{"id":65,"date":"2019-10-20T00:00:29","date_gmt":"2019-10-20T00:00:29","guid":{"rendered":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/chapter\/2-2-ethical-and-professional-foundations-of-safe-medication-administration-by-nurses\/"},"modified":"2025-01-16T22:29:14","modified_gmt":"2025-01-16T22:29:14","slug":"2-2-ethical-and-professional-foundations-of-safe-medication-administration-by-nurses","status":"publish","type":"chapter","link":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/chapter\/2-2-ethical-and-professional-foundations-of-safe-medication-administration-by-nurses\/","title":{"raw":"2.2 Ethical and Professional Foundations of Safe Medication Administration by Nurses","rendered":"2.2 Ethical and Professional Foundations of Safe Medication Administration by Nurses"},"content":{"raw":"The <a class=\"rId7\" href=\"https:\/\/www.nursingworld.org\/ana\/about-ana\/\" target=\"_blank\" rel=\"noopener noreferrer\">American Nurses Association (ANA)<\/a> is a professional organization that represents the interests of the nation's four million registered nurses and is at the forefront of improving the quality of health care for all.<sup>[footnote]American Nurses Association. (2019). <em>About ANA.<\/em> <a href=\"https:\/\/www.nursingworld.org\/ana\/about-ana\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/ana\/about-ana<\/a>\/[\/footnote] <\/sup>The ANA establishes ethical and professional standards for nurses that also guide safe administration of medications. These code of ethics and professional standards are described in ANA publications titled <em>Code of Ethics for Nurses <\/em>and<em> Nursing: Scope and Standards of Practice.<\/em>\n<h2>Code of Ethics for Nurses<\/h2>\nThe ANA developed the <em>Code of Ethics for Nurses<\/em> as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession.<sup>[footnote]American Nurses Association. (2015). <em>Code of ethics for nurses with interpretive statements.<\/em> <a href=\"https:\/\/www.nursingworld.org\/coe-view-only\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/coe-view-only<\/a>[\/footnote] <\/sup>Several provisions from the <em>Code of Ethics<\/em> impact how nurses should administer medication in an ethical manner. A summary of each provision from the <em>Code of Ethics<\/em> and how it pertains to medication administration is outlined below:\n<ul>\n \t<li><strong>Provision 1<\/strong> focuses on respect for human dignity and the right for self-determination: \u201cThe nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.\u201d<\/li>\n \t<li><strong>Provision 2<\/strong> states, \u201cThe nurse's primary commitment is to the client\u2026\u201d<sup>[footnote]American Nurses Association. (2015). <em>Code of ethics for nurses with interpretive statements.<\/em> <a href=\"https:\/\/www.nursingworld.org\/coe-view-only\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/coe-view-only<\/a>[\/footnote]<\/sup> In health care settings, nurses often experience several competing loyalties, such as to their employer, to the doctor(s), to their supervisor, or to others on the health care team. However, the client should always receive the primary commitment of the nurse. Additionally, the client has the right to accept, refuse, or terminate any treatment, including medications.<\/li>\n \t<li><strong>Provision 3<\/strong> states, \u201cThe nurse promotes, advocates for, and protects the rights, health, and safety of the patient...\u201d<sup>[footnote]American Nurses Association. (2015). <em>Code of ethics for nurses with interpretive statements.<\/em> <a href=\"https:\/\/www.nursingworld.org\/coe-view-only\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/coe-view-only<\/a>[\/footnote] <\/sup>This provision includes a nurse's responsibility to promote a culture of safety for clients. If errors occur, they must be reported, and nurses should ensure responsible disclosure of errors to clients. This also includes proper disclosure of questionable practices, such as <strong>[pb_glossary id=\"537\"]drug diversion[\/pb_glossary]<\/strong> or impaired practice by any professional.<\/li>\n \t<li><strong>Provision 4<\/strong> involves authority, accountability, and responsibility by a nurse to follow legal requirements, such as state practice acts and professional standards of care.<\/li>\n \t<li><strong>Provision 5<\/strong> includes the responsibility of the nurse to promote health and safety.<\/li>\n \t<li><strong>Provision 6<\/strong> focuses on virtues that make a nurse a morally good person. For example, nurses are held accountable to use their clinical judgment to avoid causing harm to clients (<strong>[pb_glossary id=\"538\"]maleficence[\/pb_glossary]<\/strong>) and to do good (<strong>[pb_glossary id=\"539\"]beneficence[\/pb_glossary]<\/strong>). When administering medications, nurses should validate the medication is doing more \u201cgood\u201d than \u201charm\u201d (adverse or side effects).<\/li>\n \t<li><strong>Provision 7<\/strong> focuses on a nurse practicing within the professional standards set forth by their <strong>[pb_glossary id=\"540\"]state nurse practice act[\/pb_glossary]<\/strong>, as well as standards established by professional nursing organizations.<\/li>\n \t<li><strong>Provision 8<\/strong> explains that a nurse must address the <strong>[pb_glossary id=\"541\"]social determinants of health<\/strong><strong>[\/pb_glossary]<\/strong>, such as poverty, education, safe medication, and health care disparities.<sup>[footnote]American Nurses Association. (2015). <em>Code of ethics for nurses with interpretive statements.<\/em> <a href=\"https:\/\/www.nursingworld.org\/coe-view-only\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/coe-view-only<\/a>[\/footnote]<\/sup><\/li>\n<\/ul>\nWhenever a nurse provides client care, the ANA's <em>Code of Ethics<\/em> should be used as a guide for professional ethical behavior.