:

1. Confirm all supplies are at bedside before opening any sterile packages
2. Open the catheter kit using the aseptic opening technique
3. Don sterile gloves without touching the outer surfaces
4. Maintain all items within the sterile field interior (≥ 2.5 cm from edge)
5. If the sterile drape contacts a non-sterile surface, replace it before proceeding
6. Maintain continuous eye contact with the sterile field throughout the procedure

Sterile Field Integrity — Key Decision Rules:

• Contaminated field detected mid-procedure: Stop, discard, obtain new supplies, restart
• Patient sneezes or coughs on the field: Field is contaminated; reconstruct
• Sterile item dropped on the floor: Item is contaminated; discard
• Item slips into the 1-inch border zone: Consider contaminated; do not use
• Uncertainty about an item’s sterility: Treat as contaminated; replace it

NCLEX-Style Practice Questions:

1. A nurse is inserting a urinary catheter. After donning sterile gloves, the nurse accidentally touches the outer edge of the sterile drape with the back of her right glove. What is the nurse’s priority action?

   • A) Continue the procedure — the back of the glove is still considered sterile
   • B) Remove both gloves, discard, and re-glove with a new sterile pair ✓
   • C) Use only the left hand for the remainder of the procedure
   • D) Apply an additional sterile glove over the right hand

2. While adding a sterile item to an established sterile field, a nurse allows the outer wrapper to fall onto the sterile drape. Which response is correct?

   • A) Remove the wrapper with sterile forceps and continue
   • B) The field is contaminated; discard everything and establish a new sterile field ✓
   • C) The field is only contaminated in the area where the wrapper landed
   • D) Continue only if the wrapper was opened using aseptic technique

3. During a sterile dressing change, the nurse notices a small wet spot on the sterile drape where a saline-soaked gauze was resting. What does this represent?

   • A) A normal occurrence that does not affect sterility
   • B) Strike-through contamination — the drape is no longer sterile in that area ✓
   • C) A sign that too much saline was used on the gauze
   • D) A violation only if the wet spot contacts the wound directly

Session 2.3: Wound Care and Dressing Changes

Learning Objectives:

• Perform a sterile wound assessment using the wound assessment parameters
• Select and apply appropriate wound dressings based on wound type and exudate characteristics
• Recognize signs of wound infection and wound dehiscence

Key Concepts:

Wound Assessment Parameters (acronym: MEASURE or WOUND):

• Location and size: Length × width × depth in centimeters
• Wound bed: Tissue type — pink/red (granulation), yellow (slough), black (eschar)
• Wound edges: Defined, rolled, undermined, tunneling
• Exudate: Amount (scant/moderate/heavy), type (serous, serosanguineous, sanguineous, purulent), odor
• Periwound skin: Intact, macerated, indurated, erythematous
• Pain: PQRST assessment related to wound site

Dressing Selection Principles:

• Keep wound bed moist, periwound skin dry
• Absorb excess exudate without drying the wound bed
• Protect from contamination and trauma
• Maintain thermal stability
• Allow for gas exchange

Signs of Wound Infection: Increased redness, warmth, swelling, purulent exudate, odor, increased pain, fever, elevated WBC

NCLEX-Style Practice Questions:

1. During a dressing change, the nurse observes yellow, moist tissue covering 60% of the wound bed. The nurse correctly documents this as:
   • A) Granulation tissue
   • B) Eschar
   • C) Slough ✓
   • D) Epithelial tissue

Session 2.4: Hygiene Care and Activities of Daily Living

Learning Objectives:

• Perform complete bed bath with appropriate technique while maintaining patient dignity
• Provide oral hygiene including care for patients at risk for ventilator-associated pneumonia (VAP)
• Assist with hair, nail, and perineal hygiene according to patient needs and preferences

Key Concepts:

Bed Bath Technique:

• Use warm water (105–115°F / 40–46°C); change water as needed
• Work from clean to dirty areas; face → neck → arms → chest → abdomen → legs → perineum → back
• Keep patient covered (bath blanket) except for area being washed
• Use gentle strokes; assess skin integrity during bath
• Document skin findings (redness, rashes, breakdown, edema)

