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Fundamentals for Nursing

REVIEW MODULE EDITION 10.0
Consultants
Christi Blair, DNP, RN
Contributors
Tracey Bousquet, BSN, RN
Honey C. Holman, MSN, RN
Jenni L. Hoffman, DNP,
Debborah Williams, MSN, RN FNP-C, CLNC, FAANP
Sheryl Sommer PhD, RN, CNE Mary Jane Janowski, RN, MA
Janean Johnson, MSN, RN CNE Jessica L. Johnson DNP, MSN, BSN, RN
Brenda S. Ball, MEd, BSN, RN Lisa Kongable, MA, ARNP,

PMHCNS, CNE
Cindy Morris, DNP, RN, IBCLC
Tomekia Luckett, PhD, RN
Peggy Leehy MSN, RN
Maria Sheilla Membrebe, MSN/Ed.,
Robin Hertel, EdS, MSN, RN, CMSRN RN, ONC, CMSRN, CBN
INTELLECTUAL PROPERTY NOTICE

ATI Nursing is a division of Assessment Technologies Institute®, LLC.
Copyright © 2019 Assessment Technologies Institute, LLC. All rights reserved.
The reproduction of this work in any electronic, mechanical or other means, now known or hereafter
invented, is forbidden without the written permission of Assessment Technologies Institute, LLC. All of the
content in this publication, including, for example, the cover, all of the page headers, images, illustrations,
graphics, and text, are subject to trademark, service mark, trade dress, copyright, and/or other intellectual
property rights or licenses held by Assessment Technologies Institute, LLC, one of its affiliates, or by
third parties who have licensed their materials to Assessment Technologies Institute, LLC.
FUNDAMENTALS FOR NURSING I

07/24/15 April 3, 2019 1:26 PM rm_rn_2019_fund_FRONT-MATTER 07/24
Director of content review: Kristen Lawler
Director of development: Derek Prater
Project management: Tiffany Pavlik, Shannon Tierney
Coordination of content review: Honey C. Holman, Debborah Williams
Copy editing: Kelly Von Lunen, Bethany Phillips, Kya Rodgers
Layout: Spring Lenox, Maureen Bradshaw, Bethany Phillips
Illustrations: Randi Hardy
Online media: Brant Stacy, Ron Hanson, Britney Fuller, Barry Wilson
Cover design: Jason Buck
Interior book design: Spring Lenox
IMPORTANT NOTICE TO THE READER

Assessment Technologies Institute, LLC, is the publisher of this publication. The content of this publication is for
informational and educational purposes only and may be modified or updated by the publisher at any time. This
publication is not providing medical advice and is not intended to be a substitute for professional medical advice,
diagnosis, or treatment. The publisher has designed this publication to provide accurate information regarding the
subject matter covered; however, the publisher is not responsible for errors, omissions, or for any outcomes related to
the use of the contents of this book and makes no guarantee and assumes no responsibility or liability for the use of the
products and procedures described or the correctness, sufficiency, or completeness of stated information, opinions, or
recommendations. The publisher does not recommend or endorse any specific tests, providers, products, procedures,
processes, opinions, or other information that may be mentioned in this publication. Treatments and side effects described
in this book may not be applicable to all people; likewise, some people may require a dose or experience a side effect
that is not described herein. Drugs and medical devices are discussed that may have limited availability controlled by
the Food and Drug Administration (FDA) for use only in a research study or clinical trial. Research, clinical practice,
and government regulations often change the accepted standard in this field. When consideration is being given to use
of any drug in the clinical setting, the health care provider or reader is responsible for determining FDA status of the
drug, reading the package insert, and reviewing prescribing information for the most up-to-date recommendations
on dose, precautions, and contraindications and determining the appropriate usage for the product. Any references
in this book to procedures to be employed when rendering emergency care to the sick and injured are provided solely
as a general guide. Other or additional safety measures may be required under particular circumstances. This book
is not intended as a statement of the standards of care required in any particular situation, because circumstances
and a patient’s physical condition can vary widely from one emergency to another. Nor is it intended that this book
shall in any way advise personnel concerning legal authority to perform the activities or procedures discussed. Such
specific determination should be made only with the aid of legal counsel. Some images in this book feature models.
These models do not necessarily endorse, represent, or participate in the activities represented in the images. THE
PUBLISHER MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND, WHETHER EXPRESS OR IMPLIED, WITH
RESPECT TO THE CONTENT HEREIN. THIS PUBLICATION IS PROVIDED AS-IS, AND THE PUBLISHER AND ITS AFFILIATES
SHALL NOT BE LIABLE FOR ANY ACTUAL, INCIDENTAL, SPECIAL, CONSEQUENTIAL, PUNITIVE, OR EXEMPLARY
DAMAGES RESULTING, IN WHOLE OR IN PART, FROM THE READER’S USE OF, OR RELIANCE UPON, SUCH CONTENT.
II CONTENT MASTERY SERIES

User’s Guide
Welcome to the Assessment Technologies Institute® ACTIVE LEARNING SCENARIOS
Fundamentals for Nursing Review Module Edition 9.0. The AND APPLICATION EXERCISES
mission of ATI’s Content Mastery Series® Review Modules
Each chapter includes opportunities for you to test your
is to provide user-friendly compendiums of nursing
knowledge and to practice applying that knowledge. Active
knowledge that will:
Learning Scenario exercises pose a nursing scenario and
● Help you locate important information quickly.
then direct you to use an ATI Active Learning Template
● Assist in your learning efforts.
(included at the back of this book) to record the important

● Provide exercises for applying your nursing knowledge.
knowledge a nurse should apply to the scenario. An
● Facilitate your entry into the nursing profession as a
example is then provided to which you can compare your
newly licensed nurse.
completed Active Learning Template. The Application
This newest edition of the Review Modules has been
Exercises include NCLEX-style questions (multiple-
redesigned to optimize your learning experience. We’ve
choice and multiple-select items), providing you with
fit more content into less space and have done so in a
opportunities to practice answering the kinds of questions
way that will make it even easier for you to find and
you might expect to see on ATI assessments or the NCLEX.
understand the information you need.
After the Application Exercises, an answer key is provided,
along with rationales.
ORGANIZATION
This Review Module is organized into units covering the NCLEX® CONNECTIONS
NCLEX® major client needs categories: Safe, Effective Care
To prepare for the NCLEX, it is important to understand
Environment, Health Promotion, Psychosocial Integrity,
how the content in this Review Module is connected to
and Physiological Integrity. Chapters within these
the NCLEX test plan. You can find information on the
units conform to one of four organizing principles for
detailed test plan at the National Council of State Boards
presenting the content.
of Nursing’s website, www.ncsbn.org. When reviewing
● Nursing concepts
content in this Review Module, regularly ask yourself,
● Growth and development
“How does this content fit into the test plan, and what
● Procedures
types of questions related to this content should I expect?”
● System Disorders
To help you in this process, we’ve included NCLEX
Nutritional considerations for specific Nursing concepts
Connections at the beginning of each unit and with each
chapters begin with an overview describing the central
question in the Application Exercises Answer Keys. The
concept and its relevance to nursing. Subordinate themes
NCLEX Connections at the beginning of each unit point
are covered in outline form to demonstrate relationships
out areas of the detailed test plan that relate to the content
and present the information in a clear, succinct manner.
within that unit. The NCLEX Connections attached to the
Application Exercises Answer Keys demonstrate how each
Nutritional considerations for specific Growth and
exercise fits within the detailed content outline.
development chapters cover expected growth and
These NCLEX Connections will help you understand how
development, including physical and psychosocial
the detailed content outline is organized, starting with
development, age-appropriate activities, and health
major client needs categories and subcategories and
promotion, including immunizations, health screenings,
followed by related content areas and tasks. The major
nutrition, and injury prevention.
client needs categories are:
● Safe and Effective Care Environment
Procedures chapters include an overview describing ◯ Management of Care
the procedure(s) covered in the chapter. These ◯ Safety and Infection Control
chapters provide nursing knowledge relevant to each ● Health Promotion and Maintenance
procedure, including indications, nursing considerations, ● Psychosocial Integrity
interpretation of findings, and complications. ● Physiological Integrity
nutritional needs of clients who have the given disorder. ◯ Basic Care and Comfort
These chapters cover assessments and data collection, ◯ Pharmacological and Parenteral Therapies
nutritional guidelines, nursing interventions, and ◯ Reduction of Risk Potential
complications, if applicable. ◯ Physiological Adaptation
An NCLEX Connection might, for example, alert you that

content within a unit is related to:
● Basic Care and Comfort
◯ Assistive Devices
■ Assess client use of assistive devices.
FUNDAMENTALS FOR NURSING USER’S GUIDE III

QSEN COMPETENCIES ICONS

As you use the Review Modules, you will note the Icons are used throughout the Review Module to draw
integration of the Quality and Safety Education for your attention to particular areas. Keep an eye out for
Nurses (QSEN) competencies throughout the chapters. these icons.
These competencies are integral components of the
This icon is used for NCLEX Connections.
curriculum of many nursing programs in the United States
and prepare you to provide safe, high-quality care as a
This icon indicates gerontological considerations,
newly licensed nurse. Icons appear to draw your attention
or knowledge specific to the care of older
to the six QSEN competencies.
adult clients.
Safety: The minimization of risk factors that could
This icon is used for content related to safety
cause injury or harm while promoting quality care
and is a QSEN competency. When you see this
and maintaining a secure environment for clients, self,
icon, take note of safety concerns or steps that
and others.
nurses can take to ensure client safety and a
Patient-Centered Care: The provision of caring and safe environment.
compassionate, culturally sensitive care that addresses
This icon is a QSEN competency that indicates
clients’ physiological, psychological, sociological, spiritual,
the importance of a holistic approach to
and cultural needs, preferences, and values.
providing care.
Evidence-Based Practice: The use of current knowledge
This icon, a QSEN competency, points out the
from research and other credible sources, on which to base
integration of research into clinical practice.
clinical judgment and client care.
This icon is a QSEN competency and highlights
Informatics: The use of information technology as a
the use of information technology to support
communication and information-gathering tool that
nursing practice.
supports clinical decision-making and scientifically based
nursing practice. This icon is used to focus on the QSEN
competency of integrating planning processes to
Quality Improvement: Care related and organizational
meet clients’ needs.
processes that involve the development and
implementation of a plan to improve health care services This icon highlights the QSEN competency of care
and better meet clients’ needs. delivery using an interprofessional approach.
Teamwork and Collaboration: The delivery of client care This icon appears at the top-right of pages
in partnership with multidisciplinary members of the and indicates availability of an online media
health care team to achieve continuity of care and positive supplement (a graphic, animation, or video).
client outcomes. If you have an electronic copy of the Review
Module, this icon will appear alongside clickable
links to media supplements. If you have a
hard copy version of the Review Module, visit
www.atitesting.com for details on how to access
these features.
FEEDBACK
ATI welcomes feedback regarding this Review Module.
Please provide comments to comments@atitesting.com.
As needed updates to the Review Modules are identified,

changes to the text are made for subsequent printings
of the book and for subsequent releases of the electronic
version. For the printed books, print runs are based
on when existing stock is depleted. For the electronic
versions, a number of factors influence the update
schedule. As such, ATI encourages faculty and students to
refer to the Review Module addendums for information on
what updates have been made. These addendums, which
are available in the Help/FAQs on the student site and the
Resources/eBooks & Active Learning on the faculty site,
are updated regularly and always include the most current
information on updates to the Review Modules.
IV USER’S GUIDE CONTENT MASTERY SERIES

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Table of Contents
NCLEX® Connections 1
UNIT 1 Safe, Effective Care Environment 3

SECTION: Management of Care 3
CHAPTER 1 Health Care Delivery Systems 3
CHAPTER 2 The Interprofessional

Team 7
CHAPTER 3 Ethical Responsibilities 11
CHAPTER 4 Legal Responsibilities 15
CHAPTER 5 Information Technology 21
CHAPTER 6 Delegation and Supervision 27
CHAPTER 7 Nursing Process 31
CHAPTER 8 Critical Thinking and Clinical Judgment 37
CHAPTER 9 Admissions, Transfers, and Discharge 41
SECTION: Safety and Infection Control 49
CHAPTER 10 Medical and Surgical Asepsis 49
CHAPTER 11 Infection Control 53
CHAPTER 12 Client Safety 59
CHAPTER 13 Home Safety 65
CHAPTER 14 Ergonomic Principles 73
CHAPTER 15 Security and Disaster Plans 77
FUNDAMENTALS FOR NURSING TABLE OF CONTENTS V