\n<div class=\"textbox\">\n<p class=\"arrow\">View the ANA's <a href=\"https:\/\/www.nursingworld.org\/coe-view-only\" target=\"_blank\" rel=\"noopener\">Code of Ethics for Nurses.<\/a><\/p>\n\n<\/div>\n<div class=\"__UNKNOWN__\">\n<div class=\"textbox textbox--examples\"><header class=\"textbox__header\">\n<h2>Critical Thinking Activity 2.2a\n<img class=\"alignright wp-image-55\" src=\"https:\/\/pressbooks.ccconline.org\/accdigitalmarketing\/wp-content\/uploads\/sites\/219\/2019\/09\/ORN-Icons_lightbulb-300x300-1.png\" alt=\"Image of a lightbulb inside a circle\" width=\"200\" height=\"200\"><\/h2>\n<\/header>\n<div class=\"textbox__content\" style=\"text-align: left;\">\n\nA nurse is preparing to administer medications to a client. While reviewing the chart, the nurse notices two medications with similar mechanisms of action have been prescribed by two different providers.\n\nWhat is the nurse's best response?\n\nNote: Answers to the Critical Thinking activities can be found in the \u201cAnswer Key\u201d sections at the end of the book.\n\n<\/div>\n<\/div>\n<\/div>\n<h2>Standards and Scope of Practice<\/h2>\nThe ANA publishes <em>Nursing: Scope and Standards of Practice<\/em>. This resource establishes national standards for nurses and is updated regularly.<sup>[footnote]American Nurses Association. (2021). <em>Nursing: Scope and standards of practice<\/em> (4th ed.). American Nurses Association.[\/footnote]<\/sup>\n\nThe ANA defines the scope of <strong>[pb_glossary id=\"542\"]nursing [\/pb_glossary]<\/strong> as \u201cthe protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations.\u201d A <strong>[pb_glossary id=\"543\"]registered nurse (RN)[\/pb_glossary]<\/strong>\u00a0is defined as an individual who is educationally prepared and licensed by a state to practice as a registered nurse. Nursing practice is characterized by the following tenets<sup>[footnote]American Nurses Association. (2021). <em>Nursing: Scope and standards of practice<\/em> (4th ed.). American Nurses Association.[\/footnote]<\/sup>:\n<ul>\n \t<li>Caring and health are central to the practice of the registered nurse.<\/li>\n \t<li>Nursing practice is individualized to the unique needs of the health care consumer.<\/li>\n \t<li>Registered nurses use the nursing process to plan and provide individualized care for health care consumers.<\/li>\n \t<li>Nurses coordinate care by establishing partnerships to reach a shared goal of delivering safe, quality health care.<\/li>\n<\/ul>\nThe ANA establishes Standards of Practice and Standards of Professional Performance in the <em>Nursing: Scope and Standards of Practice <\/em>publication. State nurse practice acts further define the scope of practice of RNs and Licensed Practical Nurses\/Vocational Nurses (LPNs\/VNs) within each state. Nurse practice acts are further discussed in the \u201c<a href=\"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/chapter\/2-3-legal-foundations-and-national-guidelines-for-safe-medication-administration\/\" target=\"_blank\" rel=\"noopener\">Legal Foundations and National Guidelines for Safe Medication Administration<\/a>\u201d section of this chapter.\n<div class=\"textbox\">\n<p class=\"arrow\">The ANA's <em>Nursing: Scope and Standards of Practice<\/em> publication can be purchased on the <a href=\"https:\/\/www.nursingworld.org\/practice-policy\/scope-of-practice\/\" target=\"_blank\" rel=\"noopener\">nursingworld.org<\/a> website or borrowed from many libraries.<\/p>\n\n<\/div>\n<h3>Standards of Practice<\/h3>\nThe ANA's Standards of Practice are authoritative statements of duties that all registered nurses, regardless of role, population, or specialty, are expected to perform competently. <strong>[pb_glossary id=\"545\"]Standards of Practice[\/pb_glossary]<\/strong> include assessment, diagnosis, outcome identification, planning, implementation, and evaluation (ADOPIE) components of providing client care, also known as the \"nursing process.\" When nurses safely administer medication, all components of ADOPIE are addressed.\n<h4>Assessment<\/h4>\nThe \"Assessment\" Standard of Practice is defined as, \u201cThe registered nurse collects pertinent data and information relative to the health care consumer\u2019s health or the situation.\u201d<sup>[footnote]American Nurses Association. (2021). <em>Nursing: Scope and standards of practice<\/em> (4th ed.). American Nurses Association.[\/footnote] <\/sup>A registered nurse uses a systematic method to collect and analyze client data. Assessment includes physiological data, as well as psychological, sociocultural, spiritual, economic, and lifestyle data. For example, when a nurse assesses multiple pieces of data for a hospitalized client with pain, this is considered part of a comprehensive pain assessment.\n<h4>Diagnosis<\/h4>\nThe \"Diagnosis\" Standard of Practice is defined as, \u201cThe registered nurse analyzes the assessment data to determine actual or potential diagnoses, problems, and issues.\u201d<sup>[footnote]American Nurses Association. (2021). <em>Nursing: Scope and standards of practice<\/em> (4th ed.). American Nurses Association.[\/footnote]<\/sup> A nursing diagnosis is the nurse\u2019s clinical judgment about the client's response to actual or potential health conditions or needs. Nursing diagnoses are used to create the nursing care plan and are different than medical diagnoses.<sup>[footnote]American Nurses Association. (n.d.). <em>The nursing process<\/em>. <a href=\"https:\/\/www.nursingworld.org\/practice-policy\/workforce\/what-is-nursing\/the-nursing-process\/\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/practice-policy\/workforce\/what-is-nursing\/the-nursing-process\/<\/a>[\/footnote]<\/sup>\n<h4>Outcomes Identification<\/h4>\nThe \"Outcomes Identification\" Standard of Practice is defined as, \u201cThe registered nurse identifies expected outcomes for a plan individualized to the health care consumer or the situation.\u201d<sup>[footnote]American Nurses Association. (2021). <em>Nursing: Scope and standards of practice<\/em> (4th ed.). American Nurses Association.