Oral Hygiene:

• Brush teeth every 8–12 hours with soft-bristle brush and non-foaming toothpaste
• Use suction toothbrush for patients unable to expectorate
• Apply lip moisturizer to prevent cracking
• Oral care Q2–4h for patients on mechanical ventilation (VAP prevention bundle)

Perineal Care:

• Female patients: front to back, labia majora → labia minora → urethral meatus
• Male patients: retract foreskin (if uncircumcised) → cleanse glans → replace foreskin
• Rinse and dry thoroughly; apply moisture barrier if at risk for incontinence-associated dermatitis (IAD)

NCLEX-Style Practice Questions:

1. The nurse is providing morning care to a 78-year-old patient with dementia who resists having their teeth brushed. What is the nurse’s best approach?
   • A) Document patient refused oral care and move on
   • B) Ask the patient’s family to perform oral care instead
   • C) Use a calm, step-by-step approach with simple instructions; try again in 15 minutes if still resistant ✓
   • D) Use a mouth swab instead of brushing since the patient is refusing

Session 2.5: Pressure Injury Prevention and Skin Integrity

Learning Objectives:

• Identify patients at high risk for pressure injuries using the Braden Scale
• Stage pressure injuries according to the National Pressure Injury Advisory Panel (NPIAP) staging system
• Implement evidence-based pressure injury prevention interventions

Key Concepts:

Braden Scale Risk Factors: Sensory perception, moisture, activity, mobility, nutrition, friction/shear (score ≤ 18 = at risk; ≤ 9 = very high risk)

NPIAP Pressure Injury Staging:

Stage	Description
Stage 1	Non-blanchable erythema of intact skin
Stage 2	Partial-thickness skin loss; shallow open wound or intact/ruptured blister
Stage 3	Full-thickness skin loss; subcutaneous fat visible; no bone/tendon/muscle exposed
Stage 4	Full-thickness skin loss with exposed bone, tendon, or muscle
Unstageable	Full-thickness loss obscured by slough or eschar
Deep Tissue	Purple or maroon discoloration of intact skin; may feel boggy, firm, or painful

Prevention Bundle (SSKIN):

• Surface: Use pressure-redistributing mattress/cushion
• Skin inspection: Assess every 2 hours during repositioning
• Keep moving: Reposition every 2 hours; off-load heels
• Incontinence management: Keep skin dry; apply barrier cream
• Nutrition and hydration: Ensure adequate protein and caloric intake

NCLEX-Style Practice Questions:

1. A patient who is bedridden with stage 2 pressure injury on the sacrum has a Braden Scale score of 13. Which intervention has the highest priority?
   • A) Apply petroleum-based moisturizer to intact skin
   • B) Reposition the patient every 2 hours and off-load the sacrum ✓
   • C) Document the wound and reassess in 24 hours
   • D) Apply a dry gauze dressing to the wound

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Week 3: Mobility, Nutrition, and Elimination

Week 3 Overview

Week 3 addresses three fundamental physiological needs: the ability to move safely, the ability to take in and absorb nutrition, and the ability to eliminate waste products. Students learn safe patient handling and mobility (SPHM) principles to protect both patients and nurses, nutritional assessment and enteral feeding techniques, urinary catheterization, and bowel care. These skills integrate infection control principles learned in Week 2.

Session 3.1: Safe Patient Handling and Mobility

Learning Objectives:

• Apply SPHM principles including ergonomic guidelines and assistive devices
• Perform safe patient transfers using a gait belt and mechanical lift
• Implement fall prevention strategies using a multifactorial risk assessment

Key Concepts:

SPHM Principles:

• Never manually lift more than 35 lbs of a patient’s body weight (OSHA/ANA guideline)
• Use mechanical lifts for patients who cannot bear full weight
• Use friction-reducing devices (slide sheets) for lateral transfers
• Stand-assist devices for patients with partial weight-bearing ability
• Two-person assist minimum for dependent transfers when mechanical lift unavailable