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UNIT 2 Health Promotion 85

SECTION: Nursing Throughout the Lifespan 85
CHAPTER 16 Health Promotion and Disease Prevention 85
CHAPTER 17 Client Education 89
Chapter 18 Infants (2 Days to 1 Year) 93
CHAPTER 19 Toddlers (1 to 3 Years) 99
CHAPTER 20 Preschoolers (3 to 6 Years) 103
CHAPTER 21 School-Age Children (6 to 12 Years) 107
CHAPTER 22 Adolescents (12 to 20 Years) 111
CHAPTER 23 Young Adults (20 to 35 Years) 115
CHAPTER 24 Middle Adults (35 to 65 Years) 119
CHAPTER 25 Older Adults (65 Years and Older) 123
SECTION: Health Assessment/Data Collection 129
CHAPTER 26 Data Collection and General Survey 129
CHAPTER 27 Vital Signs 135
CHAPTER 28 Head and Neck 145
CHAPTER 29 Thorax, Heart, and Abdomen 153
CHAPTER 30 Integumentary and Peripheral Vascular Systems 163
CHAPTER 31 Musculoskeletal and Neurologic Systems 169
VI TABLE OF CONTENTS CONTENT MASTERY SERIES

UNIT 3 Psychosocial Integrity 177

CHAPTER 32 Therapeutic Communication 177
CHAPTER 33 Coping 183
CHAPTER 34 Self-Concept and Sexuality 189
CHAPTER 35 Cultural and Spiritual Nursing Care 193
CHAPTER 36 Grief, Loss, and Palliative Care 203
UNIT 4 Physiological Integrity 211

SECTION: Basic Care and Comfort 211
CHAPTER 37 Hygiene 211
CHAPTER 38 Rest and Sleep 217
CHAPTER 39 Nutrition and Oral Hydration 221
CHAPTER 40 Mobility and Immobility 227
CHAPTER 41 Pain Management 235
CHAPTER 42 Complementary and Alternative Therapies 241
CHAPTER 43 Bowel Elimination 245
CHAPTER 44 Urinary Elimination 251
CHAPTER 45 Sensory Perception 259
FUNDAMENTALS FOR NURSING TABLE OF CONTENTS VII

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SECTION: Pharmacological and Parenteral Therapies 269
CHAPTER 46 Pharmacokinetics and Routes of Administration 269
CHAPTER 47 Safe Medication Administration and Error Reduction 277
CHAPTER 48 Dosage Calculation 285
CHAPTER 49 Intravenous Therapy 299
CHAPTER 50 Adverse Effects, Interactions, and Contraindications 307
CHAPTER 51 Individual Considerations of Medication Administration 313
SECTION: Reduction of Risk Potential 319
CHAPTER 52 Specimen Collection for Glucose Monitoring 319
CHAPTER 53 Airway Management 323
Pulse oximetry and oxygen therapy 323
Specimen collection and airway clearance 327
Artificial airways and tracheostomy care 329
CHAPTER 54 Nasogastric Intubation and Enteral Feedings 333
SECTION: Physiological Adaptation 341
CHAPTER 55 Pressure Injury, Wounds, and Wound Management 341
CHAPTER 56 Bacterial, Viral, Fungal, and Parasitic Infections 349
CHAPTER 57 Fluid Imbalances 355
VIII TABLE OF CONTENTS CONTENT MASTERY SERIES

CHAPTER 58 Electrolyte Imbalances 359
Sodium imbalances 359
Potassium imbalances 360
Calcium imbalances 362
Magnesium imbalances 363
References 367
Active Learning Templates A1

Basic Concept A1
Diagnostic Procedure A3
Growth and Development A5
Medication A7
Nursing Skill A9
System Disorder A11
Therapeutic Procedure A13
Concept Analysis A15
FUNDAMENTALS FOR NURSING TABLE OF CONTENTS IX

X TABLE OF CONTENTS CONTENT MASTERY SERIES

07/24/15 April 3, 2019 1:29 PM rm_rn_2019_fund_unit1sec1
NCLEX® Connections
When reviewing the following chapters, keep in mind the
relevant topics and tasks of the NCLEX outline, in particular:
Management of Care
CONCEPTS OF MANAGEMENT: Identify roles/
responsibilities of health care team members.
ASSIGNMENT, DELEGATION AND SUPERVISION: Identify

tasks for assignment or delegation based on client needs.
CONTINUITY OF CARE
Perform procedures necessary to safely admit,
transfer, or discharge a client.
Provide and receive off of care (report) on assigned clients.
ESTABLISHING PRIORITIES: Prioritize the delivery of client care.
ETHICAL PRACTICE
Recognize ethical dilemmas and take appropriate action.
Practice in a manner consistent with a code of ethics for nurses.
INFORMATION TECHNOLOGY: Utilize valid resources

to enhance the care provided to a client.
LEGAL RIGHTS AND RESPONSIBILITIES:

Identify legal issues affecting the client.
REFERRALS: Assess the need for referrals and obtain necessary orders.
ADVANCE DIRECTIVES/SELF-DETERMINATION/LIFE PLANNING:

Assess client and/or staff member knowledge of advance directives.
INFORMED CONSENT: Participate in obtaining informed consent.
CONFIDENTIALITY/INFORMATION SECURITY: Assess staff

member and client understanding of confidentiality requirements.
Safety and Infection Control

REPORTING OF INCIDENT/EVENT/IRREGULAR OCCURENCE/
VARIENCE: Identify need/situation where reporting of incident/
event/irregular occurence/cariance is appropriate.
FUNDAMENTALS FOR NURSING NCLEX® CONNECTIONS 1

07/24/15 April 3, 2019 1:29 PM rm_rn_2019_fund_unit1sec1
Health Promotion and Maintenance

HEALTH PROMOTION/DISEASE PREVENTION: Assist
the client in maintaining an optimum level of health.
TECHNIQUES OF PHYSICAL ASSESSMENT: Apply

knowledge of nursing procedures and psychomotor
skills to techniques of physical assessment.
2 NCLEX® CONNECTIONS CONTENT MASTERY SERIES

CHAPTER 1
UNIT 1 SAFE, EFFECTIVE CARE ENVIRONMENT ● Ambulatory care clinics
SECTION: MANAGEMENT OF CARE ● Occupational health clinics
Stand-alone surgical centers
Health Care
●
● Urgent care centers

CHAPTER 1
Delivery Systems
● Complementary therapy centers
● Urgent and emergent care centers
● Public health agencies
● Crisis centers
Diagnostic centers
Health care delivery systems incorporate
●
● Specialized services (dialysis, oncology, rehabilitation,

interactions between health care providers burn) centers
and clients within the constraints of financing

mechanisms and regulatory agencies. REGULATORY AGENCIES
● U.S. Department of Health and Human Services
Health care systems include the clients who ● U.S. Food and Drug Administration (FDA)
State and local public health agencies
participate, the settings in which health care takes
●
● State licensing boards to ensure that health care

place, the agencies that regulate health care, and providers and agencies comply with state regulations
The Joint Commission to set quality standards for
the mechanisms that provide financial support.
●
accreditation of health care facilities

Professional Standards Review Organizations to monitor
Most nurses deliver care within the context of
●
health care services provided

health care systems. As these systems continue ● Utilization review committees to monitor
for appropriate diagnosis and treatment of
to become more business-driven and less hospitalized clients
service-oriented, the challenge to nursing today
is to retain its caring values while practicing HEALTH CARE FINANCING MECHANISMS
within a cost-containment structure. PUBLIC FEDERALLY FUNDED PROGRAMS
Medicare is for clients 65 years of age or older and those
who have permanent disabilities.
COMPONENTS OF HEALTH ● Part A: Insurance for hospital stays, home health, and
CARE SYSTEMS hospice (available to those 65 years of age or older and
those who have permanent disabilities)
Part B: Insurance for outpatient and provider services
PARTICIPANTS
●
(available to those 65 years or older and those who have

Consumers (clients) permanent disabilities, but is voluntary and requires a
monthly premium)
Licensed providers ● Part C: A Medicare advantage or supplement plan
● Registered nurses
(covering parts A and B, and sometimes D)
● Licensed practical nurses (also known as licensed ● Part D: Medication coverage for those eligible and
vocational nurses)
requires a monthly premium
● Advanced practice nurses (APN)
Medicaid is for clients who have low incomes.

● Medical doctors ● It is federally and state funded.
● Pharmacists ● Individual states determine eligibility requirements.
● Dentists
The Patient Protection and Affordable Care Act of 2010 is
● Dietitians
a federal statute aimed at:
● Physical, respiratory, and occupational therapists ● Increasing access to health care for all individuals and
Unlicensed providers (assistive personnel) instituting an individual mandate for health insurance.
● Decreasing health care costs.
Providing opportunities for uninsured people to become
SETTINGS
●
insured at an affordable cost.

● Hospitals State Children’s Health Insurance Program: Coverage for
● Homes uninsured children up to age 19 at low cost to parents
● Skilled-nursing, assisted-living, and
extended-care facilities
● Community/health departments
● Adult day care centers
● Schools
● Hospices
● Providers’ offices
FUNDAMENTALS FOR NURSING CHAPTER 1 HEALTH CARE DELIVERY SYSTEMS 3

PRIVATE PLANS RELATIONSHIP BETWEEN HEALTH
● Traditional insurance reimburses for services on a CARE SYSTEMS AND LEVELS OF CARE
fee-for-service basis.
People: The level of care depends on the needs of the
● Managed care organizations (MCOs): Primary care
client. Licensed and unlicensed health care personnel
providers oversee comprehensive care for enrolled
work in every level of care.
clients and focus on prevention and health promotion.
● Preferred provider organizations (PPOs): Clients choose Setting: The settings for secondary and tertiary care are
from a list of contracted providers and hospitals. usually within a hospital or specific facility. Settings for
Using non-contracted providers increases the other levels of care vary.
out-of-pocket costs.
Regulatory agencies help ensure the quality and quantity
● Exclusive provider organizations (EPOs): Clients
of health care and the protection of health care consumers.
choose from a list of providers and hospitals
within a contracted organization with no Health care finance influences the quality and type of
out-of-network coverage. care by setting parameters for cost containment and
● Long-term care insurance: A supplement for long-term reimbursement.
care expenses Medicare does not cover
SAFETY AND QUALITY

LEVELS OF HEALTH CARE In response to concerns about the safety and quality
Preventive health care focuses on educating and of client care in the United States, Quality and Safety
equipping clients to reduce and control risk factors for Education for Nurses (QSEN) assists nursing programs in
disease. Examples include programs that promote preparing nurses to provide safe, high-quality care. To
immunization, stress management, occupational health, draw attention to the six QSEN competencies, these icons
and seat belt use. appear throughout the review modules.
Primary health care emphasizes health promotion and Safety: The minimization of risk factors that could cause
includes prenatal and well-baby care, family planning, injury or harm while promoting high-quality care and
nutrition counseling, and disease control. This level maintaining a secure environment for clients, self,
of care is a sustained partnership between clients and others
and providers. Examples include office or clinic visits,
Patient-Centered Care: The provision of caring and
community health centers, and scheduled school- or
work-centered screenings (vision, hearing, obesity).
clients’ physiological, psychological, sociological, spiritual,
Secondary health care includes the diagnosis and and cultural needs, preferences, and values. The client is
treatment of acute illness and injury. Examples include included in the decision-making process.
care in hospital settings (inpatient and emergency
Evidence Based Practice: The use of current knowledge
departments), diagnostic centers, and urgent and
from research and other credible sources on which to base
emergent care centers.
clinical judgment and client care
Tertiary health care, or acute care, involves the provision
Informatics: The use of information technology as a
of specialized and highly technical care. Examples include
communication and information-gathering tool that
intensive care, oncology centers, and burn centers.
supports clinical decision-making and scientifically-based
Restorative health care involves intermediate follow-up nursing practice
care for restoring health and promoting self-care.
Quality Improvement: Care-related and organizational
Examples include home health care, rehabilitation centers,
processes that involve the development and
and skilled nursing facilities.
implementation of a plan to improve health care services
Continuing health care addresses long-term or chronic and better meet clients’ needs
health care needs over a period of time. Examples include
Teamwork and Collaboration: The delivery of client care
end-of-life care, palliative care, hospice, adult day care,
in partnership with interprofessional members of the
assisted living, and in-home respite care.
health care team to achieve continuity of care and positive
client outcomes
THE FUTURE OF HEALTH CARE

The ultimate issue in designing and delivering health care
is ensuring the health and welfare of the population.
4 CHAPTER 1 HEALTH CARE DELIVERY SYSTEMS CONTENT MASTERY SERIES