[\/footnote]<\/sup> The nurse sets measurable and achievable short- and long-term goals and specific outcomes in collaboration with the client based on their assessment data and nursing diagnoses.\n<h4>Planning<\/h4>\nThe \"Planning\" Standard of Practice is defined as, \u201cThe registered nurse develops a collaborative plan encompassing strategies to achieve expected outcomes.\u201d<sup>[footnote]American Nurses Association. (2021). <em>Nursing: Scope and standards of practice<\/em> (4th ed.). American Nurses Association.[\/footnote] <\/sup>Assessment data, diagnoses, and goals are used to select evidence-based nursing interventions customized to each client\u2019s needs and concerns. Goals, expected outcomes, and nursing interventions are documented in the client\u2019s nursing care plan so that nurses, as well as other health professionals, have access to it for continuity of care.<sup>[footnote]American Nurses Association. (n.d.). <em>The nursing process.<\/em> <a href=\"https:\/\/www.nursingworld.org\/practice-policy\/workforce\/what-is-nursing\/the-nursing-process\/\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/practice-policy\/workforce\/what-is-nursing\/the-nursing-process\/<\/a>[\/footnote]<\/sup>\n<h4>Implementation<\/h4>\nThe \"Implementation\" Standard of Practice is defined as, \"The nurse implements the identified plan.\u201d<sup>[footnote]American Nurses Association. (2021). <em>Nursing: Scope and standards of practice<\/em> (3rd ed.). American Nurses Association.[\/footnote] <\/sup>Nursing interventions are implemented or delegated to licensed practical nurses\/vocational nurses (LPNs\/VNs) or unlicensed assistive personnel (UAP) with supervision. Interventions are also documented in the client\u2019s electronic medical record as they are completed.<sup>[footnote]American Nurses Association. (n.d.) <em>The nursing process.<\/em> <a href=\"https:\/\/www.nursingworld.org\/practice-policy\/workforce\/what-is-nursing\/the-nursing-process\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/practice-policy\/workforce\/what-is-nursing\/the-nursing-process<\/a>\/[\/footnote]<\/sup>\n\nThe \"Implementation\" Standard of Professional Practice also includes the subcategories \"Coordination of Care\" and \"Health Teaching and Health Promotion\" to promote health and a safe environment.<sup>[footnote]American Nurses Association. (2021). <em>Nursing: Scope and standards of practice<\/em> (4th ed.). American Nurses Association.[\/footnote]<\/sup>\n<h5>Coordination of Care<\/h5>\nThe ANA standard for coordination of care states, \u201cThe registered nurse coordinates care delivery.\u201d<sup>[footnote]American Nurses Association. (2021). <em>Nursing: Scope and standards of practice<\/em> (4th ed.). American Nurses Association.[\/footnote] <\/sup>When ensuring medications are administered safely, the nurse collaborates with the client and the interprofessional health care team to meet mutually agreed upon outcomes. The nurse also engages the client in self-care to achieve their preferred goals for quality of life.\u00a0 For example, one client with chronic pain may have a pain management goal of \"5\" with their quality of life preference of having the ability to participate in social activities with friends but not experiencing burdensome side effect of medication. Another client with chronic pain may have a pain management goal of \"0\" with a quality of life preference of having no pain no matter what the side effects. The nurse advocates for these clients' goals and preferences with the interprofessional team.\n\nNurses also serve vital roles in ensuring safe transitions and continuity of care regarding clients' use of medications. Additional information about safe medication use and transitions of care is discussed in the \"<a href=\"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/chapter\/2-5-preventing-medication-errors\/\" target=\"_blank\" rel=\"noopener\">Preventing Medication Errors<\/a>\" section of this chapter.\n<h5>Health Teaching and Health Promotion<\/h5>\nWhen administering medications, nurses teach clients about the medications and potential side effects to promote optimal health. The ANA standard for health teaching and health promotion states, \u201cThe registered nurse employs strategies to teach and promote health and wellness.\u201d<sup>[footnote]American Nurses Association. (2021). <em>Nursing: Scope and standards of practice<\/em> (4th ed.). American Nurses Association.[\/footnote] <\/sup>Specific behaviors related to teaching about medication are as follows<sup>[footnote]American Nurses Association. (2021). <em>Nursing: Scope and standards of practice<\/em> (4th ed.). American Nurses Association.[\/footnote]<\/sup>:\n<ul>\n \t<li>Use health teaching and health promotion methods in collaboration with the client's values, beliefs, health practices, developmental level, learning needs, readiness and ability to learn, language preference, spirituality, culture, and socioeconomic status.<\/li>\n \t<li>Provide clients with information and education about intended effects and potential adverse effects of the plan of care.<\/li>\n \t<li>Provide anticipatory guidance to clients to promote health and prevent or reduce risk.<\/li>\n<\/ul>\nIn the book <em>Preventing Medication Errors<\/em> by the Institute of Medicine (2007), the following are additional key national guidelines when teaching clients about safe use of their medications:\n<ul>\n \t<li>Clients should maintain an active list of all prescription drugs, over-the-counter (OTC) drugs, and dietary supplements they are taking, the reasons for taking them, and any known drug allergies. Every provider involved in the medication-use process for a client should have access to this list.<\/li>\n \t<li>Clients should be provided information about side effects, contraindications, methods for handling adverse reactions, and sources for obtaining additional objective, high-quality information.