Safe Transfer Technique (Pivot Transfer with Gait Belt):

1. Explain procedure and assess patient’s ability to participate
2. Apply gait belt at waist over clothing (snug; two fingers underneath)
3. Lower bed to lowest position; lock wheels; move IV pole if present
4. Position patient at edge of bed; feet flat on floor
5. Stand offset from patient’s weak side; block patient’s knee with your knee
6. Assist to standing on count of three; pivot toward chair
7. Lower patient slowly; ensure buttocks touch seat before releasing

Fall Risk Assessment: Use validated tool (MORSE, Hendrich II); high-risk interventions include yellow socks/armband, bed alarm, call light within reach, hourly rounding, medication review (opioids, sedatives, antihypertensives), orthostatic BP monitoring.

NCLEX-Style Practice Questions:

1. A nurse is preparing to transfer a patient from bed to wheelchair. The patient had a left-sided stroke and has left-sided hemiplegia. Where should the nurse position the wheelchair?
   • A) On the patient’s left (affected) side
   • B) On the patient’s right (unaffected) side ✓
   • C) Directly in front of the patient
   • D) Behind the patient for support

Session 3.2: Range of Motion and Positioning

Learning Objectives:

• Perform passive and active-assistive range-of-motion (ROM) exercises
• Position patients correctly in supine, lateral, prone, Fowler’s, and semi-Fowler’s positions
• Apply principles of body alignment to prevent contractures and skin breakdown

Key Concepts:

Fowler’s Positions:

• High Fowler’s: 90° — eating, post-op awakening, acute respiratory distress
• Semi-Fowler’s: 30–45° — sleeping, post-op patients, head-of-bed elevation for aspiration prevention
• Low Fowler’s: 15–30° — post-spinal anesthesia (initially flat), comfort

Lateral (Side-Lying) Position:

• Support head, top arm, and top leg with pillows
• Avoid direct pressure on greater trochanter (use 30° tilt)
• Use for ear drainage, after-meal positioning preference, sleep

ROM Exercise Principles:

• Perform each movement slowly and smoothly through full range of motion
• Stop if patient reports pain; never force movement
• Support proximal joint while moving distal joint
• Passive ROM: nurse moves the joint; Active-assistive: patient participates with support; Active: patient performs independently
• Document ROM exercises per shift

NCLEX-Style Practice Questions:

1. A patient with pneumonia has increased work of breathing and SpO₂ of 91%. Which position should the nurse implement as a priority?
   • A) Supine (flat)
   • B) Trendelenburg
   • C) High Fowler’s ✓
   • D) Left lateral decubitus

Session 3.3: Nutritional Assessment and Enteral Nutrition

Learning Objectives:

• Perform a basic nutritional screening assessment using a validated tool
• Verify nasogastric (NG) tube placement using evidence-based methods
• Administer enteral tube feedings safely and document tolerance

Key Concepts:

Nutritional Screening:

• Use validated tool: MUST (Malnutrition Universal Screening Tool) or NRS-2002
• Assess BMI, recent unintentional weight loss, acute disease effect
• Refer to registered dietitian (RD) for comprehensive assessment

NG Tube Placement Verification (Evidence-Based):

• Gold standard: Chest X-ray — used for initial placement verification before first feeding
• Ongoing verification: pH testing of aspirate (gastric pH < 5 indicates gastric placement)
• NOT reliable: Auscultation of air injection (“whoosh” test) — no longer recommended
• Measure external tube length (nose to earlobe to xiphoid) and mark with tape; document at insertion

Enteral Feeding Administration:

• Verify tube placement before each feeding or every 4–8 hours during continuous feeds
• Check gastric residual volume (GRV) per facility policy (typically hold if GRV > 200–500 mL)
• Flush tube with 30 mL water before and after feeding and medication administration
• Keep head of bed elevated at 30–45° during and for 30–60 minutes after feeding
• Monitor for intolerance: nausea, vomiting, abdominal distension, diarrhea, aspiration

NCLEX-Style Practice Questions:

1. Before beginning a scheduled intermittent tube feeding, the nurse aspirates 250 mL of gastric residual. The facility policy states to hold feedings for GRV > 200 mL. What is the nurse’s best action?
   • A) Discard the aspirate, infuse the feeding, and document
   • B) Return the aspirate, hold the feeding, and notify the provider ✓
   • C) Discard the aspirate and delay the feeding for 1 hour
   • D) Administer half the scheduled feeding volume and reassess

Session 3.4: Urinary Catheterization

Learning Objectives:

• Insert a urinary catheter using sterile technique following the CAUTI prevention bundle
• Provide ongoing catheter care and document urinary output
• Identify indications, contraindications, and complications of urinary catheterization

Key Concepts:

Catheter-Associated Urinary Tract Infection (CAUTI) Prevention:

• Insert only when medically indicated (not for convenience or incontinence)
• Use smallest catheter size appropriate
• Maintain closed drainage system
• Keep drainage bag below bladder at all times; never allow backflow
• Perform catheter care with soap and water during daily bath
• Reassess and remove catheter daily (daily catheter reminders/removal protocols)

Straight vs. Indwelling Catheterization:

• Straight (intermittent) catheter: Inserted to drain bladder and removed immediately; used for specimen collection, measuring residual urine, relieving acute retention
• Indwelling (Foley) catheter: Remains in place; balloon inflated in bladder; used for accurate output monitoring, urinary obstruction, perioperative care, or healing perineal wounds

Catheter Insertion (Female) Steps:

1. Gather sterile kit; explain procedure
2. Position patient in dorsal recumbent (supine with knees bent, feet flat)
3. Open sterile kit using sterile technique; don sterile gloves
4. Apply sterile drapes; use dominant hand only for catheter handling after prep
5. Cleanse urethral meatus front-to-back with antiseptic swabs (labia → meatus)
6. Insert catheter 2–3 inches until urine flows; advance 1 inch more
7. Inflate balloon with sterile water per manufacturer (typically 10 mL)
8. Gently pull back until resistance felt; secure to inner thigh
9. Connect drainage bag; document time, volume, and appearance of urine

NCLEX-Style Practice Questions:

1. The nurse is inserting an indwelling urinary catheter in a female patient. After urine begins to flow, the nurse inserts the catheter 1 more inch and inflates the balloon. The patient immediately reports sharp pain. What is the nurse’s priority action?
   • A) Continue inflating the balloon slowly
   • B) Deflate the balloon immediately and advance the catheter further before reinflating ✓
   • C) Deflate the balloon and remove the catheter; restart with a new kit
   • D) Document the finding and monitor for hematuria

Session 3.5: Bowel Elimination and Care

Learning Objectives:

• Assess bowel sounds and bowel elimination patterns
• Perform a soap-suds enema safely
• Describe the care of a patient with a colostomy or ileostomy

Key Concepts:

Bowel Sound Assessment:

• Normal: 5–30 sounds/minute; gurgling, clicking
• Hypoactive (< 5/min): Post-op ileus, opioid use, peritonitis
• Hyperactive: Diarrhea, gastroenteritis, early bowel obstruction
• Absent: Paralytic ileus, peritonitis — must listen for 5 full minutes in each quadrant

Constipation Prevention:

• Fluid intake 2–3 L/day (unless restricted)
• Dietary fiber 25–35 g/day
• Physical activity as tolerated
• Avoid prolonged bed rest
• Bowel protocol for patients on opioids (scheduled laxatives)

Enema Administration:

• Position patient in left Sims’ (left side-lying, right knee to chest) — follows the sigmoid colon anatomy
• Lubricate rectal tube; insert 3–4 inches in adults
• Administer solution at 100–105°F (38–41°C); hold container 12–18 inches above rectum
• Instruct patient to retain solution per order (usually 5–10 minutes for cleansing enemas)
• Lower container immediately if patient reports cramping
• Document type, amount, and results

Ostomy Care:

• Assess stoma color (should be pink/red, moist); pale or dark purple = ischemia → notify provider
• Empty pouch when ⅓ to ½ full
• Change entire pouching system every 3–5 days or when leaking
• Measure stoma at each change until 4–6 weeks post-op (stoma shrinks as edema resolves)
• Peristomal skin should be intact; treat skin breakdown early

NCLEX-Style Practice Questions:

1. The nurse is preparing to administer a cleansing enema. In which position should the patient be placed?
   • A) Right Sims’ position
   • B) Left Sims’ position ✓
   • C) High Fowler’s position
   • D) Supine with knees slightly flexed

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Week 4: Oxygenation, Medication Administration, and Integration

Week 4 Overview

The final week addresses oxygenation support techniques, the full spectrum of medication administration routes, and specimen collection. The week concludes with NCLEX-style clinical reasoning integration using Next Generation NCLEX (NGN) case studies, bringing together all course competencies in preparation for the KEA1, WKA1, and LRA1 assessments. Students review the clinical judgment model applied to complex, multi-system patient scenarios.

Session 4.1: Oxygen Therapy and Airway Management

Learning Objectives:

• Select the appropriate oxygen delivery device based on the patient’s oxygenation needs
• Perform nasopharyngeal suctioning safely using appropriate technique
• Recognize the early signs of respiratory compromise and initiate appropriate nursing interventions

Key Concepts:

Oxygen Delivery Devices:

Device	FiO₂ Range	Flow Rate	Notes
Nasal cannula	24–44%	1–6 L/min	Comfortable; for mild hypoxemia
Simple face mask	35–50%	6–10 L/min	Min 6 L/min to prevent CO₂ rebreathing
Partial rebreather mask	40–70%	6–11 L/min	Reservoir bag; 1/3 deflates on inspiration
Non-rebreather mask	60–90%	10–15 L/min	One-way valves; highest FiO₂ without intubation
Venturi mask	24–50% (precise)	Varies	Best for COPD; reliable FiO₂

Oropharyngeal/Nasopharyngeal Airway:

• Oropharyngeal (OPA): unconscious patients without gag reflex
• Nasopharyngeal (NPA): semi-conscious patients who may have gag reflex; lubricate before insertion; measure from tip of nose to earlobe

Suctioning Principles:

• Suction only when clinically indicated (not on a routine schedule)
• Hyperoxygenate before and after suctioning (100% O₂ × 30–60 seconds)
• Limit suction time to 10–15 seconds per pass
• Allow 30–60 second rest between passes; limit to 3 passes per episode

NCLEX-Style Practice Questions:

1. A patient with COPD has an SpO₂ of 88% on room air. The provider orders oxygen to maintain SpO₂ at 88–92%. Which delivery device is most appropriate for this patient?

   • A) Non-rebreather mask at 15 L/min
   • B) Simple face mask at 8 L/min
   • C) Venturi mask at ordered FiO₂ ✓
   • D) Nasal cannula at 6 L/min

2. The nurse is performing nasotracheal suctioning. Which finding should cause the nurse to stop suctioning immediately?

   • A) The patient coughs during the procedure
   • B) SpO₂ drops to 88% and the patient’s heart rate drops to 48 bpm ✓
   • C) The patient asks the nurse to stop
   • D) A small amount of clear secretions is visible in the suction tubing

Session 4.2: Incentive Spirometry and Breathing Exercises

Learning Objectives:

• Teach and supervise incentive spirometry technique for at-risk patients
• Instruct patients in diaphragmatic breathing and pursed-lip breathing
• Implement the post-operative respiratory care bundle

Key Concepts:

Incentive Spirometry (IS):

• Prevents atelectasis and pulmonary complications post-operatively
• Goal: achieve a sustained slow deep inspiration (not a rapid inhalation)
• Technique: exhale normally → place mouthpiece → inhale slowly and deeply → sustain for 3–5 seconds → exhale → rest → repeat 10 times/hour while awake
• Splint incision with pillow during deep breathing post-abdominal or thoracic surgery

Pursed-Lip Breathing:

• Indicated for COPD, anxiety-related dyspnea
• Inhale slowly through nose × 2 counts → exhale through pursed lips × 4 counts
• Increases positive end-expiratory pressure, prevents small airway collapse

Post-operative Respiratory Bundle (TCDB):

• Turn: Reposition every 2 hours; promotes even ventilation
• Cough: Instruct to splint and cough forcefully q1–2 hours
• Deep breathe: 10 deep breaths hourly while awake
• Incentive spirometry: 10 breaths hourly while awake

NCLEX-Style Practice Questions:

1. The nurse is teaching incentive spirometry to a patient before abdominal surgery. Which patient statement indicates understanding?
   • A) “I should breathe in and out as fast as I can to make the ball rise quickly.”
   • B) “I’ll use this once in the morning and once at night.”
   • C) “I should breathe in slowly and hold it for a few seconds to keep the ball up.” ✓
   • D) “I can stop using this after my first day out of bed.”

Session 4.3: Medication Administration — Oral, Topical, and Injections

Learning Objectives:

• Apply the rights of medication administration before giving any medication
• Administer subcutaneous and intramuscular injections using correct technique and site selection
• Identify high-alert medications and required safety checks

Key Concepts:

Rights of Medication Administration:

Right	Key Points
Right patient	Two identifiers (name + date of birth or MRN)
Right medication	Generic and brand name familiarity; read label 3 times
Right dose	Calculate independently; double-check high-alert meds
Right route	Never administer IV medications IM without order
Right time	Within 30–60 minutes of scheduled time per facility policy
Right documentation	Chart immediately after administering
Right reason	Know the indication before giving
Right response	Monitor for therapeutic and adverse effects

Subcutaneous Injection:

• Sites: abdomen (2 inches from umbilicus), outer upper arm, anterior thigh, upper outer back
• Needle: 25–31 gauge, 5/8 inch; angle 45° (thin patient) or 90° (average/obese patient)
• No aspiration required for SC injections (ADA guideline for insulin and heparin)
• Rotate sites; document injection site

Intramuscular Injection:

• Preferred site: Ventrogluteal (safest; away from major nerves and blood vessels)
• Alternative sites: Vastus lateralis (preferred for pediatrics), deltoid (≤ 2 mL)
• Needle: 22–25 gauge, 1–1.5 inch; 90° angle; aspirate only if site requires per facility policy
• Z-track technique: pull skin 2.5–3.5 cm laterally before injection; release after withdrawal

High-Alert Medications (require independent double-check):

• Insulin
• Anticoagulants (heparin, warfarin, enoxaparin)
• Concentrated electrolytes (potassium chloride, concentrated sodium chloride)
• Opioids
• Chemotherapy agents

NCLEX-Style Practice Questions:

1. The nurse is preparing to administer insulin glargine (Lantus) 20 units subcutaneously. After scanning the patient’s armband, what is the nurse’s next action?

   • A) Aspirate the syringe after insertion to check for blood return
   • B) Scan the medication barcode and verify against the MAR ✓
   • C) Administer in the deltoid muscle for fastest absorption
   • D) Mix the insulin with NPH insulin in the same syringe

2. A nurse is about to give an IM injection in the ventrogluteal site. Which anatomical landmark is used to locate this site?

   • A) Posterior iliac crest and greater trochanter
   • B) Anterior superior iliac spine and greater trochanter ✓
   • C) Iliac crest and the medial border of the ilium
   • D) Acromion process and axilla

Session 4.4: Intravenous Medications and Specimen Collection

Learning Objectives:

• Identify the types of IV access and perform IV site assessment
• Describe correct technique for collecting urine, stool, sputum, and wound specimens
• Explain the importance of correct labeling and transport of specimens

Key Concepts:

IV Site Assessment (PICC/PIV):

• Assess every 1–2 hours for patency and complications
• Infiltration: Swelling, coolness, pallor, pain — stop infusion; elevate extremity; apply warm compress for isotonic solutions
• Phlebitis: Redness, warmth, pain, palpable cord along vein — stop infusion; apply warm compress; restart in new site
• Extravasation: Infiltration of a vesicant medication — emergent; stop infusion; aspirate residual; notify provider; administer antidote per protocol