Application Exercises Active Learning Scenario
1. A nurse is discussing restorative health care A nurse on a medical-surgical unit is acquainting a

with a newly licensed nurse. Which of the group of nurses with the Quality and Safety Education
following examples should the nurse include for Nurses (QSEN) initiative. Use the ATI Active Learning
in the teaching? (Select all that apply.) Template: Basic Concept to complete this item.
A. Home health care RELATED CONTENT: List the six QSEN competencies,
B. Rehabilitation facilities along with a brief description of each.
C. Diagnostic centers
D. Skilled nursing facilities
E. Oncology centers
2. A nurse is explaining the various types of health

care coverage clients might have to a group
of nurses. Which of the following health care
financing mechanisms should the nurse include
as federally funded? (Select all that apply.)
A. Preferred provider organization (PPO)
B. Medicare
C. Long-term care insurance
D. Exclusive provider organization (EPO)
E. Medicaid
3. A nurse manager is developing strategies to care

for the increasing number of clients who have
obesity. Which of the following actions should the
nurse include as a primary health care strategy?
A. Collaborating with providers to perform obesity
screenings during routine office visits
B. Ensuring the availability of specialized beds in
rehabilitation centers for clients who have obesity
C. Providing specialized intraoperative training
in surgical treatments for obesity
D. Educating acute care nurses about postoperative
complications related to obesity
4. A nurse is discussing the purpose of regulatory

agencies during a staff meeting. Which of the
following tasks should the nurse identify as the
responsibility of state licensing boards?
A. Monitoring evidence-based practice for
clients who have a specific diagnosis
B. Ensuring that health care providers
comply with regulations
C. Setting quality standards for accreditation
of health care facilities
D. Determining whether medications are
safe for administration to clients
5. A nurse is explaining the various levels of health care

services to a group of newly licensed nurses. Which of
the following examples of care or care settings should
the nurse classify as tertiary care? (Select all that apply.)
A. Intensive care unit
B. Oncology treatment center
C. Burn center
D. Cardiac rehabilitation
E. Home health care
FUNDAMENTALS FOR NURSING CHAPTER 1 HEALTH CARE DELIVERY SYSTEMS 5

Application Exercises Key Active Learning Scenario Key
1. A. CORRECT: Restorative health care involves intermediate sing the TI ctive Learning Template: Basic Concept
follow-up care for restoring health and promoting self-care. RELATED CONTENT
Home health care is a type of restorative health care. ●
Safety: Minimization of risk factors that could cause injury
B. CORRECT: Restorative health care involves intermediate or harm while promoting quality care and maintaining
follow-up care for restoring health and promoting self-care. a secure environment for clients, self, and others
Rehabilitation facilities are a type of restorative health care. ●
Patient-Centered Care: Provision of caring and
C. Secondary health care includes the diagnosis and
treatment of acute injury or illness. Diagnostic
clients’ physiological, psychological, sociological,
centers are a type of secondary health care.
spiritual, and cultural needs, preferences, and values
D. CORRECT: Restorative health care involves intermediate
follow-up care for restoring health and promoting self-care.
●
Evidence-Based Practice: Use of current knowledge
Skilled nursing facilities are a type of restorative health care. from research and other credible sources on which
E. Tertiary health care is specialized and highly technical care. to base clinical judgment and client care
An oncology center is a type of tertiary health care. ●
Informatics: Use of information technology as a communication
and information-gathering tool that supports clinical
NCLEX Connection: Management of Care,
®
decision-making and scientifically based nursing practice
Health Promotion Disease Prevention ●
Quality Improvement: Care-related and organizational processes
that involve the development and implementation of a plan to
2. A. PPOs are privately funded. improve health care services and better meet clients’ needs
B. CORRECT: Medicare is federally funded. ●
Teamwork and Collaboration: Delivery of client care in partnership
C. Long-term care insurance is privately funded. with multidisciplinary members of the health care team to
D. EPOs are privately funded. achieve continuity of care and positive client outcomes
E. CORRECT: Medicaid is federally funded. NCLEX® Connection: Management of Care, Information
NCLEX® Connection: Management of Care, Technology
Information Technology
3. A. CORRECT: Identify obesity screenings at office visits as

an example of primary health care. Primary health care
emphasizes health promotion and disease control, is often
delivered during office visits, and includes screenings.
B. Identify care that is provided in a rehabilitation center
as an example of restorative health care.
C. Identify specialized and highly technical care
as an example of tertiary health care.
D. Identify acute care of clients as an example
of secondary health care.
NCLEX® Connection: Health Promotion and Maintenance,
Health Promotion Disease Prevention
4. A. Identify that utilization review committees have the

responsibility of monitoring for appropriate diagnosis
and treatment according to evidence-based practice for
diagnosis and treatment of hospitalized clients.
B. CORRECT: Identify that state licensing boards are
responsible for ensuring that health care providers
and agencies comply with state regulations.
C. Identify that the Joint Commission has the
responsibility of setting quality standards for
accreditation of health care facilities.
D. Identify that the U.S. Food and Drug Administration
has the responsibility of determining whether
medications are safe for administration to clients.
NCLEX® Connection: Management of Care,
Information Technology
5. A. CORRECT: Tertiary health care involves the provision

of specialized and highly technical care (the care
nurses deliver in intensive care units).
B. CORRECT: Tertiary health care involves the provision
of specialized and highly technical care (the care
nurses deliver in oncology treatment centers).
C. CORRECT: Tertiary health care involves the
provision of specialized and highly technical care
(the care nurses deliver in burn centers).
D. This is an example of restorative care and also of
tertiary prevention, but not of tertiary care.
E. This is an example of restorative care.
NCLEX® Connection: Health Promotion and Maintenance,
Health Promotion Disease Prevention
6 CHAPTER 1 HEALTH CARE DELIVERY SYSTEMS CONTENT MASTERY SERIES

Online Video: Interdisciplinary Team
CHAPTER 2
UNIT 1 SAFE, EFFECTIVE CARE ENVIRONMENT Occupational therapist: Assesses and plans for clients
SECTION: MANAGEMENT OF CARE to regain activities of daily living (ADL) skills, especially
motor skills of the upper extremities.
CHAPTER 2 The Interprofessional Example of when to refer: A client has
Team difficulties using an eating utensil with

their dominant hand following a stroke.
Pharmacist: Provides, monitors, and evaluates medication.
Supervises pharmacy technicians in states that allow this
RNs and practical nurses (PNs) are integral practice.
members of the interprofessional health care Example of when to refer: A client is concerned
team. Each discipline represented on an about a new medication’s interactions
with any of their other medications.
interprofessional team uses a set of skills within
Physical therapist: Assesses and plans for clients to
the scope of practice for the specific profession. increase musculoskeletal function, especially of the lower
In some instances, the scope of practice for one extremities, to maintain mobility.
discipline overlaps with the scope of practice or Example of when to refer: Following hip
arthroplasty, a client requires assistance
set of skills for another profession. For example, learning to ambulate and regain strength.
the nurse and the respiratory care therapist both Provider: Assesses, diagnoses, and treats disease and
possess the knowledge and skill to perform injury. Providers include medical doctors (MDs), doctors
of osteopathy (DOs), advanced practice nurses (APNs),
chest physiotherapy (using postural drainage, and physician assistants (PAs). State regulations vary in
percussion, and vibration to promote drainage their requirements for supervision of APNs and PAs by a
physician (MDs and DOs).
of secretions from the lungs).
Example of when to refer: A client has a
The interprofessional health care team works temperature of 39º C (102.2º F), is achy
and shaking, and reports feeling cold.
collaboratively to provide holistic care to clients.
Radiologic technologist: Positions clients and performs
The nurse is most often the manager of care and x-rays and other imaging procedures for providers to
review for diagnosis of disorders of various body parts.
must understand the roles and responsibilities of
Example of when to refer: A client reports
other health care team members to collaborate severe pain in their hip after a fall, and the
and make appropriate referrals. provider prescribes an x-ray of the client’s hip.
Respiratory therapist: Evaluates respiratory status and
provides respiratory treatments including oxygen therapy,
INTERPROFESSIONAL PERSONNEL chest physiotherapy, inhalation therapy, and mechanical
(NON-NURSING) ventilation.
Spiritual support staff: Provides spiritual care (pastors,
Example of when to refer: A client who
rabbis, priests).
has respiratory disease is short of breath
Example of when to refer: A client requests and requests a nebulizer treatment.
communion, or the family asks for prayer prior
Social worker: Works with clients and families by
to the client undergoing a procedure.
coordinating inpatient and community resources to meet
Registered dietitian: Assesses, plans for, and educates psychosocial and environmental needs that are necessary
regarding nutrition needs. Designs special diets, and for recovery and discharge.
supervises meal preparation.
Example of when to refer: A client who has terminal
Example of when to refer: A client has a low albumin cancer wishes to go home but is no longer able to
level and recently had an unexplained weight loss. perform many ADLs. The client’s partner needs
medical equipment in the home to care for the client.
Laboratory technician: Obtains specimens of body fluids,
and performs diagnostic tests. Speech-language pathologist: Evaluates and makes
recommendations regarding the impact of disorders or
Example of when to refer: A provider
injuries on speech, language, and swallowing. Teaches
needs to see a client’s complete blood
techniques and exercises to improve function.
count (CBC) results immediately.
Example of when to refer: A client is having difficulty
swallowing a regular diet after trauma to the head
and neck.
FUNDAMENTALS FOR NURSING CHAPTER 2 THE INTERPROFESSIONAL TEAM 7

NURSING PERSONNEL EXPANDED NURSING ROLES
The nursing team works together to advocate for and meet Advanced practice nurse (APN): Has a great deal of
the needs of clients within the health care delivery system. autonomy. APNs usually have a minimum of a master’s
degree in nursing (or related field), advanced education in
Registered nurse (RN) pharmacology and physical assessment, and certification
in a specialized area of practice. Included in this role are
The RN is the lead team member, soliciting input from all
the following.
nursing team members and setting priorities for the ● Clinical nurse specialist (CNS): Typically specializes in
coordination of client care.
a practice setting or a clinical field.
EDUCATIONAL PREPARATION ● Nurse practitioner (NP): Collaborates with one or more
● Must meet the state board of nursing’s requirements providers to deliver nonemergency primary health care
for licensure. in a variety of settings.
● Requires completion of a diploma program, an associate ● Certified registered nurse anesthetist (CRNA):
degree, or a baccalaureate degree in nursing prior to Administers anesthesia and provides care during
taking the licensure exam (licensed). procedures under the supervision of an anesthesiologist.
● Certified nurse‑midwife (CNM): Collaborates with one
ROLES AND RESPONSIBILITIES
or more providers to deliver care to maternal-newborn
● Function legally under state nurse practice acts.
clients and their families.
● Perform assessments; establish nursing diagnoses,
goals, and interventions; and conduct ongoing Nurse educator: Teaches in schools of nursing, staff
client evaluations. development departments in health care facilities, or
● Develop interprofessional plans for client care. client education departments.
● Share appropriate information among team members;
Nurse administrator: Provides leadership to nursing
initiate referrals for client assistance, including health
departments within a health care facility.
education; and identify community resources.
Nurse researcher: Conducts research primarily to improve
Practical nurse (PN) the quality of client care.
EDUCATIONAL PREPARATION
● Must meet the state board of nursing’s requirements
● Requires vocational or community college education
prior to taking the licensure exam (licensed)

● Work under the supervision of the RN.
● Collaborate within the nursing process, assist with the
plan of care, consult with other team members, and
recognize the need for referrals to assist with actual or
potential problems.
Possess technical knowledge and skills.
●
Active Learning Scenario
● Participate in the delivery of nursing care, using the
nursing process as a framework.
A nurse is teaching a group of newly licensed nurses about
the various nursing roles they can aspire to after they
Assistive personnel (AP) achieve mastery in basic nursing skills. Use the ATI Active
Learning Template: Basic Concept to complete this item.
This includes certified nursing assistants (CNAs) and
certified medical assistants (CMAs), and non-nursing RELATED CONTENT: Describe at least five types
personnel (dialysis technicians, monitor technicians, of advance practice nursing roles, including a brief
and phlebotomists). description of their primary responsibilities.
EDUCATIONAL PREPARATION
● Must meet the state’s formal or informal training
requirements
● Requirement by most states for training and
examination to attain CNA status

● Work under the direct supervision of an RN or PN.
● Position description in the employing facility outlines
specific tasks.
● Tasks can include feeding clients, preparing nutritional
supplements, lifting, basic care (grooming, bathing,
transferring, toileting, positioning), measuring and
recording vital signs, and ambulating clients.
8 CHAPTER 2 THE INTERPROFESSIONAL TEAM CONTENT MASTERY SERIES

Application Exercises
1. A nurse is caring for a group of clients on a 3. A client who is postoperative following knee
medical-surgical unit. For which of the following arthroplasty is concerned about the adverse effects of
client care needs should the nurse initiate a referral the medication prescribed for pain management. Which
for a social worker? (Select all that apply.) of the following members of the interprofessional
A. A client who has terminal cancer care team can assist the client in understanding
requests hospice care in the home. the medication’s effects? (Select all that apply.)
B. A client asks about community resources A. Provider

available for older adults. B. Certified nursing assistant
C. A client states, “I would like to have my C. Pharmacist
child baptized before surgery.” D. Registered nurse
D. A client requests an electric wheelchair E. Respiratory therapist
for use after discharge.
E. A client states, “I do not understand
how to use a nebulizer.” 4. A client who had a cerebrovascular accident has
persistent problems with dysphagia. The nurse caring
for the client should initiate a referral with which of the
2. A goal for a client who has difficulty with following members of the interprofessional care team?
self-feeding due to rheumatoid arthritis is to use A. Social worker
adaptive devices. The nurse caring for the client
B. Certified nursing assistant
should initiate a referral to which of the following
members of the interprofessional care team? C. Occupational therapist
A. Social worker D. Speech-language pathologist
B. Certified nursing assistant
C. Registered dietitian 5. A nurse is acquainting a group of newly licensed
D. Occupational therapist nurses with the roles of the various members of
the health care team they will encounter on a
medical-surgical unit. When providing examples of
the types of tasks certified nursing assistants (CNAs)
can perform, which of the following client activities
should the nurse include? (Select all that apply.)
A. Bathing
B. Ambulating
C. Toileting
D. Determining pain level
E. Measuring vital signs
FUNDAMENTALS FOR NURSING CHAPTER 2 THE INTERPROFESSIONAL TEAM 9