<sup>[footnote]Institute of Medicine. (2007). <em>Preventing medication errors.<\/em> The National Academies Press. <a href=\"https:\/\/doi.org\/10.17226\/11623\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/doi.org\/10.17226\/11623<\/a>[\/footnote]<\/sup><\/li>\n<\/ul>\n<h4>Evaluation<\/h4>\nThe \"Evaluation\" Standard of Practice is defined as, \u201cThe registered nurse evaluates progress toward attainment of goals and outcomes.\u201d<sup>[footnote]American Nurses Association. (2021). <em>Nursing: Scope and standards of practice<\/em> (4th ed.). American Nurses Association.[\/footnote] <\/sup>During evaluation, nurses assess the client and compare the findings against the initial assessment to determine the effectiveness of the interventions and overall nursing care plan. Both the client\u2019s status and the effectiveness of the nursing care must be continuously evaluated and modified as needed.<sup>[footnote]American Nurses Association. (n.d.). <em>The nursing process.<\/em> <a href=\"https:\/\/www.nursingworld.org\/practice-policy\/workforce\/what-is-nursing\/the-nursing-process\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/practice-policy\/workforce\/what-is-nursing\/the-nursing-process<\/a>\/[\/footnote]<\/sup>\n<div class=\"textbox\">\n<p class=\"arrow\">Read additional information about the nursing process in the \"<a href=\"https:\/\/wtcs.pressbooks.pub\/nursingfundamentals\/chapter\/4-2-basic-concepts\/\" target=\"_blank\" rel=\"noopener\">Nursing Process<\/a>\" chapter of Open RN <em>Nursing Fundamentals<\/em>.<\/p>\n\n<\/div>\n<h3>Standards of Professional Performance<\/h3>\nANA's Standards of Professional Performance describe a competent level of behavior for nurses, including activities related to ethics, culturally congruent practice, communication, collaboration, leadership, education, evidence-based practice, and quality of practice.<sup>[footnote]American Nurses Association. (2021). <em>Nursing: Scope and standards of practice<\/em> (4th ed.). American Nurses Association.[\/footnote]<\/sup>\n\nThe ANA defines <strong>[pb_glossary id=\"547\"]culturally congruent practice[\/pb_glossary]<\/strong> as the application of evidence-based nursing that is in agreement with the preferred cultural values, beliefs, worldview, and practices of the health care consumer and other stakeholders. <strong>[pb_glossary id=\"550\"]Cultural competence[\/pb_glossary]<\/strong> represents the process by which nurses demonstrate culturally congruent practice. Nurses must assess the cultural beliefs and practices of their clients and implement culturally congruent interventions when administering medications and teaching about them. Additional information about cultural implications for medication administration is further discussed in the \u201c<a href=\"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/chapter\/2-4-cultural-and-social-determinants-related-to-medication-administration\/\" target=\"_blank\" rel=\"noopener\">Cultural and Social Determinants Related to Medication Administration<\/a>\u201d section later in this chapter.\n<div class=\"__UNKNOWN__\">\n<div class=\"textbox textbox--examples\"><header class=\"textbox__header\">\n<h2>Critical Thinking Activity 2.2b\n<img class=\"alignright wp-image-55\" src=\"https:\/\/pressbooks.ccconline.org\/accdigitalmarketing\/wp-content\/uploads\/sites\/219\/2019\/09\/ORN-Icons_lightbulb-300x300-1.png\" alt=\"Image of a lightbulb inside a circle\" width=\"200\" height=\"200\"><\/h2>\n<\/header>\n<div class=\"textbox__content\" style=\"text-align: left;\">\n\nA nurse is preparing to administer metoprolol, a cardiac medication, to a client and implements the nursing process:\n\n<strong>ASSESSES<\/strong> the vital signs prior to administration and discovers the heart rate is 48.\n\n<strong>DIAGNOSES<\/strong> that the heart rate is too low to safely administer the medication per the parameters provided. Establishes the <strong>OUTCOME<\/strong> to keep the client's heart rate within normal range of 60-100.\n\n<strong>PLANS<\/strong> to call the provider, as well as report this incident in the shift handoff report.\n\nImplements <strong>INTERVENTIONS<\/strong> by withholding the metoprolol at this time, documenting the incident that the medication is withheld, and notifying the provider.\n\nContinues to <strong>EVALUATE<\/strong> the client status throughout the shift after not receiving the metoprolol.\n\nThe nurse is providing health teaching to a client about the medication before discharge. The nurse provides a handout with instructions, as well as a list of the current medications.\n\nWhat other information should be provided to the client?\n\nNote: Answers to the Critical Thinking activities can be found in the \u201cAnswer Key\u201d sections at the end of the book.\n\n<\/div>\n<\/div>\n<\/div>\nFigure 2.1 is an image from <em>Nursing: Scope and Standards of Practice<\/em> by the ANA that illustrates how the scope of practice, standards of practice, and code of ethics form the \u201cbase\u201d of nursing practice.<sup>[footnote]American Nurses Association. (2015). <em>Nursing: Scope and standards of practice<\/em> (3rd ed.). American Nurses Association.[\/footnote]<\/sup> Nursing practice is further guided by the Nurse Practice Act in the state in which a nurse works, federal and state rules and regulations, institutional policies and procedures, and self-determination by the individual nurse. All these components are required to provide quality, safe client care that is evidence-based. These components will be further discussed in the remaining sections of this chapter.