Fundamentals of Nursing Study Notes

Nursing fundamentals are the foundation everything else is built on. Content from fundamentals courses appears on every nursing school exam and is heavily represented on the NCLEX — particularly in the Safe and Effective Care Environment category. This guide covers the highest-yield fundamentals topics, organized for efficient review.

The Nursing Process: ADPIE

The nursing process is the systematic framework nurses use to deliver individualized, evidence-based care. NCLEX questions are structured around it — understanding each step helps you recognize what a question is asking you to do.

Assessment: Collect subjective (what the patient says) and objective (what you observe/measure) data. Assessment always comes first — never implement without assessing
Diagnosis: Analyze data to identify nursing diagnoses. Example: “Impaired gas exchange related to pneumonia as evidenced by SpO2 88%”
Planning: Set measurable, patient-centered, time-bound goals. Goals reflect what the patient will do, not what the nurse will do
Implementation: Carry out the nursing interventions — administering medications, repositioning, teaching, inserting catheters
Evaluation: Determine whether goals were met. If not, reassess and modify the plan

NCLEX tip: If a question presents a new patient or a change in patient status, the answer is almost always to assess first before doing anything else.

Vital Signs: Normal Ranges and Technique

Temperature: 36.1–37.2°C (97–99°F) oral. Rectal is 0.5°C higher; axillary is 0.5°C lower. Fever = >38°C (100.4°F)
Pulse: 60–100 bpm. Assess rate, rhythm, and quality. Apical for 1 full minute when rate is irregular or before cardiac medications (digoxin, beta-blockers)
Respirations: 12–20 breaths/min in adults. Count for full minute without telling the patient (knowing alters their rate)
Blood pressure: Normal <120/80 mmHg. Stage 1 HTN = 130–139/80–89. Stage 2 HTN = ≥140/90. Measure both arms on initial assessment
SpO2: Normal 95–100%. Below 90% = hypoxemia requiring intervention. Inaccurate with poor perfusion, nail polish, carbon monoxide poisoning
Pain: Assess 0–10; reassess after interventions

Orthostatic Hypotension

Defined as SBP drop ≥20 mmHg or DBP drop ≥10 mmHg within 3 minutes of standing. Measure lying → after standing 1 minute → after standing 3 minutes. Common in dehydration, prolonged bedrest, antihypertensives, and diuretics. Educate patients to change positions slowly.

Infection Control and Standard Precautions

Standard precautions apply to all patients regardless of diagnosis. Treat all blood, body fluids, non-intact skin, and mucous membranes as potentially infectious.

Hand Hygiene

The single most effective infection control measure. Perform before/after every patient contact, before donning gloves, after removing gloves, before/after invasive procedures, before handling medications. Use soap and water for C. diff — alcohol-based hand rub does NOT kill C. diff spores.

Transmission-Based Precautions

Contact precautions: Gown + gloves. MRSA, VRE, C. diff, wound infections, scabies
Droplet precautions: Surgical mask. Influenza, pertussis, meningococcal meningitis, mumps, rubella, COVID-19
Airborne precautions: N95 respirator + negative pressure room. TB, measles (rubeola), varicella (chickenpox), disseminated zoster

Mnemonic for airborne: “My TV” — Measles, TB, Varicella.

PPE Donning and Doffing Order

Donning: Gown → Mask/respirator → Goggles/face shield → Gloves
Doffing (most contaminated first): Gloves → Goggles/face shield → Gown → Mask/respirator → Hand hygiene after each step

Medication Administration: Rights and Safety

Modern practice recognizes ten rights of medication administration:

Right patient (two identifiers — name + DOB or MRN)
Right medication
Right dose
Right route
Right time
Right documentation
Right reason (therapeutic indication confirmed)
Right patient education
Right to refuse (patient autonomy)
Right assessment (parameters before administration — BP before antihypertensive, HR before digoxin)

High-alert medications (ISMP list) require extra caution: anticoagulants (heparin, warfarin), insulin, opioids, concentrated electrolytes (KCl IV), chemotherapy, neuromuscular blocking agents. Most facilities require two-nurse verification for these.