Application Exercises Key Active Learning Scenario Key
1. A. CORRECT: Initiate a referral for a social worker sing the TI ctive Learning Template: Basic Concept
to provide information and assistance in RELATED CONTENT
coordinating hospice care for a client. ●
Clinical nurse specialist (CNS): Typically specializes
B. CORRECT: Initiate a referral for a social worker to
in a practice setting or a clinical field.
provide information and assistance in coordinating
care for community resources available for clients.
●
Nurse practitioner (NP): Collaborates with one or more providers to
C. Initiate a referral for spiritual support staff if a client deliver nonemergency primary health care in a variety of settings.
requests specific religious sacraments or prayers. ●
Certified registered nurse anesthetist (CRNA): Administers
D. CORRECT: Initiate a referral for a social anesthesia and provides care during procedures
worker to assist the client in obtaining medical under the supervision of an anesthesiologist.
equipment for use after discharge. ●
Certified nurse-midwife (CNM): Collaborates
E. Provide client teaching for concerns regarding the with one or more providers to deliver care to
use of a nebulizer. If additional information is needed, maternal-newborn clients and their families.
initiate a referral for a respiratory therapist. ●
Nurse educator: Teaches in schools of nursing,
NCLEX® Connection: Management of Care, Referrals staff development departments in health care
facilities, or client education departments.
●
Nurse administrator: Provides leadership to nursing
2. A. A social worker can coordinate community services to help departments within a health care facility.
the client, but not specifically with self-feeding devices. ●
Nurse researcher: Conducts research primarily
B. A certified nursing assistant can help the client to improve the quality of client care.
with feeding, but does not typically procure
NCLEX® Connection: Management of Care, Concepts of
adaptive devices for the client.
Management
C. A registered dietitian can help with educating the
client about meeting nutritional needs, but cannot
help with the client’s physical limitations.
D. CORRECT: An occupational therapist can assist clients
who have physical challenges to use adaptive devices
and strategies to help with self-care activities.
NCLEX® Connection: Management of Care, Referrals
3. A. CORRECT: The provider must be knowledgeable

about any medication prescribed for the client,
including its actions, effects, and interactions.
B. It is not within the scope of a certified nursing assistant’s
duties to counsel a client about medications.
C. CORRECT: A pharmacist must be knowledgeable
about any medication dispensed for the client,
including its actions, effects, and interactions.
D. CORRECT: A registered nurse must be knowledgeable
about any medication administered, including
its actions, effects, and interactions.
E. Although some analgesics can cause respiratory depression,
requiring assistance from a respiratory therapist, it is not
within this therapist’s scope of practice to counsel the
client about medications prescribed by the provider.
4. A. A social worker can coordinate community services to

help the client, but not specifically with dysphagia.
B. A certified nursing assistant can help the client with
feeding, but cannot assess and treat dysphagia.
C. An occupational therapist can assist clients who have
motor challenges to improve abilities with self-care
and work, but cannot assess and treat dysphagia.
D. CORRECT: A speech-language pathologist can
initiate specific therapy for clients who have difficulty
with feeding due to swallowing difficulties.
5. A. CORRECT: It is within the range of function for a CNA

to provide basic care to clients (bathing).
B. CORRECT: It is within the range of function for a CNA to
provide basic care to clients, (assisting with ambulation).
C. CORRECT: It is within the range of function for a CNA to
provide basic care to clients (assisting with toileting).
D. Determining pain level is a task that requires the
assessment skills of licensed personnel (nurses). It
is outside the range of function for a CNA.
E. CORRECT: It is within the range of function
for a CNA to provide basic care to clients
(measuring and recording vital signs).
NCLEX® Connection: Management of Care, ssignment,
Delegation and Supervision
10 CHAPTER 2 THE INTERPROFESSIONAL TEAM CONTENT MASTERY SERIES

CHAPTER 3
UNIT 1 SAFE, EFFECTIVE CARE ENVIRONMENT ETHICAL DILEMMAS
SECTION: MANAGEMENT OF CARE
● Ethical dilemmas are problems that involve more than
Ethical one choice and stem from differences in the values and
CHAPTER 3 beliefs of the decision makers. These are common in
Responsibilities health care, and nurses must apply ethical theory and
decision-making to ethical problems.
● A problem is an ethical dilemma when:
◯ A review of scientific data is not enough to solve it.
Ethics is the study of conduct and character, and ◯ It involves a conflict between two moral imperatives.
a code of ethics is a guide for the expectations ◯ The answer will have a profound effect on the
and standards of a profession. situation and the client.
Ethical theories examine principles, ideas,

systems, and philosophies that affect judgments ETHICAL DECISION-MAKING
about what is right and wrong, and good and Ethical decision-making is a process that requires striking
bad. Common ethical theories are utilitarianism, a balance between science and morality.
deontology, consensus in bioethics, and
ethics of care. When making an ethical decision:
● Identify whether the issue is indeed an ethical dilemma.
Ethical principles for individuals, groups of ● Gather as much relevant information as possible about
individuals, and societies are standards of what the dilemma.
is right or wrong with regard to important social ● Reflect on your own values as they relate to
values and norms. the dilemma.
● State the ethical dilemma, including all surrounding
Values are personal beliefs about ideas that issues and the individuals it involves.
determine standards that shape behavior. ● List and analyze all possible options for resolving the
dilemma, and review the implications of each option.
Morals are personal values and beliefs about ● Select the option that is in concert with the ethical
behavior and decision-making. principle that applies to this situation, the decision
maker’s values and beliefs, and the profession’s values
for client care. Justify selecting that one option in light
ETHICAL DECISION-MAKING IN NURSING of the relevant variables.
● Apply this decision to the dilemma, and evaluate
Bioethics refers to the application of ethics to health and

the outcomes.
life. It addresses dilemmas (stem cell research, organ
transplantation, gender reassignment, and reproductive Ethics committees generally address unusual or complex
technologies [in vitro fertilization, surrogate parenting]). ethical issues.
Other ethical dilemmas include abortion and acquired
Examples of ethical guidelines for nurses are the
immunodeficiency syndrome.
American Nurses Association’s Code of thics for urses With
Interpretive Statements (2015) and the International Council
BASIC PRINCIPLES OF ETHICS of Nurses’ The IC Code of thics for urses (2012).
● Advocacy: support and defend clients’ health, wellness, Moral distress occurs when the nurse is placed in a
safety, wishes, and personal rights, including privacy. difficult situation where the actions taken are different
● Responsibility: willingness to respect obligations and from what the nurse feels is ethically correct.
follow through on promises.
● Accountability: ability to answer for one’s own actions.
● Confidentiality: protection of privacy without 3.1 Nursing’s roles in ethical
diminishing access to high-quality care. decision-making
An agent for clients facing an ethical decision. Examples:
ETHICAL PRINCIPLES FOR CLIENT CARE ●
Caring for an adolescent client who has to
● Autonomy: the right to make one’s own personal decide whether to undergo an abortion even
though her parents believe it is wrong
decisions, even when those decisions might not be in ●
Discussing options with a parent who has to decide
that person’s own best interest. whether to consent to a blood transfusion for a
● Beneficence: action that promotes good for others, child when his religion prohibits such treatment
without any self-interest. A decision maker for health care delivery. Examples:
● Fidelity: fulfillment of promises. ●
Assigning staff nurses a higher client load
than previously because administration has
● Justice: fairness in care delivery and use of resources. reduced the number of nurses per shift
● Nonmaleficence: a commitment to do no harm. ●
Witnessing a surgeon discussing only surgical options with
● Veracity: a commitment to tell the truth. a client without mentioning more conservative measures
FUNDAMENTALS FOR NURSING CHAPTER 3 ETHICAL RESPONSIBILITIES 11

Application Exercises Active Learning Scenario
1. A nurse is caring for a client who decides not to A nurse is teaching a group of newly licensed nurses about
have surgery despite significant blockages of the process of resolving ethical dilemmas. Use the ATI Active
the coronary arteries. The nurse understands Learning Template: Basic Concept to complete this item.
that this client’s choice is an example of
UNDERLYING PRINCIPLES: Define the
which of the following ethical principles?
ethical decision-making process.
A. Fidelity
NURSING INTERVENTIONS: List the steps
B. Autonomy
of making an ethical decision.
C. Justice
D. Nonmaleficence
2. A nurse offers pain medication to a client who

is postoperative prior to ambulation. The nurse
understands that this aspect of care delivery is an
example of which of the following ethical principles?
A. Fidelity
B. Autonomy
C. Justice
D. Beneficence
3. A nurse is instructing a group of newly licensed

nurses about the responsibilities organ donation and
procurement involve. When the nurse explains that all
clients waiting for a kidney transplant have to meet the
same qualifications, the newly licensed nurses should
understand that this aspect of care delivery is an
example of which of the following ethical principles?
A. Fidelity
B. Autonomy
C. Justice
D. Nonmaleficence
4. A nurse questions a medication prescription

as too extreme in light of the client’s
advanced age and unstable status. The nurse
understands that this action is an example of
which of the following ethical principles?
A. Fidelity
B. Autonomy
C. Justice
D. Nonmaleficence
5. A nurse is instructing a group of newly licensed

nurses about how to know and what to expect
when ethical dilemmas arise. Which of the
following situations should the newly licensed
nurses identify as an ethical dilemma?
A. A nurse on a medical-surgical unit
demonstrates signs of chemical impairment.
B. A nurse overhears another nurse telling an
older adult client that if he doesn’t stay in
bed, she will have to apply restraints.
C. A family has conflicting feelings about
the initiation of enteral tube feedings
for their father, who is terminally ill.
D. A client who is terminally ill hesitates to name their
partner on their durable power of attorney form.
12 CHAPTER 3 ETHICAL RESPONSIBILITIES CONTENT MASTERY SERIES

Application Exercises Key
1. A. Fidelity is the fulfillment of promises. The nurse has not 3. A. Fidelity is the fulfillment of promises. Because donor
made any promises; this is the client’s decision. organs are a scarce resource compared with the numbers
B. CORRECT: In this situation, the client is exercising of potential recipients who need them, no one can promise
their right to make their own personal decision about anyone an organ. Thus, this principle does not apply.
surgery, regardless of others’ opinions of what is B. Autonomy is the right to make personal decisions,
“best” for them. This is an example of autonomy. even when they are not necessarily in the person’s
C. Justice is fairness in care delivery and in the use best interest. No personal decision is involved
of resources. Because the client has chosen not with the qualifications for organ recipients.
to use them, this principle does not apply. C. CORRECT: Justice is fairness in care delivery and in the
D. Nonmaleficence is a commitment to do no harm. use of resources. By applying the same qualifications to all
In this situation, harm can occur whether or not potential kidney transplant recipients, organ procurement
the client has surgery. However, because they organizations demonstrate this ethical principle in
choose not to, this principle does not apply. determining the allocation of these scarce resources.
NCLEX® Connection: Management of Care, thical Practice D. Nonmaleficence is a commitment to do no harm.
In this situation, harm can occur to organ donors
and to recipients. The requirements of the organ
2. A. Fidelity is the fulfillment of promises. Unless the nurse has procurement organizations are standard procedures
specifically promised the client a pain-free recovery, which and do not address avoidance of harm or injury.
is unlikely, this principle does not apply to this action. NCLEX® Connection: Management of Care, thical Practice
B. Autonomy is the right to make personal decisions,
even when they are not necessarily in the person’s
best interest. In this situation, the nurse is delivering 4. A. Fidelity is the fulfillment of promises. The nurse is not
responsible client care. This principle does not apply. addressing a specific promise when they determine
C. Justice is fairness in care delivery and in the use of the appropriateness of a prescription for the client.
resources. Pain management is available for all clients who Thus, this principle does not apply.
are postoperative, so this principle does not apply. B. Autonomy is the right to make personal decisions,
D. CORRECT: Beneficence is action that promotes good even when they are not necessarily in the person’s
for others, without any self-interest. By administering best interest. No personal decision is involved when
pain medication before the client attempts a potentially the nurse questions the client’s prescription.
painful exercise like ambulation, the nurse is taking a C. Justice is fairness in care delivery and in the use of
specific and positive action to help the client. resources. In this situation, the nurse is delivering
NCLEX® Connection: Management of Care, thical Practice responsible client care and is not assessing available
resources. This principle does not apply.
D. CORRECT: Nonmaleficence is a commitment to
do no harm. In this situation, administering the
medication could harm the client. By questioning it,
the nurse is demonstrating this ethical principle.
NCLEX® Connection: Management of Care, thical Practice
5. A Delivering client care while showing signs of a substance

use disorder is a legal issue, not an ethical dilemma.
B. A nurse who threatens to restrain a client has committed
assault. This is a legal issue, not an ethical dilemma.
C. CORRECT: Making the decision about initiating enteral
tube feedings is an example of an ethical dilemma.
A review of scientific data cannot resolve the issue,
and it is not easy to resolve. The decision will have a
profound effect on the situation and on the client.
D. The selection of a person to make health care decisions on a
client’s behalf is a legal decision, not an ethical dilemma.
Active Learning Scenario Key

sing the ctive Learning Template: Basic Concept
UNDERLYING PRINCIPLES: Ethical decision-making is a process
that requires striking a balance between science and morality.
NURSING INTERVENTIONS
●
Identifying whether the issue is an ethical dilemma
●
Gathering as much relevant information
as possible about the dilemma
●
Reflecting on one’s own values as they relate to the dilemma
●
Stating the ethical dilemma, including all surrounding
issues and individuals it involves
●
Listing and analyzing all possible options for resolving
the dilemma with implications of each option
●
Selecting the option that is in concert with the ethical principle
that applies to this situation, the decision maker’s values
and beliefs, and the profession’s values for client care
●
Justifying the selection of one option in light of relevant variables
FUNDAMENTALS FOR NURSING CHAPTER 3 ETHICAL RESPONSIBILITIES 13