\n\n[caption id=\"\" align=\"aligncenter\" width=\"903\"]<img class=\"\" title=\"&quot;Nursing\u202f: Scope and Standards of Practice&quot; image retrieved from http:\/\/search.ebscohost.com\/login.aspx?direct=true&amp;db=nlebk&amp;AN=1077002&amp;site=eds-live&amp;scope=site \" src=\"https:\/\/pressbooks.ccconline.org\/accdigitalmarketing\/wp-content\/uploads\/sites\/219\/2019\/10\/image8-2.png\" alt=\"Image showing American Nursing Association Model of Professional Nursing Practice Regulation\" width=\"903\" height=\"926\"> Figure 2.1 ANA Model of Professional Nursing Practice[\/caption]\n<h2>NCLEX and the Clinical Judgment Model<\/h2>\nThe National Council Licensure Examination (NCLEX) is the national exam that graduates must pass successfully to obtain their nursing license after graduating from a nursing program of study. The NCLEX-PN is taken to become a licensed practical\/vocational nurse (LPN\/VN), and the NCLEX-RN is taken to become a licensed registered nurse (RN). The purpose of the NCLEX is to evaluate if a nursing graduate demonstrates the ability to provide safe, competent, entry-level nursing care. The NCLEX is developed by the National Council of State Boards of Nursing (NCSBN), an independent, nonprofit organization composed of the 50 state boards of nursing and other regulatory agencies.<sup>[footnote]NCSBN. <a href=\"https:\/\/www.ncsbn.org\/nclex.htm\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ncsbn.org\/nclex.htm<\/a>[\/footnote]<\/sup>\n\nA new edition of the NCLEX was launched in April 2023 that contains \u201cNext Generation\u201d questions. The Next Generation NCLEX (NGN) assesses how well the candidate can think critically and use clinical judgment. The NCSBN defines clinical judgment as \"the observed outcome of critical thinking and decision-making. It is an iterative process with multiple steps that uses nursing knowledge to observe and assess presenting situations, identify a prioritized client concern and generate the best possible evidence-based solutions in order to deliver safe client care.\"\n\nThe NCLEX uses the NCSBN's Clinical Judgment Measurement Model (NCJMM) to assess the candidate's ability to use safe clinical judgment when providing nursing care.<sup>\u00a0<\/sup>Exam questions used to assess clinical judgment may be contained in a case study or as individual stand-alone items. A case study contains six questions that are associated with the same client scenario and addresses the following steps in clinical judgment<sup>[footnote]NCSBN. (n.d.).<em> 2023 NCLEX-RN test plan<\/em>. <a href=\"https:\/\/www.ncsbn.org\/exams\/testplans.page\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ncsbn.org\/exams\/testplans.page<\/a>[\/footnote]<\/sup>:\n<ul>\n \t<li><strong>Recognize cues:<\/strong> Identify relevant and important information from different sources (e.g., medical history, vital signs).<\/li>\n \t<li><strong>Analyze cues:<\/strong> Organize and connect the recognized cues to the client\u2019s clinical presentation.<\/li>\n \t<li><strong>Prioritize hypotheses: <\/strong>Evaluate and prioritize hypotheses (based on urgency, likelihood, risk, difficulty, time constraints, etc.).<\/li>\n \t<li><strong>Generate solutions:<\/strong> Identify expected outcomes and use hypotheses to define a set of interventions for the expected outcomes.<\/li>\n \t<li><strong>Take action:<\/strong> Implement the solution(s) that address the highest priority.<\/li>\n \t<li><strong>Evaluate outcomes:<\/strong> Compare observed outcomes to expected outcomes.<\/li>\n<\/ul>\nThroughout this book, learning activities are provided to assist students in learning how to apply the nursing process (i.e., ANA's Standards of Care) to answer NGN-style questions that evaluate clinical judgment. Some of these activities are written, with answers in the Answer Key at the end of the book, and others are interactive and require use of the online book.","rendered":"<p>The <a class=\"rId7\" href=\"https:\/\/www.nursingworld.org\/ana\/about-ana\/\" target=\"_blank\" rel=\"noopener noreferrer\">American Nurses Association (ANA)<\/a> is a professional organization that represents the interests of the nation&#8217;s four million registered nurses and is at the forefront of improving the quality of health care for all.<sup><a class=\"footnote\" title=\"American Nurses Association. (2019). About ANA. https:\/\/www.nursingworld.org\/ana\/about-ana\/\" id=\"return-footnote-65-1\" href=\"#footnote-65-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a> <\/sup>The ANA establishes ethical and professional standards for nurses that also guide safe administration of medications. These code of ethics and professional standards are described in ANA publications titled <em>Code of Ethics for Nurses <\/em>and<em> Nursing: Scope and Standards of Practice.<\/em><\/p>\n<h2>Code of Ethics for Nurses<\/h2>\n<p>The ANA developed the <em>Code of Ethics for Nurses<\/em> as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession.<sup><a class=\"footnote\" title=\"American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. https:\/\/www.nursingworld.org\/coe-view-only\" id=\"return-footnote-65-2\" href=\"#footnote-65-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a> <\/sup>Several provisions from the <em>Code of Ethics<\/em> impact how nurses should administer medication in an ethical manner. A summary of each provision from the <em>Code of Ethics<\/em> and how it pertains to medication administration is outlined below:<\/p>\n<ul>\n<li><strong>Provision 1<\/strong> focuses on respect for human dignity and the right for self-determination: \u201cThe nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.\u201d<\/li>\n<li><strong>Provision 2<\/strong> states, \u201cThe nurse&#8217;s primary commitment is to the client\u2026\u201d<sup><a class=\"footnote\" title=\"American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. https:\/\/www.nursingworld.org\/coe-view-only\" id=\"return-footnote-65-3\" href=\"#footnote-65-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a><\/sup> In health care settings, nurses often experience several competing loyalties, such as to their employer, to the doctor(s), to their supervisor, or to others on the health care team. However, the client should always receive the primary commitment of the nurse. Additionally, the client has the right to accept, refuse, or terminate any treatment, including medications.