Wound Care Basics

Wound Healing Phases

Hemostasis (minutes–hours): Vasoconstriction, platelet plug, clot formation
Inflammatory (1–4 days): Redness, warmth, swelling, pain — normal signs of healing, not infection
Proliferative (4 days–3 weeks): Granulation tissue forms, wound contracts
Maturation/remodeling (3 weeks–2 years): Scar tissue formation

Pressure Injury Staging

Stage 1: Non-blanchable erythema, intact skin
Stage 2: Partial-thickness skin loss — shallow open wound, blister, or abrasion
Stage 3: Full-thickness skin loss — subcutaneous tissue visible, no bone/tendon/muscle
Stage 4: Full-thickness tissue loss — bone, tendon, or muscle exposed
Unstageable: Base covered with slough or eschar — cannot determine depth until debrided
Deep tissue injury: Intact or non-intact skin with purple/maroon discoloration or blood-filled blister

Braden Scale assesses pressure injury risk (sensory perception, moisture, activity, mobility, nutrition, friction/shear). Score 6–23. Lower score = higher risk. ≤18 = at risk.

Therapeutic Communication

Open-ended questions: “Tell me more about your pain” — encourages free sharing
Reflection: Repeating or paraphrasing to show understanding
Empathy: “It sounds like you’re feeling frightened.”
Silence: Therapeutic — allows the patient time to think and feel heard
Clarification: “Can you help me understand what you mean by…?”

Non-therapeutic responses to avoid: False reassurance (“Everything will be fine”), giving advice (“You should…”), changing the subject, using jargon, asking “why” questions (implies judgment).

Delegation and Supervision

RNs delegate tasks to LPNs and UAPs while retaining accountability for patient outcomes. The five rights of delegation:

Right task (appropriate per facility policy and state law)
Right circumstance (patient stable, task routine)
Right person (delegate has training and competency)
Right direction/communication (clear, specific instructions)
Right supervision (RN monitors and evaluates after delegation)

UAPs can perform: Vital signs on stable patients, I&O, basic hygiene, ambulation of stable patients, bed making, feeding stable patients
UAPs cannot perform: Assessment, patient teaching, medication administration, invasive procedures, or any task requiring professional nursing judgment
LPNs can perform: Medication administration (including IV in many states), wound care, tracheostomy suctioning, stable patient care under RN supervision
Only RNs perform: Initial assessment, care plan development, patient teaching, discharge planning, blood product administration (most states), interpretation of assessment data

NCLEX Tips: Nursing Fundamentals

Assessment always comes before intervention — if asked what to do first, the answer is usually to assess
When a patient refuses treatment, document it and notify the provider — respect patient autonomy
Airborne precautions: TB, Measles, Varicella — N95 and negative pressure room required
C. diff: soap and water hand hygiene only — alcohol gel does NOT kill C. diff spores
Cannot delegate assessment, teaching, or care plan modification to LPN or UAP
Stage 3 and 4 pressure injuries cannot be reverse-staged as they heal

Official Resources and Further Reading

External References

CDC Isolation Precautions Guidelines — infection control standards for healthcare settings
Institute for Safe Medication Practices (ISMP) — medication safety resources and error prevention guidelines

Frequently Asked Questions: Nursing Fundamentals

What is the difference between a nursing diagnosis and a medical diagnosis?

A medical diagnosis identifies a disease (pneumonia, heart failure). A nursing diagnosis identifies the patient’s response to a health problem that the nurse can treat — such as “Impaired gas exchange” or “Risk for falls.” Nursing diagnoses guide the care plan.

How do you count respirations without the patient knowing?

After taking the pulse, keep fingers on the wrist and begin counting chest rises without telling the patient. Patients who know they’re being observed will alter their rate. Count for a full 60 seconds.

What are the two required patient identifiers before giving medication?

Name and date of birth (or medical record number). Room number alone is not acceptable. Verify both against the patient’s armband and the medication administration record before giving any medication.

Can an LPN delegate tasks to a UAP?

Delegation authority is regulated by state nurse practice acts, which vary. In most states, LPNs can direct UAPs for basic care tasks they supervise. The RN remains responsible for overall assessment, care planning, and patient outcomes regardless of what the LPN delegates.