14 CHAPTER 3 ETHICAL RESPONSIBILITIES CONTENT MASTERY SERIES
CHAPTER 4
UNIT 1 SAFE, EFFECTIVE CARE ENVIRONMENT STATE LAWS
SECTION: MANAGEMENT OF CARE
● Each state has enacted statutes that define the
Legal parameters of nursing practice and give the authority

CHAPTER 4 to regulate the practice of nursing to its state board
Responsibilities ●
of nursing.
In turn, the boards of nursing have the authority to
adopt rules and regulations that further regulate
nursing practice. Although the practice of nursing is
Understanding the laws governing nursing similar among states, it is critical that nurses know the
laws and rules governing nursing in the state in which
practice helps nurses protect clients’ rights and they practice.
reduce the risk of nursing liability. ● Boards of nursing have the authority to issue and revoke
a nursing license.
Nurses are accountable for practicing nursing ● Boards also set standards for nursing programs and
further delineate the scope of practice for RNs, practical
within the confines of the law to shield nurses (PNs), and advanced practice nurses.
themselves from liability; advocate for clients’ ● All states have some type of Good Samaritan law that
protects health care workers from liability when they
rights; provide care that is within the nurse’s intervene at the scene of an emergency.
scope of practice; discern the responsibilities
of nursing in relationship to the responsibilities LICENSURE
of other members of the health care team; and In general, nurses must have a current license in every
state in which they practice. The states (about half of
provide safe, proficient care consistent with them) that have adopted the nurse licensure compact are
standards of care. exceptions. This model allows licensed nurses who reside
in a compact state to practice in other compact states
under a multistate license. Within the compact, nurses
SOURCES OF LAW must practice in accordance with the statues and rules of
the state in which they provide care.
FEDERAL REGULATIONS
Federal laws affecting nursing practice
● Health Insurance Portability and
4.1 Types of torts
Accountability Act (HIPAA)
● Americans with Disabilities Act (ADA)
● Mental Health Parity Act (MHPA)

Unintentional torts
● Patient Self-Determination
NEGLIGENCE: A nurse fails to implement safety measures for a client at risk for falls.
Act (PSDA) MALPRACTICE (PROFESSIONAL NEGLIGENCE): A nurse administers a large dose
of medication due to a calculation error. The client has a cardiac arrest and dies.
CRIMINAL AND CIVIL LAWS Quasi-intentional torts

BREACH OF CONFIDENTIALITY: A nurse releases a client’s
● Criminal law is a subsection of public medical diagnosis to a member of the press.
law and relates to the relationship
DEFAMATION OF CHARACTER: A nurse tells a coworker that
between an individual and the they believe the client has been unfaithful to their partner.
government. A nurse who falsifies
a record to cover up a serious Intentional torts
mistake can be guilty of breaking a ASSAULT BATTERY FALSE IMPRISONMENT
criminal law. The conduct of one Intentional and wrongful A person is confined or
● Civil laws protect individual rights. person makes another physical contact with a restrained against their will
person fearful and person that involves an A nurse uses restraints
One type of civil law that relates apprehensive injury or offensive contact on a competent client
to the provision of nursing care is A nurse threatens to place A nurse restrains a to prevent their leaving
tort law. (4.1) an NG tube in a client client and administers the health care facility.
who is refusing to eat. an injection against
their wishes.
FUNDAMENTALS FOR NURSING CHAPTER 4 LEGAL RESPONSIBILITIES 15

PROFESSIONAL NEGLIGENCE CLIENTS’ RIGHTS
Professional negligence is the failure of a person who Nurses are accountable for protecting the rights of
has professional training to act in a reasonable and clients. Examples include informed consent, refusal
prudent manner. The terms “reasonable” and “prudent” of treatment, advance directives, confidentiality, and
generally describe a person who has the average judgment, information security.
intelligence, foresight, and skill that a person with similar ● Clients’ rights are legal privileges or powers clients have
training and experience would have. when they receive health care services.
● Negligence issues that prompt most malpractice suits ● Clients using the services of a health care institution
include failure to: retain their rights as individuals and citizens.
◯ Follow professional and facility-established ● The American Hospital Association identifies
standards of care. clients’ rights in health care settings. See The
◯ Use equipment in a responsible and Patient Care Partnership on the American Hospital
knowledgeable manner. Association website.
◯ Communicate effectively and thoroughly with clients. ● Nursing facilities that participate in Medicare programs
◯ Document care the nurse provided. also follow Resident Rights statutes that govern
◯ Notify the provider of a change in the their operation.
client’s condition.
Complete a prescribed procedure.
NURSING ROLE IN CLIENTS’ RIGHTS
◯
● Nursing students face liability if they harm clients as

a result of their direct actions or inaction. They should ● Nurses must ensure that clients understand their rights,
not perform tasks for which they are not prepared, and must protect their clients’ rights.
and they should have supervision as they learn new ● Regardless of the client’s age, nursing needs, or health
procedures. If a student harms a client, then the student, care setting, the basic tenets are the same. The client
instructor, educational institution, and facility share has the right to:
liability for the wrong action or inaction. (4.2) ◯ Understand the aspects of care to be active in the
● Nurses can avoid liability for negligence by: decision-making process.

◯ Following standards of care. ◯ Accept, refuse, or request modification of the
◯ Giving competent care. plan of care.

◯ Communicating with other health team members ◯ Receive care from competent individuals who treat
and clients. the client with respect.

◯ Developing a caring rapport with clients.
◯ Fully documenting assessments, interventions,
and evaluations.
◯ Being familiar with and following a facility’s policies
and procedures.
4.2 The five elements necessary to prove negligence

ELEMENT OF LIABILITY EXPLANATION EXAMPLE: CLIENT WHO IS A FALL RISK
1. Duty to provide care as Care a nurse should give or what a The nurse should complete a fall risk assessment
defined by a standard reasonably prudent nurse would do for all clients during admission.
2. Breach of duty by failure Failure to give the standard of care The nurse does not perform a fall risk
to meet standard assessment during admission.
3. Foreseeability of harm Knowledge that failing to give the proper The nurse should know that failure to take fall risk
standard of care could harm the client precautions could endanger a client at risk for falls.
4. Breach of duty has Failure to meet the standard Without a fall risk assessment, the nurse
potential to cause had potential to cause harm – does not know the client’s risk for falls and
harm (combines relationship must be provable does not take the proper precautions.
elements 2 and 3)
5. Harm occurs Actual harm to the client occurs The client falls out of bed and fractures their hip.
16 CHAPTER 4 LEGAL RESPONSIBILITIES CONTENT MASTERY SERIES

Online Video: Informed Consent
INFORMED CONSENT ● A competent adult must sign the form for informed
consent. The person who signs the form must be capable
● Informed consent is a legal process by which a client
of understanding the information from the health care
or the client’s legally appointed designee has given
professional who will perform the service (a surgical
written permission for a procedure or treatment.
procedure) and the person must be able to communicate
Consent is informed when a provider explains and the
with the health care professional. When the person
client understands:
giving the informed consent is unable to communicate
◯ The reason the client needs the treatment
due to a language barrier or a hearing impairment, a

or procedure.
trained medical interpreter must intervene. Many health
◯ How the treatment or procedure will benefit the client.
care facilities contract with professional interpreters

◯ The risks involved if the client chooses to receive the
who have additional skills in medical terminology to

treatment or procedure.
assist with providing information.
◯ Other options to treat the problem, including not ● Individuals who can grant consent for another person
treating the problem.
include the following.
● The nurse’s role in the informed consent process is to ◯ Parent of a minor
witness the client’s signature on the informed consent ◯ Legal guardian
form and to ensure that the provider has obtained the ◯ Court-specified representative
informed consent responsibly. ◯ An individual who has durable power of attorney
INFORMED CONSENT GUIDELINES authority for health care

Clients must consent to all care they receive in a health ● Emancipated minors (minors who are independent
care facility. from their parents [a married minor]) can consent
● For most aspects of nursing care, implied consent for themselves.
is adequate. Clients provide implied consent when ● Include a mature adolescent in the informed consent
they adhere to the instructions the nurse provides. process by allowing them to sign an assent as a part of
For example, the nurse is preparing to perform a the informed consent document. (4.3)
tuberculosis skin test, and the client holds out their arm ● The nurse must verify that consent is informed and
for the nurse. witness the client signing the consent form.
● For an invasive procedure or surgery, the client must
provide written consent.
● State laws prescribe who is able to give informed
consent. Laws vary regarding age limitations and
emergencies. Nurses are responsible for knowing the
laws in the state(s) in which they practice.
4.3 Responsibilities for informed consent
Provider Client Nurse

Obtains informed consent. To do so, Gives informed consent. To give Witnesses informed consent.
the provider must give the client informed consent, the client must This means the nurse must
●
The purpose of the procedure. ●
Give it voluntarily (no coercion involved). ●
Ensure that the provider gave the
●
A complete description of the procedure. ●
Be competent and of legal age or be client the necessary information.
●
A description of the professionals an emancipated minor. When the client ●
Ensure that the client understood
who will perform and participate is unable to provide consent, another the information and is competent
in the procedure. authorized person must give consent. to give informed consent.
●
A description of the potential harm, ●
Receive enough information to ●
Have the client sign the informed
pain, or discomfort that might occur. make a decision based on an consent document.
understanding of what to expect. Notify the provider if the client has more
●
Options for other treatments. ●
questions or appears not to understand

●
The option to refuse treatment and any of the information. The provider is
the consequences of doing so. then responsible for giving clarification.
●
Document questions the client has,
notification of the provider, reinforcement
of teaching, and use of an interpreter.

REFUSAL OF TREATMENT ADVANCE DIRECTIVES
● The PSDA stipulates that staff must inform clients they The purpose of advance directives is to communicate a
admit to a health care facility of their right to accept or client’s wishes regarding end-of-life care should the client
refuse care. Competent adults have the right to refuse become unable to do so.
treatment, including the right to leave a facility without ● The PSDA requires asking all clients on admission
a discharge prescription from the provider. to a health care facility whether they have
● If the client refuses a treatment or procedure, the client advance directives.
signs a document indicating that they understand the ● Staff should give clients who do not have advance
risk involved with refusing the treatment or procedure directives written information that outlines their rights
and that they have chosen to refuse it. related to health care decisions and how to formulate
● When a client decides to leave the facility against advance directives.
medical advice (without a discharge prescription), the ● A health care representative should be available to help
nurse notifies the provider and discusses with the with this process.
client the risks to expect when leaving the facility prior
to discharge. Types of advance directives
● The nurse asks the client to sign an Against Medical
Living will
Advice form and documents the incident. ● A living will is a legal document that expresses the
client’s wishes regarding medical treatment in the

STANDARDS OF CARE (PRACTICE) event the client becomes incapacitated and is facing
end-of-life issues.
● Nurses base practice on established standards of care or ● Most state laws include provisions that protect health
legal guidelines for care, including the following.
care providers who follow a living will from liability.
◯ The nurse practice act of each state.
◯ Published standards of nursing practice from Durable power of attorney for health care
professional organizations and specialty groups, A durable power of attorney for health care is a document
including the American Nurses Association (ANA), the in which clients designate a health care proxy to make
American Association of Critical Care Nurses (AACN), health care decisions for them if they are unable to do so.
and the American Association of Occupational Health The proxy can be any competent adult the client chooses.
Nurses (AAOHN).
◯ Health care facilities’ policies and procedures, which
Provider’s orders
Unless a provider writes a “do not resuscitate” (DNR) or
establish the standard of practice for employees of
“allow natural death” (AND) prescription in the client’s
that facility. They provide detailed information about
medical record, the nurse initiates cardiopulmonary
how the nurse should respond to or provide care
resuscitation (CPR) when the client has no pulse or
in specific situations and while performing client
respirations. The provider consults the client and the
care procedures.
family prior to administering a DNR or AND.
● Standards of care define and direct the level of care
nurses should give, and they implicate nurses who did NURSING ROLE IN ADVANCE DIRECTIVES
not follow these standards in malpractice lawsuits. Nursing responsibilities include the following.
● Nurses should refuse to practice beyond the legal scope ● Provide written information about advance directives.
of practice or outside of their areas of competence ● Document the client’s advance directives status.
regardless of reason (staffing shortage, lack of ● Ensure that the advance directives reflect the client’s
appropriate personnel). current decisions.
● Nurses should use the formal chain of command to ● Inform all members of the health care team of the
verbalize concerns related to assignment in light of client’s advance directives.
current legal scope of practice, job description, and area
of competence.
MANDATORY REPORTING
Health care providers have a legal obligation to report
IMPAIRED COWORKERS their findings in accordance with state law in the
Impaired health care providers pose a significant risk to following situations.
client safety.
● A nurse who suspects a coworker of any behavior that
ABUSE
Nurses must report any suspicion of abuse (child or elder
jeopardizes client care or could indicate a substance
abuse, adult violence) following facility policy.
use disorder has a duty to report the coworker to the
appropriate manager.
● Many facilities’ policies provide access to assistance
programs that facilitate entry into a treatment program.
● Each state has laws and regulations that govern the
disposition of nurses who have substance use disorders.
Criminal charges could apply.
18 CHAPTER 4 LEGAL RESPONSIBILITIES CONTENT MASTERY SERIES