<\/li>\n<li><strong>Provision 3<\/strong> states, \u201cThe nurse promotes, advocates for, and protects the rights, health, and safety of the patient&#8230;\u201d<sup><a class=\"footnote\" title=\"American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. https:\/\/www.nursingworld.org\/coe-view-only\" id=\"return-footnote-65-4\" href=\"#footnote-65-4\" aria-label=\"Footnote 4\"><sup class=\"footnote\">[4]<\/sup><\/a> <\/sup>This provision includes a nurse&#8217;s responsibility to promote a culture of safety for clients. If errors occur, they must be reported, and nurses should ensure responsible disclosure of errors to clients. This also includes proper disclosure of questionable practices, such as <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_65_537\">drug diversion<\/a><\/strong> or impaired practice by any professional.<\/li>\n<li><strong>Provision 4<\/strong> involves authority, accountability, and responsibility by a nurse to follow legal requirements, such as state practice acts and professional standards of care.<\/li>\n<li><strong>Provision 5<\/strong> includes the responsibility of the nurse to promote health and safety.<\/li>\n<li><strong>Provision 6<\/strong> focuses on virtues that make a nurse a morally good person. For example, nurses are held accountable to use their clinical judgment to avoid causing harm to clients (<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_65_538\">maleficence<\/a><\/strong>) and to do good (<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_65_539\">beneficence<\/a><\/strong>). When administering medications, nurses should validate the medication is doing more \u201cgood\u201d than \u201charm\u201d (adverse or side effects).<\/li>\n<li><strong>Provision 7<\/strong> focuses on a nurse practicing within the professional standards set forth by their <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_65_540\">state nurse practice act<\/a><\/strong>, as well as standards established by professional nursing organizations.<\/li>\n<li><strong>Provision 8<\/strong> explains that a nurse must address the <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_65_541\">social determinants of health<\/strong><strong><\/a><\/strong>, such as poverty, education, safe medication, and health care disparities.<sup><a class=\"footnote\" title=\"American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. https:\/\/www.nursingworld.org\/coe-view-only\" id=\"return-footnote-65-5\" href=\"#footnote-65-5\" aria-label=\"Footnote 5\"><sup class=\"footnote\">[5]<\/sup><\/a><\/sup><\/li>\n<\/ul>\n<p>Whenever a nurse provides client care, the ANA&#8217;s <em>Code of Ethics<\/em> should be used as a guide for professional ethical behavior.<\/p>\n<div class=\"textbox\">\n<p class=\"arrow\">View the ANA&#8217;s <a href=\"https:\/\/www.nursingworld.org\/coe-view-only\" target=\"_blank\" rel=\"noopener\">Code of Ethics for Nurses.<\/a><\/p>\n<\/div>\n<div class=\"__UNKNOWN__\">\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<h2>Critical Thinking Activity 2.2a<br \/>\n<img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-55\" src=\"https:\/\/pressbooks.ccconline.org\/accdigitalmarketing\/wp-content\/uploads\/sites\/219\/2019\/09\/ORN-Icons_lightbulb-300x300-1.png\" alt=\"Image of a lightbulb inside a circle\" width=\"200\" height=\"200\" srcset=\"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-content\/uploads\/sites\/219\/2019\/09\/ORN-Icons_lightbulb-300x300-1.png 300w, https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-content\/uploads\/sites\/219\/2019\/09\/ORN-Icons_lightbulb-300x300-1-150x150.png 150w, https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-content\/uploads\/sites\/219\/2019\/09\/ORN-Icons_lightbulb-300x300-1-65x65.png 65w, https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-content\/uploads\/sites\/219\/2019\/09\/ORN-Icons_lightbulb-300x300-1-225x225.png 225w\" sizes=\"auto, (max-width: 200px) 100vw, 200px\" \/><\/h2>\n<\/header>\n<div class=\"textbox__content\" style=\"text-align: left;\">\n<p>A nurse is preparing to administer medications to a client. While reviewing the chart, the nurse notices two medications with similar mechanisms of action have been prescribed by two different providers.<\/p>\n<p>What is the nurse&#8217;s best response?<\/p>\n<p>Note: Answers to the Critical Thinking activities can be found in the \u201cAnswer Key\u201d sections at the end of the book.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<h2>Standards and Scope of Practice<\/h2>\n<p>The ANA publishes <em>Nursing: Scope and Standards of Practice<\/em>. This resource establishes national standards for nurses and is updated regularly.<sup><a class=\"footnote\" title=\"American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.\" id=\"return-footnote-65-6\" href=\"#footnote-65-6\" aria-label=\"Footnote 6\"><sup class=\"footnote\">[6]<\/sup><\/a><\/sup><\/p>\n<p>The ANA defines the scope of <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_65_542\">nursing <\/a><\/strong> as \u201cthe protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations.\u201d A <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_65_543\">registered nurse (RN)<\/a><\/strong>\u00a0is defined as an individual who is educationally prepared and licensed by a state to practice as a registered nurse. Nursing practice is characterized by the following tenets<sup><a class=\"footnote\" title=\"American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.\" id=\"return-footnote-65-7\" href=\"#footnote-65-7\" aria-label=\"Footnote 7\"><sup class=\"footnote\">[7]<\/sup><\/a><\/sup>:<\/p>\n<ul>\n<li>Caring and health are central to the practice of the registered nurse.<\/li>\n<li>Nursing practice is individualized to the unique needs of the health care consumer.