Specimen Collection Summary:

Specimen	Collection Notes
Clean catch urine	Midstream; cleanse urethral meatus first; container must not touch skin
Catheter urine (C&S)	Clamp tubing 15–30 min; aspirate from port with sterile syringe (never from drainage bag)
Wound culture	Irrigate wound first; swab from clean granulation tissue (not exudate or eschar)
Stool for C. diff	Liquid or unformed stool; collected in sterile container; do not use if patient receiving antibiotics
Sputum	Early morning; instruct to cough deeply (not saliva); collect in sterile container
Blood cultures	Two sets from two sites; 20 min apart; use sterile technique; collect before antibiotics if possible

NCLEX-Style Practice Questions:

1. The nurse needs to collect a urine specimen for culture and sensitivity from a patient with an indwelling urinary catheter. Which action is correct?
   • A) Collect the specimen from the drainage bag
   • B) Clamp the tubing, then aspirate from the sampling port using a sterile syringe ✓
   • C) Remove the catheter and collect a clean-catch specimen
   • D) Collect the specimen directly from the catheter tubing

Session 4.5: Clinical Integration — NGN Case Studies and Lab Readiness

Learning Objectives:

• Apply the NCSBN Clinical Judgment Model to an unfolding multi-system patient case
• Demonstrate readiness for KEA1 (HESI), WKA1 (Shadow Health DCE), and LRA1 (On Ground Lab)
• Identify priority interventions using Maslow’s Hierarchy, ABCs, and Safety principles

Key Concepts:

Prioritization Frameworks:

Maslow’s Hierarchy of Needs (bottom-up priority):

1. Physiological (airway, breathing, circulation, nutrition, elimination)
2. Safety and security (fall prevention, medication safety, infection control)
3. Love/belonging (therapeutic relationship, family involvement)
4. Esteem (dignity, autonomy, cultural sensitivity)
5. Self-actualization (patient education, health promotion)

ABCs + Safety:

• Always address Airway first, then Breathing, then Circulation
• Life-threatening abnormalities take priority over non-life-threatening ones
• Safety concerns (fall risk, medication error risk) are addressed before comfort needs

NGN Item Type Review:

• Extended multiple response: Select all that apply from a larger list
• Matrix grid: For each row, select an appropriate column response
• Drop-down (cloze): Fill in the blank from a dropdown list
• Drag-and-drop (ordered response): Prioritize interventions in sequence
• Highlighting: Highlight relevant findings in a clinical note
• Bowtie: Identify the condition most likely occurring, interventions, and parameters to monitor

Assessment Readiness Checklist:

For KEA1 (HESI):

• Review all 11 course competencies
• Complete HESI case studies for each competency area
• Practice NCLEX-style questions (aim 70%+ baseline)

For WKA1 (Shadow Health DCE — Ticket to Ride):

• Complete Shadow Health practice assignments
• Review therapeutic communication and SBAR
• Practice head-to-toe assessment documentation

For LRA1 (On Ground Lab):

• Review all skills checklists (see below)
• Practice each skill with a lab partner
• Know critical steps (steps that, if missed, result in automatic failure)

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Clinical Skills Checklist

The following skills may be evaluated during the LRA1 On Ground Lab assessment. Students should practice each skill until they can perform it independently with correct technique.