COMMUNICABLE DISEASES
Nurses must report communicable disease diagnoses to
the local or state health department. For a complete list
of reportable diseases and a description of the reporting
system, go to the Centers for Disease Control and
Prevention’s website, www.cdc.gov. Each state mandates
which diseases to report in that state.
● Reporting allows officials to: Active Learning Scenario
◯ Ensure appropriate medical treatment of diseases
(tuberculosis). A nurse is teaching a group of newly licensed nurses

◯ Monitor for common-source outbreaks (foodborne, about avoiding liability for negligence. Use the ATI Active
hepatitis A). Learning Template: Basic Concept to complete this item.
◯ Plan and evaluate control and prevention plans
UNDERLYING PRINCIPLES: List the five

(immunizations).
◯ Identify outbreaks and epidemics.
elements necessary to prove negligence.
◯ Determine public health priorities based on trends. NURSING INTERVENTIONS: List at least four
ways nurses can avoid liability for negligence.
Application Exercises
1. A nurse observes an assistive personnel (AP) 4. A nurse is caring for a client who is about to undergo
reprimanding a client for not using the urinal an elective surgical procedure. The nurse should
properly. The AP tells the client that diapers will take which of the following actions regarding
be used next time the urinal is used improperly. informed consent? (Select all that apply.)
Which of the following torts is the AP committing? A. Make sure the surgeon obtained
A. Assault the client’s consent.
B. Battery B. Witness the client’s signature on the consent form.
C. False imprisonment C. Explain the risks and benefits of the procedure.
D. Invasion of privacy D. Describe the consequences of
choosing not to have the surgery.
E. Tell the client about alternatives
2. A nurse is caring for a competent adult client who
to having the surgery.
tells the nurse, “I am leaving the hospital this morning
whether the doctor discharges me or not.” The
nurse believes that this is not in the client’s best 5. A nurse has noticed several occasions in the past
interest, and prepares to administer a PRN sedative week when another nurse on the unit seemed
medication the client has not requested along with drowsy and unable to focus on the issue at hand.
the scheduled morning medication. Which of the Today, the nurse was found asleep in a chair in
following types of tort is the nurse about to commit? the break room not during a break time. Which
A. Assault of the following actions should the nurse take?
B. False imprisonment A. Alert the American Nurses Association.
C. Negligence B. Fill out an incident report.
D. Breach of confidentiality C. Report the observations to the
nurse manager on the unit.
D. Leave the nurse alone to sleep.
3. A nurse in a surgeon’s office is providing preoperative
teaching for a client who is scheduled for surgery
the following week. The client tells the nurse that
“I plan to prepare my advance directives before
I come to the hospital.” Which of the following
statements made by the client should indicate to
the nurse an understanding of advance directives?
A. “I’d rather have my brother make decisions
for me, but I know it has to be my wife.”
B. “I know they won’t go ahead with the
surgery unless I prepare these forms.”
C. “I plan to write that I don’t want them to
keep me on a breathing machine.”
D. “I will get my regular doctor to approve my
plan before I hand it in at the hospital.”

Another random document with
no related content on Scribd:
this question not in terms of an individual, but in terms of the
species.
Yet Mr. Belloc insists upon writing of “the Fittest” as a sort of
conspicuously competitive prize boy, a favourable “sport,” who has to
meet his female equivalent and breed a new variety. That is all the
world away from the manner in which a biologist thinks of the
process of specific life. He sees a species as a vast multitude of
individuals in which those without individual advantages tend to fail
and those with them tend to be left to continue the race. The most
important fact is the general relative failure of the disadvantaged.
The fact next in order of importance is the general relative survival of
the advantaged. The most important consequence is that the
average of the species moves in the direction of advantageous
differences, moving faster or slower according to its rate of
reproduction and the urgency of its circumstances—that is to say, to
the severity of its death-rate. Any one particular individual may have
any sort of luck; that does not affect the general result.
I do not know what Mr. Belloc’s mathematical attainments are, or
indeed whether he has ever learnt to count beyond zero. There is no
evidence on that matter to go upon in these papers. But one may
suppose him able to understand what an average is, and he must
face up to the fact that the characteristics of a species are
determined by its average specimens. This dickering about with
fancy stories of abnormal nuptials has nothing to do with the Theory
of Natural Selection. We are dealing here with large processes and
great numbers, secular changes and realities broadly viewed.
I must apologise for pressing these points home. But I think it is
worth while to take this opportunity of clearing up a system of foggy
misconceptions about the Theory itself that may not be confined
altogether to Mr. Belloc.
Mr. Belloc Comes to His Evidence

And now let us come to Mr. Belloc’s second triad of arguments—
his arguments, as he calls them, “from Evidence.” The sole witness
on Evidence called is his own sturdy self. He calls himself into the
box, and I will admit he gives his testimony in a bluff, straightforward
manner—a good witness. He says very properly that the theory of
Natural Selection repudiates any absolute fixity of species. But we
have to remember that the rate of change in any species is
dependent upon the balance between that species and its
conditions, and if this remains fairly stable the species may remain
for as long without remarkable developments, or indulge in variations
not conditioned by external necessities. The classical Lingula of the
geological text-books, a warm-water shell-fish, has remained much
the same creature throughout the entire record, for hundreds of
millions of years it may be. It was suited to its submarine life, and
hardly any variation was possible that was not a disadvantage. It
swayed about within narrow limits.
This admission of a practical stability annoys Mr. Belloc; it seems
to be a mean trick on the part of the Theory of Natural Selection. He
rather spoils his case by saying that “according to Natural Selection”
the swallow ought to go on flying “faster and faster with the process
of time.” Until it bursts into flames like a meteor and vanishes from
our world? And the Lingula ought to become more and more
quiescent until it becomes a pebble? Yet plainly there is nothing in
the Theory of Natural Selection to make the swallow fly any faster
than its needs require. Excess of swiftness in a swallow may be as
disadvantageous as jumping to conclusions can be to a
controversialist.
But here is a statement that is spirited and yet tolerably fair:—
“If Natural Selection be true, then what we call a Pig is but a

fleeting vision; all the past he has been becoming a Pig, and all
the future he will spend evolving out of Pigdom, and Pig is but a
moment’s phase in the eternal flux.”
This overlooks the melancholy possibility of an extinction of Pigs,

but it may be accepted on the whole as true. And against this Mr.
Belloc gives us his word, for that upon examination is what his
“Evidence” amounts to—that Types are Fixed. He jerks in capitals
here in a rather convincing way. It is restrained of him, considering
how great a part typography plays in his rhetoric, that he has not put
it up in block capitals or had the paper perforated with the words:
Fixed Types.
“We have the evidence of our senses that we are

surrounded by fixed types.”
For weeks and months it would seem Mr. Belloc has walked
about Sussex accumulating first-hand material for these
disputations, and all this time the Pigs have remained Pigs. When he
prodded them they squealed. They remained pedestrian in spite of
his investigatory pursuit. Not one did he find “scuttling away” with a
fore-limb, “half-leg, half-wing.” He has the evidence of his senses
also, I may remind him, that the world is flat. And yet when we take a
longer view we find the world is round, and Pigs are changing, and
Sus Scrofa is not the beast it was two thousand years ago.
Mr. Belloc is conscious of historical training, and I would suggest
to him that it might be an improving exercise to study the Pig
throughout history and to compare the Pigs of the past with the Pigs
of a contemporary agricultural show. He might inform himself upon
the bulk, longevity, appetites, kindliness, and general disposition of
the Pig to-day. He might realise then that the Pig to-day, viewed not
as the conservative occupant of a Sussex sty, but as a species, was
something just a little different as a whole, but different, definably
different, from the Pig of two thousand or five thousand years ago.
He might retort that the Pig has been the victim of selective breeding
and is not therefore a good instance of Natural Selection, but it was
he who brought Pigs into this discussion. Dogs again have been
greatly moulded by man in a relatively short time, and, again, horses.
Almost all species of animals and plants that have come into contact
with man in the last few thousand years have been greatly modified
by his exertions, and we have no records of any detailed
observations of structure or habits of creatures outside man’s range
of interest before the last three or four centuries. Even man himself,
though he changes with relative slowness because of the slowness
with which he comes to sexual maturity, has changed very
perceptibly in the last five thousand years.
Mr. Belloc a Fixed Type

Mr. Belloc says he has not (“Argument from Evidence”). He says
it very emphatically (“Crushing Argument from Evidence”—to adopt
the phraseology of his cross-heads). Let me refer him to a recent
lecture by Sir Arthur Keith (Royal Society of Medicine, Nov. 16,
1925) for a first gleam of enlightenment. He will realise a certain
rashness in his statement. I will not fill these pages with an attempt
to cover all the changes in the average man that have gone on in the
last two or three thousand years. For example, in the face and skull,
types with an edge-to-edge bite of the teeth are giving place to those
with an overlapping bite; the palate is undergoing contraction, the
physiognomy changes. And so on throughout all man’s structure. No
doubt one can find plentiful instances to-day of people almost exactly
like the people of five thousand years ago in their general physique.
But that is not the point. The proportions and so forth that were
exceptional then are becoming prevalent now; the proportions that
were prevalent then, now become rare. The average type is
changing. Considering that man only gets through about four
generations in a century, it is a very impressive endorsement of the
theory of Natural Selection that he has undergone these palpable
modifications in the course of a brief score of centuries. Mr. Belloc’s
delusion that no such modification has occurred may be due to his
presumption that any modification would have to show equally in
each and every individual. I think it is. He seems quite capable of
presuming that.
Triumphant Demand of Mr. Belloc