<\/li>\n<li>Registered nurses use the nursing process to plan and provide individualized care for health care consumers.<\/li>\n<li>Nurses coordinate care by establishing partnerships to reach a shared goal of delivering safe, quality health care.<\/li>\n<\/ul>\n<p>The ANA establishes Standards of Practice and Standards of Professional Performance in the <em>Nursing: Scope and Standards of Practice <\/em>publication. State nurse practice acts further define the scope of practice of RNs and Licensed Practical Nurses\/Vocational Nurses (LPNs\/VNs) within each state. Nurse practice acts are further discussed in the \u201c<a href=\"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/chapter\/2-3-legal-foundations-and-national-guidelines-for-safe-medication-administration\/\" target=\"_blank\" rel=\"noopener\">Legal Foundations and National Guidelines for Safe Medication Administration<\/a>\u201d section of this chapter.<\/p>\n<div class=\"textbox\">\n<p class=\"arrow\">The ANA&#8217;s <em>Nursing: Scope and Standards of Practice<\/em> publication can be purchased on the <a href=\"https:\/\/www.nursingworld.org\/practice-policy\/scope-of-practice\/\" target=\"_blank\" rel=\"noopener\">nursingworld.org<\/a> website or borrowed from many libraries.<\/p>\n<\/div>\n<h3>Standards of Practice<\/h3>\n<p>The ANA&#8217;s Standards of Practice are authoritative statements of duties that all registered nurses, regardless of role, population, or specialty, are expected to perform competently. <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_65_545\">Standards of Practice<\/a><\/strong> include assessment, diagnosis, outcome identification, planning, implementation, and evaluation (ADOPIE) components of providing client care, also known as the &#8220;nursing process.&#8221; When nurses safely administer medication, all components of ADOPIE are addressed.<\/p>\n<h4>Assessment<\/h4>\n<p>The &#8220;Assessment&#8221; Standard of Practice is defined as, \u201cThe registered nurse collects pertinent data and information relative to the health care consumer\u2019s health or the situation.\u201d<sup><a class=\"footnote\" title=\"American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.\" id=\"return-footnote-65-8\" href=\"#footnote-65-8\" aria-label=\"Footnote 8\"><sup class=\"footnote\">[8]<\/sup><\/a> <\/sup>A registered nurse uses a systematic method to collect and analyze client data. Assessment includes physiological data, as well as psychological, sociocultural, spiritual, economic, and lifestyle data. For example, when a nurse assesses multiple pieces of data for a hospitalized client with pain, this is considered part of a comprehensive pain assessment.<\/p>\n<h4>Diagnosis<\/h4>\n<p>The &#8220;Diagnosis&#8221; Standard of Practice is defined as, \u201cThe registered nurse analyzes the assessment data to determine actual or potential diagnoses, problems, and issues.\u201d<sup><a class=\"footnote\" title=\"American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.\" id=\"return-footnote-65-9\" href=\"#footnote-65-9\" aria-label=\"Footnote 9\"><sup class=\"footnote\">[9]<\/sup><\/a><\/sup> A nursing diagnosis is the nurse\u2019s clinical judgment about the client&#8217;s response to actual or potential health conditions or needs. Nursing diagnoses are used to create the nursing care plan and are different than medical diagnoses.<sup><a class=\"footnote\" title=\"American Nurses Association. (n.d.). The nursing process. https:\/\/www.nursingworld.org\/practice-policy\/workforce\/what-is-nursing\/the-nursing-process\/\" id=\"return-footnote-65-10\" href=\"#footnote-65-10\" aria-label=\"Footnote 10\"><sup class=\"footnote\">[10]<\/sup><\/a><\/sup><\/p>\n<h4>Outcomes Identification<\/h4>\n<p>The &#8220;Outcomes Identification&#8221; Standard of Practice is defined as, \u201cThe registered nurse identifies expected outcomes for a plan individualized to the health care consumer or the situation.\u201d<sup><a class=\"footnote\" title=\"American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.\" id=\"return-footnote-65-11\" href=\"#footnote-65-11\" aria-label=\"Footnote 11\"><sup class=\"footnote\">[11]<\/sup><\/a><\/sup> The nurse sets measurable and achievable short- and long-term goals and specific outcomes in collaboration with the client based on their assessment data and nursing diagnoses.<\/p>\n<h4>Planning<\/h4>\n<p>The &#8220;Planning&#8221; Standard of Practice is defined as, \u201cThe registered nurse develops a collaborative plan encompassing strategies to achieve expected outcomes.\u201d<sup><a class=\"footnote\" title=\"American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.\" id=\"return-footnote-65-12\" href=\"#footnote-65-12\" aria-label=\"Footnote 12\"><sup class=\"footnote\">[12]<\/sup><\/a> <\/sup>Assessment data, diagnoses, and goals are used to select evidence-based nursing interventions customized to each client\u2019s needs and concerns. Goals, expected outcomes, and nursing interventions are documented in the client\u2019s nursing care plan so that nurses, as well as other health professionals, have access to it for continuity of care.<sup><a class=\"footnote\" title=\"American Nurses Association. (n.d.). The nursing process. https:\/\/www.nursingworld.org\/practice-policy\/workforce\/what-is-nursing\/the-nursing-process\/\" id=\"return-footnote-65-13\" href=\"#footnote-65-13\" aria-label=\"Footnote 13\"><sup class=\"footnote\">[13]<\/sup><\/a><\/sup><\/p>\n<h4>Implementation<\/h4>\n<p>The &#8220;Implementation&#8221; Standard of Practice is defined as, &#8220;The nurse implements the identified plan.\u201d<sup><a class=\"footnote\" title=\"American Nurses Association. (2021). Nursing: Scope and standards of practice (3rd ed.). American Nurses Association.\" id=\"return-footnote-65-14\" href=\"#footnote-65-14\" aria-label=\"Footnote 14\"><sup class=\"footnote\">[14]<\/sup><\/a> <\/sup>Nursing interventions are implemented or delegated to licensed practical nurses\/vocational nurses (LPNs\/VNs) or unlicensed assistive personnel (UAP) with supervision. Interventions are also documented in the client\u2019s electronic medical record as they are completed.