Infection Control and Asepsis

• Perform correct hand hygiene (soap and water; ABHR)
• Don and doff PPE in correct sequence (gown → mask → eye protection → gloves on; reverse for removal)
• Set up and maintain a sterile field without contamination
• Open sterile packages using correct technique
• Don sterile gloves using open and closed methods

Health Assessment

• Perform systematic head-to-toe assessment
• Measure and document all vital signs (T, P, R, BP, SpO₂, Pain)
• Assess pain using appropriate scale (NRS, FLACC, Wong-Baker FACES, CPOT)
• Perform abdominal assessment in correct order (inspect → auscultate → percuss → palpate)

Hygiene and Skin Integrity

• Perform complete bed bath maintaining patient dignity
• Provide oral hygiene
• Apply Braden Scale and identify at-risk patients
• Stage a pressure injury correctly using NPIAP staging

Mobility and Safety

• Apply gait belt and perform pivot transfer
• Position patient correctly (Fowler’s, lateral, prone)
• Perform passive ROM exercises for upper and lower extremities
• Implement fall prevention bundle

Elimination

• Insert female urinary catheter using sterile technique
• Provide catheter care
• Document urinary output accurately
• Administer enema in correct position with correct technique

Nutrition

• Verify NG tube placement (pH and external measurement)
• Administer intermittent tube feeding
• Check gastric residual volume and respond appropriately

Oxygenation

• Apply and teach use of incentive spirometry
• Apply nasal cannula and adjust flow rate per order
• Teach TCDB exercises (turn, cough, deep breathe)

Medication Administration

• Verify the 8 rights of medication administration
• Prepare and administer subcutaneous injection using Z-track if required
• Prepare and administer IM injection (ventrogluteal site preferred)
• Assess IV site for complications (infiltration, phlebitis)

Specimen Collection

• Collect clean-catch urine specimen with correct patient instruction
• Collect catheter urine specimen from sampling port
• Describe wound culture collection technique

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NCLEX Preparation Resources

Content Areas by NCLEX-NG Client Needs Category

NCLEX-NG Category	D442 Topics
Safe and Effective Care Environment (SECE)	Infection control, CAUTI prevention, fall prevention, medication safety, sterile technique
Health Promotion and Maintenance (HPM)	Nutritional assessment, hygiene, pressure injury prevention, patient education
Psychosocial Integrity (PhysI)	Therapeutic communication, cultural sensitivity, patient dignity during hygiene care
Physiological Integrity — Basic Care & Comfort (PA)	Mobility, elimination, nutrition, oxygen therapy, hygiene
Physiological Integrity — Pharmacological (RRP)	Rights of medication administration, IM/SC injections, high-alert medications
Physiological Integrity — Reduction of Risk Potential (SIC)	Vital signs, specimen collection, wound assessment, tube feeding safety

High-Yield NCLEX Topics for D442

1. Priority/delegation questions — Which patient do you see first? What can be delegated to the NAP?
2. Sterile technique violations — Identify the error in a scenario
3. Vital signs critical values — Know normal ranges and when to call the provider
4. CAUTI prevention bundle — When to insert, when to remove, how to maintain
5. Medication administration errors — Rights violations, look-alike/sound-alike medications
6. Pressure injury staging — Match the description to the correct stage
7. Tube feeding complications — Aspiration, high residual, misplacement
8. Fall risk — Identify at-risk patients and implement prevention strategies

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Required Materials

• Course textbook (provided through WGU course platform)
• Shadow Health Digital Clinical Experience (DCE) access — provided through course
• HESI access — provided through course
• Lab kit (provided for on-ground lab sessions): includes gown, gloves, sterile catheter kit, dressing supplies

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References

• American Nurses Association (ANA). (2023). Nursing: Scope and standards of practice (4th ed.). ANA.
• Centers for Disease Control and Prevention (CDC). (2024). Guideline for hand hygiene in health-care settings. CDC.
• Centers for Disease Control and Prevention (CDC). (2024). CAUTI guidelines. CDC.
• LoBiondo-Wood, G., & Haber, J. (2022). Nursing research: Methods and critical appraisal for evidence-based practice (10th ed.). Elsevier.
• National Pressure Injury Advisory Panel (NPIAP). (2019). Pressure injury staging definitions. NPIAP.
• NCSBN. (2023). Next generation NCLEX (NGN) clinical judgment measurement model. NCSBN.
• Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2023). Fundamentals of nursing (11th ed.). Elsevier Mosby.
• The Joint Commission. (2024). National patient safety goals. The Joint Commission.
• WGU. (2026). D442 Basic Nursing Skills course overview. Western Governors University.