Mr. Belloc’s next Argument from Evidence is a demand from the
geologist for a continuous “series of changing forms passing one into
the other.” He does not want merely “intermediate forms,” he says;
he wants the whole series—grandfather, father, and son. He does
not say whether he insists upon a pedigree with the bones and
proper certificates of birth, but I suppose it comes to that. This
argument, I am afraid, wins, hands down. Mr. Belloc may score the
point. The reprehensible negligence displayed by the lower animals
in the burial of their dead, or even the proper dating of their own
remains, leaves the apologist for the Theory of Natural Selection
helpless before this simple requisition. It is true that we now have, in
the case of the camels, the horses, and the elephants, an
extraordinary display of fossil types, exhibiting step by step the
development and differentiation of species and genera. But this, I
take it, rather concerns his Third than his Second Argument from
Evidence.
A Magnificent Generalisation
The third argument is essentially a display of Mr. Belloc’s inability
to understand the nature of the record of the rocks. I will assume that
he knows what “strata” are, but it is clear that he does not
understand that any uniform stratum indicates the maintenance of
uniform conditions while it was deposited and an absence of
selective stresses, and that when it gives place to another different
stratum, that signifies a change in conditions, not only in the
conditions of the place where the stratum is found, but in the supply
of material. An estuary sinks and gives place to marine sands, or
fresh water brings down river gravels which cover over an
accumulation of shingle. Now if he will think what would happen to-
day under such circumstances, he will realise that the fauna and
flora of the stratum first considered will drift away and that another
fauna and flora will come in with the new conditions. Fresh things will
come to feed and wade and drown in the waters, and old types will
no longer frequent them. The fossil remains of one stratum are very
rarely directly successive to those below it or directly ancestral to
those above it. A succession of forms is much more difficult and
elusive to follow up, therefore, than Mr. Belloc imagines. And then if
he will consider what happens to the rabbits and rats and mice on
his Sussex estate, and how they die and what happens to their
bodies, he may begin to realise just what proportion of the remains
of these creatures is ever likely to find its way to fossilisation.
Perhaps years pass without the bones of a single rabbit from the
whole of England finding their way to a resting-place where they may
become fossil. Nevertheless the rabbit is a very common animal.
And then if Mr. Belloc will think of palæontologists, millions of years
after this time, working at the strata that we are forming to-day,
working at a gravel or sand-pit here or a chance exposure there, and
prevented from any general excavation, and if he will ask himself
what proportion of the rare few rabbits actually fossilised are likely to
come to light, I think he will begin to realise for the first time in his life
the tremendous “gappiness” of the geological record and how very
childish and absurd is his demand for an unbroken series of forms.
The geological record is not like an array of hundreds of volumes
containing a complete history of the past. It is much more like a few
score crumpled pages from such an array, the rest of the volumes
having either never been printed, or having been destroyed or being
inaccessible.
In his Third Argument from Evidence Mr. Belloc obliges us with a
summary of this record of the rocks, about which he knows so little. I
need scarcely note here that the only evidence adduced is his own
inspired conviction. No “European” palæontologist or biologist is
brought out of the Humbert safe and quoted. Here was a chance to
puzzle me dreadfully with something “in French,” and it is
scandalously thrown away. Mr. Belloc tells us, just out of his head,
that instead of there being that succession of forms in the geological
record the Theory of Natural Selection requires, there are
“enormously long periods of stable type” and “(presumably) rapid
periods of transition.” That “presumably” is splendid; scientific
caution and all the rest of it—rapid periods when I suppose the
Creative Spirit got busy and types woke up and said, “Turn over; let’s
change a bit.”
There is really nothing to be said about this magnificent
generalisation except that it is pure Bellocking. Wherever there is a
group of strata, sufficiently thick and sufficiently alike to witness to a
long-sustained period of slight alterations in conditions, there we find
the successive species approximating. This is not a statement à la
Belloc. In spite of the chances against such a thing occurring, and in
defiance of Mr. Belloc’s assertion that it does not occur, there are
several series of forms in time, giving a practically direct succession
of species. Mr. Belloc may read about it and at the same time
exercise this abnormal linguistic gift which sits upon him so
gracefully, his knowledge of the French language, in Deperet’s
Transformations du Monde Animal, where all these questions are
conveniently summarised. There he will get the results of Waagen
with a succession of Ammonites and also of Neumayr with Paludina,
and there also he will get information about the sequence of the
species of Mastodon throughout the Tertiary age and read about the
orderly progress of a pig group, the Brachyodus of the Eocene and
Oligocene. There is a touch of irony in the fact that his own special
protégé, the Pig, should thus turn upon him and rend his Third
Argument from Evidence.
More recondite for Mr. Belloc is the work of Hilgendorf upon
Planorbis, because it is in German; but the drift of it is visible in the
Palæontology wing of the London Natural History Museum, Room
VIII. A species of these gasteropods was, during the slow processes
of secular change, caught in a big lake, fed by hot springs. It
underwent progressive modification into a series of successive new
species as conditions changed through the ages. Dr. Klähms’
specimens show this beautifully. Rowe’s account of the evolutionary
series in the genus Micraster (Q.J.M.S., 1899) is also accessible to
Mr. Belloc, and he will find other matter to ponder in Goodrich’s
Living Organisms, 1924. The finest series of all, longer in range and
completer in its links, is that of the Horse. There is an excellent little
pamphlet by Matthew and Chubb, well illustrated, The Evolution of
the Horse, published by the American Museum of Natural History,
New York, so plain, so simple, so entirely and humiliatingly
destructive of Mr. Belloc’s nonsensical assertions, that I pray him to
get it and read it for the good of his really very unkempt and
neglected soul.
Thus we observe that Mr. Belloc does not know the facts in this
case of Natural Selection, and that he argues very badly from such
facts as he misconceives. It is for the reader to decide which at the
end is more suitable as a laughing-stock—the Theory of Natural
Selection or Mr. Belloc. And having thus studied this great Catholic
apologist as an amateur biologist and arrived at the result, we will
next go on to consider what he has to say about the origins of
mankind—and Original Sin.
IV
MR. BELLOC’S ADVENTURES AMONG THE
SUB-MEN: MANIFEST TERROR OF THE
NEANDERTHALER
FROM Mr. Belloc’s feats with Natural Selection we come to his

adventures among his ancestors and the fall of man. These are, if
possible, even more valiant than his beautiful exposure of the “half-
educated assurance” of current biological knowledge. He rushes
about the arena, darting from point to point, talking of my ignorance
of the “main recent European work in Anthropology,” and avoiding
something with extraordinary skill and dexterity. What it is he is
avoiding I will presently explain. No one who has read my previous
articles need be told that not a single name, not a single paper, is
cited from that galaxy of “main recent European” anthropology. With
one small exception. There is a well-known savant, M. Marcellin
Boule, who wrote of the Grottes de Grimaldi in 1906. Some facetious
person seems to have written to Mr. Belloc and told him that M.
Boule in 1906 “definitely proved the exact opposite” of the
conclusions given by Mr. Wright in his Quaternary Ice Age (1914),
and quoted in my Outline. Mr. Belloc writes this down, elevates M.
Boule to the magnificence of “Boule” simply and follows up with the
habitual insults. By counting from his one fixed mathematical point,
zero in some dimension unknown to me, he concludes that I must be
twenty years out of date, though the difference between 1906 and
1914, by ordinary ways of reckoning, is really not minus twenty but
plus eight.
The same ungracious humorist seems to have stuffed up Mr.
Belloc with a story that for the last twenty years the climate of the
earth has ceased to vary with the eccentricity of the earth’s orbit, and
that any natural consequences of the precession of the equinoxes no
longer occur; that climate has, in fact, cut loose from astronomical
considerations, and that you can find out all about it in the
Encyclopædia Britannica. You cannot. Mr. Belloc should have tried.
Some day he must find time to puzzle out M. Boule’s curve of
oscillation of the Mediterranean and correlate it with Penck’s, and go
into the mystery of certain Moustierian implements that M. Boule
says are not Moustierian; and after that he had better read over the
little discussion about changes of climate in the Outline of History—it
is really quite simply put—and see what it is I really said and what
his leg-pulling friend has been up to with him in that matter. It may be
kinder to Mr. Belloc to help him with a hint. Croll made an excellent
book in which he pointed out a number of astronomical processes
which must produce changes of climate. He suggested that these
processes were sufficient to account for the fluctuations of the glacial
age. They are not. But they remain perfectly valid causes of climatic
variation. Croll is no more done for than Darwin is done for. That is
where Mr. Belloc’s friend let Mr. Belloc down.
But Mr. Belloc does not always work on the information of
facetious friends, and sometimes one is clearly in the presence of
the unassisted expert controversialist. When, for example, I say that
the Tasmanians are not racially Neanderthalers, but that they are
Neanderthaloid, he can bring himself to alter the former word also to
Neanderthaloid in order to allege an inconsistency. And confident
that most of his Catholic readers will not check him back by my book,
he can ascribe to me views about race for which there is no shadow
of justification. But it is disagreeable to me to follow up such issues,
they concern Mr. Belloc much more than they do the living questions
under discussion, and I will not even catalogue what other such
instances of unashamed controversy occur.
Mr. Belloc as Iconoclast

In the course of the darting to and fro amongst human and sub-
human pre-history, Mr. Belloc criticises me severely for quoting Sir
Arthur Keith’s opinion upon the Piltdown remains. I have followed
English authorities. All these remains are in England, and so they
have been studied at first hand mostly by English people. No one
can regret this insularity on the part of Eoanthropus more than I do,
but it leaves Mr. Belloc’s “European opinion on the whole” rejecting
Sir Arthur Keith as a rather more than usually absurd instance of Mr.
Belloc’s distinctive method. “What European opinion?” you ask. Mr.
Belloc does not say. Probably Belloking of Upsala and Bellokopoulos
of Athens. Mr. Belloc—forgetting that in an earlier edition of the
Outline I give a full summary of the evidence in this case, up-to-date
—informs his Catholic audience that I have apparently read nothing
about the Piltdown vestige but an “English work.” And then he
proceeds to fall foul of the “restoration” of Eoanthropus. It is an
imaginary picture of the creature, and I myself think that the artist
has erred on the human side. Mr. Belloc objects to all such
restorations.
Well, we have at least a saucerful of skull fragments and a
doubtful jawbone to go upon, and the picture does not pretend to be,
and no reader can possibly suppose it to be, anything but a tentative
restoration. But why a great Catholic apologist of all people, the
champion of a Church which has plastered the world with portraits of
the Virgin Mary, of the Holy Family, and with pictures of saints and
miracles in the utmost profusion, without any warning to the simple-
minded that these gracious and moving figures to which they give
their hearts may be totally unlike the beings they profess to
represent—why he should turn iconoclast and object to these
modestly propounded restorations passes my comprehension. At
Cava di Tirrene near Naples I have been privileged to see, in all
reverence, a hair of the Virgin, small particles of St. Peter, and other
evidences of Christianity; and they did not seem to me to be so
considerable in amount as even the Eoanthropus fragments. And
again, in this strange outbreak of iconoclastic rage, he says:—
“Again, we have the coloured picture of a dance of American
Red Indians round a fire solemnly presented as a
‘reconstruction’ of Palæolithic society.”
He has not even observed that the chief figures in that picture
are copied directly from the actual rock paintings of Palæolithic men
although this is plainly stated.
Mr. Belloc Discovers a Mare’s-Nest

And yet he must have looked at the reproductions of these rock
paintings given in the Outline. Because in his ninth paper he comes
out with the most wonderful of all the mare’s-nests he has
discovered in the Outline of History, and it concerns these very
pictures. You see there is an account of the Reindeer men who lived
in France and North Spain, and it is said of them that it is doubtful if
they used the bow. Mr. Belloc declares that it is my bitter hatred of
religion that makes me say this, but indeed it is not. It is still doubtful
if the Reindeer hunters had the bow. The fires of Smithfield would
not tempt me to say certainly either that they had it or that they did
not have it, until I know. But they seem to have killed the reindeer
and the horse and bison by spearing them. Mr. Belloc may have
evidence unknown to the rest of mankind in that Humbert safe of his,
otherwise that is the present state of our knowledge. But, as I explain
on pages 56 and 57 in language that a child might understand,
simultaneously with that reindeer-hunting life in the north there were
more advanced (I know the word will disgust Mr. Belloc with its horrid
suggestion of progress, but I have to use it) Palæolithic people
scattered over the greater part of Spain and reaching into the South
of France who had the bow. It says so in the text: “Men carry bows”
runs my text, describing certain rock pictures reproduced in my book.
I wrote it in the text; and in the legends that are under these pictures,
legends read and approved by me, the statement is repeated. The
matter is as plain as daylight and as plainly stated. Mr. Belloc will get
if he says over to himself slowly: “Reindeer men, bows doubtful;
Azilian, Capsian men to the south, bows certainly.” And now
consider Mr. Belloc, weaving his mare’s-nest:—
“Upon page 55 he writes, concerning the Palæolithic man of

the cave drawings, this sentence: ‘it is doubtful if they knew of
the bow.’
“When I first read that sentence, I was so staggered, I could
hardly believe I had read it right.
“That a person pretending to teach popular prehistorical
science in 1925 should tell us of the cave painters that it was
‘doubtful if they knew of the bow’ seemed to me quite out of
nature.
“It was the more extraordinary because here before me, in
Mr. Wells’s own book, were reproductions of these cave
paintings, with the bow and the arrow appearing all over them!
Even if he did not take the trouble to look at the pictures that
were to illustrate his book, and left that department (as he
probably did) to hack work, he ought, as an ordinary educated
man, to have known the ultimate facts of the case.
“Palæolithic man was an archer, and an archer with an
efficient weapon.
“The thing is a commonplace; only gross ignorance can
have overlooked it; but, as I have said, there is a cause behind
that ignorance. Mr. Wells would not have made this enormous
error if he had not been possessed with the necessity of making
facts fit in with his theology.”
The Chasing of Mr. Belloc Begins

There is a real splendour in these three almost consecutive
passages. And note incidentally how this facile controversialist
bespatters also my helpers and assistants. They do “hack work.”
Palæolithic man, speaking generally, was not an archer. Only the
later Palæolithic men, dealing with a smaller quarry than the
reindeer, seem to have used the bow. Manifestly it is not I who am
fitting my facts with my theology here, but Mr. Belloc. He is inventing
an error which is incredible even to himself as he invents it, and he is
filling up space as hard as he can with indignation at my imaginary
offence.
Why is he going on like this? In the interests of that Catholic soul
in danger? Possibly. But his pen is running so fast here, it seems to
me, not so much to get to something as to get away from something.
The Catholic soul most in danger in these papers of Mr. Belloc’s is
Mr. Belloc’s, and the thing he is running away from through these six
long disputations is a grisly beast, neither ape nor true man, called
the Neanderthaler, Homo Neanderthalensis. This Homo
Neanderthalensis is the real “palæolithic” man. For three-quarters of
the “palæolithic” age he was the only sort of man. The Reindeer
men, the Capsian men, are “modern” beside him. He was no more
an archer than he was an electrical engineer. He was no more an
artist than Mr. Belloc is a man of science.
Instead of bothering with any more of the poor little bits of argey-
bargey about this or that detail in my account of the earlier true men
that Mr. Belloc sees fit to make—instead of discussing whether these
first human savages, who drew and painted like Bushmen and
hunted like Labrador Indians, did or did not progress in the arts of life
before they passed out of history, let me note now the far more
important matters that he refuses to look at.
Mr. Belloc makes a vast pother about Eoanthropus, which is no
more than a few bits of bone; he says nothing of the other creature
to whom I have devoted a whole chapter: the man that was not a
man. Loud headlines, challenging section headings, appeal in vain to
Mr. Belloc’s averted mind. Of this Neanderthal man we have plentiful
evidence, and the collection increases every year. Always in
sufficiently old deposits, and always with consistent characteristics.
Here is a creature which not only made implements but fires, which
gathered together ornamental stones, which buried its dead. Mr.
Belloc says burying the dead is a proof of a belief in immortality. And
this creature had strange teeth, differing widely from the human,
more elaborate and less bestial; it had a differently hung head; it was
chinless, it had a non-opposable thumb. Says M. Boule, the one
anthropologist known to Mr. Belloc: “In its absence of forehead the
Neanderthal type strikingly resembles the anthropoid apes.” And he
adds that it “must have possessed only a rudimentary psychic nature
... markedly inferior to that of any modern race.” When I heard that
Mr. Belloc was going to explain and answer the Outline of History,
my thought went at once to this creature. What would Mr. Belloc say
of it? Would he put it before or after the Fall? Would he correct its
anatomy by wonderful new science out of his safe? Would he treat it
like a brother and say it held by the most exalted monotheism, or
treat it as a monster made to mislead wicked men?
He says nothing! He just walks away whenever it comes near
him.
But I am sure it does not leave him. In the night, if not by day, it
must be asking him: “Have I a soul to save, Mr. Belloc? Is that
Heidelberg jawbone one of us, Mr. Belloc, or not? You’ve forgotten
me, Mr. Belloc. For four-fifths of the Palæolithic age I was ‘man.’
There was no other. I shamble and I cannot walk erect and look up
at heaven as you do, Mr. Belloc, but dare you cast me to the dogs?”
No reply.
The poor Neanderthaler has to go to the dogs, I fear, by
implication, for Mr. Belloc puts it with all the convincing force of
italics, that “Man is a fixed type.” We realise now why he wrote the
four wonderful chapters about Natural Selection that we have done
our best to appreciate. It was to seem to establish this idea of fixed
types. Man had to be shown as a “Fixed Type” for reasons that will
soon be apparent. Apart from Mr. Belloc’s assertion, there is no
evidence that man is any exception to the rest of living creatures. He
changes. They all change. All this remarkable discourse about bows
or no bows and about the high thinking and simple living of these
wandering savages of twenty or more thousand years ago, which
runs through half a dozen papers, seems to be an attempt to believe
that these early men were creatures exactly like ourselves; and an
attempt to believe that the more animal savages of the preceding
hundred thousand years did not for all practical purposes exist at all.
An attempt to believe and induce belief; not an attempt to
demonstrate. Mr. Belloc emerges where he went in, with much said
and nothing proved, and the Outline undamaged by his attack. And
emerging he makes a confession that he never was really concerned
with the facts of the case at all. “Sympathy or antagonism with the
Catholic faith is the only thing of real importance in attempting to
teach history”—and there you are! All these argumentative
gesticulations, all these tortured attempts to confute, are acts of
devotion to Mr. Belloc’s peculiar vision of the Catholic faith.
I am afraid it is useless for me to suggest a pilgrimage to Mr.
Belloc, or I would ask him to visit a popular resort not two hours by
automobile from the little corner of France in which I am wont to
shelter my suburban Protestantism from the too bracing English
winter. That is the caves at Rochers Rouges, at which, as it
happens, his one quoted authority, M. Boule, worked for several
years. There in an atmosphere entirely “Latin” and “continental,”
under the guidance of Signor Alfredo Lorenzi, he can see for himself
his Fixed Type Man at successive levels of change. No northern man
need be with him when he faces the facts of these caves; no
Protestant shadow need dog his steps; his French, that rare
distinguished gift, will be understood, and he may even air such
Provençal or Italian as he is master of. The horrid Neanderthaler is
not in evidence. But there, protected by glass covers, he will be able
to see the skeletons of Cro-Magnon man and Grimaldi man lying in
the very positions in which they were discovered. He will see for
himself the differences of level at which they were found and have
some help in imagining the ages that separate the successive types.
He will note massiveness of skull and protrusion of jaw. He will see
the stone implements they used, the ashes of their fires, and have
some material for imagining the quality of their savagery. He can
hunt about for arrow-heads to bear out his valiant assertion that
Palæolithic man was “an archer with an efficient weapon.” He will
hunt until stooping and the sunshine make him giddy, in vain. And
then, with these bones fresh in his mind, he should go to the
Museum at Monaco and see the skeleton of a modern human being.
He will find no end of loud talk and valiant singing and good red wine
necessary before he can get back to his faith in man as a Fixed
Type.
Where Was the Garden of Eden?

It is extremely difficult to find out what Mr. Belloc, as a
representative Catholic, believes about human origins. I was
extremely curious to get the Catholic view of these matters, and I
heard of the advent of these articles with very great pleasure,
because I thought I should at last be able to grasp what I had
hitherto failed to understand in the Catholic position. But if Mr. Belloc
has said all that there is to say for Catholicism upon these points,
Catholicism is bankrupt. He assures me that to believe in the Biblical
account of the Creation is a stupid Protestant tendency, and that
Catholics do not do anything of the sort. His attitude towards the
Bible throughout is one almost of contempt. It is not for me to decide
between Christians upon this delicate issue. And Catholics, I gather,
have always believed in Evolution and are far above the intellectual
level of the American Fundamentalist. It is very important to Catholic
self-respect to keep that last point in mind. Catholic evolution is a
queer process into which “Design” makes occasional convulsive
raids; between which raids species remain “fixed”; but still it is a sort
of Evolution. My peasant neighbours in Provence, devout Catholics
and very charming people, have not the slightest suspicion that they
are Evolutionists, though Mr. Belloc assures me they are.
But, in spite of this smart Evolutionary town wear of the Church,
it has somehow to be believed by Catholics that “man” is and always
has been and will be the same creature, “fixed.” That much Mr.
Belloc gives us reiteratively. A contemporary writer, the Rev. Morris
Morris, has written an interesting book, Man Created During
Descent, to show that man’s immortal soul was injected into the
universe at the beginning of the Neolithic period, which makes those
Azilians and Capsians, with their bows and carvings, mere animals.
The new Belloc-Catholic teaching is similar, but it puts the human
beginnings earlier. Somewhen after the Chellean and Moustierian
periods, and before the Reindeer men, I gather that “man” appeared,
according to Catholic doctrines, exactly what he is now. Or rather
better. He was clad in skins and feathers, smeared with paint, a
cave-hunting wanderer with not even a dog at his heels; but he was,
because Mr. Belloc says so, a devout monotheist and had a lucid
belief in personal immortality. His art was pure and exalted—there
were little bone figures of steatopygous women in evidence. He had
no connection with the Neanderthal predecessor—or else he had
jumped miraculously out of the Neanderthaler’s bestial skin.
Sometimes it seems to be one thing and sometimes the other. But all
that stuff about Adam and Eve and the Garden and the Tree and the
Serpent, so abundantly figured in Catholic painting and sculpture,
seems to have dropped out of this new version of Catholic truth.
Yet those pictures are still shown to the faithful! And what the Fall
becomes in these new revelations of Catholicism, or whether there
was a Fall, historically speaking, Mr. Belloc leaves in the densest
obscurity. I have read and re-read these articles of his, and I seek
those lucid Latin precisions he has promised me in vain. Was and is
that Eden story merely symbolical, and has the Church always
taught that it is merely symbolical? And if so, what in terms of current
knowledge do these symbols stand for? Is it symbolical of some
series of events in time or is it not? If it is, when and what were the
events in time? And if it is not, but if it is symbolical of some
experience or adventure or change in the life of each one of us, what
is the nature of that personal fall? What is the significance of the
Garden, the Innocence, the Tree, the Serpent? To get anything clear
and hard out of Mr. Belloc’s papers in reply to these questions is like
searching for a diamond in a lake of skilly. I am left with the
uncomfortable feeling that Mr. Belloc is as vague and unbelieving
about this fundamental Catholic idea as the foggiest of foggy
Protestants and Modernists, but that he has lacked the directness of
mind to admit as much even to himself. Yet surely the whole system
of salvation, the whole Christian scheme, rests upon the
presumption of a fall. Without a fall, what is the value of salvation?
Why redeem what has never been lost? Without a condemnation
what is the struggle? What indeed, in that case, is the Catholic
Church about?
What modern thought is about is a thing easier to explain. In the
Outline of History, against which Mr. Belloc is rather carping than
levelling criticism, there is set out, as the main form of that Outline, a
progressive development of conscious will in life. It is not a form
thrust upon the massed facts by any fanatical prepossession; it is a
form they insisted upon assuming under my summarising hand.
What is going on in this dispute is not that I am beating and putting
over my ideas upon Mr. Belloc or that he is beating and putting over
his ideas upon me, but that the immense increase of light and
knowledge during the past century is imposing a new realisation of
the quality and depth and import of life upon us both, and that I am
acquiescent and he is recalcitrant. I judge his faith by the new
history, and he judges the new history by his faith.
V
FIXITY OR PROGRESS
I AM glad to say that we are emerging now from the worst of the
controversial stuff, irritating and offensive, in which Mr. Belloc is so
manifestly my master, and coming to matters of a more honest
interest.
I have stuck to my argument through the cut and slash, sneer
and innuendo of Mr. Belloc’s first twelve papers. I have done my best
to be kind and generous with him. I have made the best excuses I
can for him. I have shown how his oddities of bearing and style arise
out of the difficulties of his position, and how his absurd reasonings
about Natural Selection and his deliberate and tedious
bemuddlement of the early Palæolithic sub-men with the late
Reindeer men and the Capsian men are all conditioned by the
necessity he is under to declare and believe that “man” is, as he puts
it, a “Fixed Type,” the same in the past and now and always. He is
under this necessity because he believes that otherwise the
Christian faith cannot be made to stand up as a rational system, and
because, as I have shown by a quotation of his own words, he
makes their compatibility with his idea of Catholic teaching his
criterion in the acceptance or rejection of facts.
I will confess I do not think that things are as bad as this with
Christianity. I believe a far better case could be made for Catholicism
by an insistence that its value and justification lie in the change and
in the direction of the human will, in giving comfort and consolation
and peace, in producing saints and beautiful living; and that the truth
of the history it tells of space and time is entirely in relation to the
development of these spiritual aspects, and has no necessary
connection whatever with scientific truth. This line of thought is no

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Fundamentals for Nursing

Sheryl Sommer PhD, RN, CNE Mary Jane Janowski, RN, MA

Janean Johnson, MSN, RN CNE Jessica L. Johnson DNP, MSN, BSN, RN

Brenda S. Ball, MEd, BSN, RN Lisa Kongable, MA, ARNP,

INTELLECTUAL PROPERTY NOTICE

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FUNDAMENTALS FOR NURSING I

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Copy editing: Kelly Von Lunen, Bethany Phillips, Kya Rodgers

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Cover design: Jason Buck

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IMPORTANT NOTICE TO THE READER

II CONTENT MASTERY SERIES

(included at the back of this book) to record the important

nutritional guidelines, nursing interventions, and ◯ Reduction of Risk Potential

complications, if applicable. ◯ Physiological Adaptation

An NCLEX Connection might, for example, alert you that

■ Assess client use of assistive devices.

FUNDAMENTALS FOR NURSING USER’S GUIDE III

QSEN COMPETENCIES ICONS

As needed updates to the Review Modules are identified,

IV USER’S GUIDE CONTENT MASTERY SERIES

UNIT 1 Safe, Effective Care Environment 3

CHAPTER 1 Health Care Delivery Systems 3

CHAPTER 2 The Interprofessional

CHAPTER 3 Ethical Responsibilities 11

CHAPTER 4 Legal Responsibilities 15

CHAPTER 5 Information Technology 21

CHAPTER 6 Delegation and Supervision 27

CHAPTER 7 Nursing Process 31

CHAPTER 8 Critical Thinking and Clinical Judgment 37

CHAPTER 9 Admissions, Transfers, and Discharge 41

SECTION: Safety and Infection Control 49

CHAPTER 10 Medical and Surgical Asepsis 49

CHAPTER 11 Infection Control 53

CHAPTER 12 Client Safety 59

CHAPTER 13 Home Safety 65

CHAPTER 14 Ergonomic Principles 73

CHAPTER 15 Security and Disaster Plans 77

FUNDAMENTALS FOR NURSING TABLE OF CONTENTS V

UNIT 2 Health Promotion 85

CHAPTER 16 Health Promotion and Disease Prevention 85

CHAPTER 17 Client Education 89

Chapter 18 Infants (2 Days to 1 Year) 93

CHAPTER 19 Toddlers (1 to 3 Years) 99

CHAPTER 20 Preschoolers (3 to 6 Years) 103

CHAPTER 21 School-Age Children (6 to 12 Years) 107

CHAPTER 22 Adolescents (12 to 20 Years) 111

CHAPTER 23 Young Adults (20 to 35 Years) 115