<sup><a class=\"footnote\" title=\"American Nurses Association. (n.d.) The nursing process. https:\/\/www.nursingworld.org\/practice-policy\/workforce\/what-is-nursing\/the-nursing-process\/\" id=\"return-footnote-65-15\" href=\"#footnote-65-15\" aria-label=\"Footnote 15\"><sup class=\"footnote\">[15]<\/sup><\/a><\/sup><\/p>\n<p>The &#8220;Implementation&#8221; Standard of Professional Practice also includes the subcategories &#8220;Coordination of Care&#8221; and &#8220;Health Teaching and Health Promotion&#8221; to promote health and a safe environment.<sup><a class=\"footnote\" title=\"American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.\" id=\"return-footnote-65-16\" href=\"#footnote-65-16\" aria-label=\"Footnote 16\"><sup class=\"footnote\">[16]<\/sup><\/a><\/sup><\/p>\n<h5>Coordination of Care<\/h5>\n<p>The ANA standard for coordination of care states, \u201cThe registered nurse coordinates care delivery.\u201d<sup><a class=\"footnote\" title=\"American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.\" id=\"return-footnote-65-17\" href=\"#footnote-65-17\" aria-label=\"Footnote 17\"><sup class=\"footnote\">[17]<\/sup><\/a> <\/sup>When ensuring medications are administered safely, the nurse collaborates with the client and the interprofessional health care team to meet mutually agreed upon outcomes. The nurse also engages the client in self-care to achieve their preferred goals for quality of life.\u00a0 For example, one client with chronic pain may have a pain management goal of &#8220;5&#8221; with their quality of life preference of having the ability to participate in social activities with friends but not experiencing burdensome side effect of medication. Another client with chronic pain may have a pain management goal of &#8220;0&#8221; with a quality of life preference of having no pain no matter what the side effects. The nurse advocates for these clients&#8217; goals and preferences with the interprofessional team.<\/p>\n<p>Nurses also serve vital roles in ensuring safe transitions and continuity of care regarding clients&#8217; use of medications. Additional information about safe medication use and transitions of care is discussed in the &#8220;<a href=\"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/chapter\/2-5-preventing-medication-errors\/\" target=\"_blank\" rel=\"noopener\">Preventing Medication Errors<\/a>&#8221; section of this chapter.<\/p>\n<h5>Health Teaching and Health Promotion<\/h5>\n<p>When administering medications, nurses teach clients about the medications and potential side effects to promote optimal health. The ANA standard for health teaching and health promotion states, \u201cThe registered nurse employs strategies to teach and promote health and wellness.\u201d<sup><a class=\"footnote\" title=\"American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.\" id=\"return-footnote-65-18\" href=\"#footnote-65-18\" aria-label=\"Footnote 18\"><sup class=\"footnote\">[18]<\/sup><\/a> <\/sup>Specific behaviors related to teaching about medication are as follows<sup><a class=\"footnote\" title=\"American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.\" id=\"return-footnote-65-19\" href=\"#footnote-65-19\" aria-label=\"Footnote 19\"><sup class=\"footnote\">[19]<\/sup><\/a><\/sup>:<\/p>\n<ul>\n<li>Use health teaching and health promotion methods in collaboration with the client&#8217;s values, beliefs, health practices, developmental level, learning needs, readiness and ability to learn, language preference, spirituality, culture, and socioeconomic status.<\/li>\n<li>Provide clients with information and education about intended effects and potential adverse effects of the plan of care.<\/li>\n<li>Provide anticipatory guidance to clients to promote health and prevent or reduce risk.<\/li>\n<\/ul>\n<p>In the book <em>Preventing Medication Errors<\/em> by the Institute of Medicine (2007), the following are additional key national guidelines when teaching clients about safe use of their medications:<\/p>\n<ul>\n<li>Clients should maintain an active list of all prescription drugs, over-the-counter (OTC) drugs, and dietary supplements they are taking, the reasons for taking them, and any known drug allergies. Every provider involved in the medication-use process for a client should have access to this list.<\/li>\n<li>Clients should be provided information about side effects, contraindications, methods for handling adverse reactions, and sources for obtaining additional objective, high-quality information.<sup><a class=\"footnote\" title=\"Institute of Medicine. (2007). Preventing medication errors. The National Academies Press. https:\/\/doi.org\/10.17226\/11623\" id=\"return-footnote-65-20\" href=\"#footnote-65-20\" aria-label=\"Footnote 20\"><sup class=\"footnote\">[20]<\/sup><\/a><\/sup><\/li>\n<\/ul>\n<h4>Evaluation<\/h4>\n<p>The &#8220;Evaluation&#8221; Standard of Practice is defined as, \u201cThe registered nurse evaluates progress toward attainment of goals and outcomes.\u201d<sup><a class=\"footnote\" title=\"American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.\" id=\"return-footnote-65-21\" href=\"#footnote-65-21\" aria-label=\"Footnote 21\"><sup class=\"footnote\">[21]<\/sup><\/a> <\/sup>During evaluation, nurses assess the client and compare the findings against the initial assessment to determine the effectiveness of the interventions and overall nursing care plan. Both the client\u2019s status and the effectiveness of the nursing care must be continuously evaluated and modified as needed.<sup><a class=\"footnote\" title=\"American Nurses Association. (n.d.). The nursing process. https:\/\/www.nursingworld.org\/practice-policy\/workforce\/what-is-nursing\/the-nursing-process\/\" id=\"return-footnote-65-22\" href=\"#footnote-65-22\" aria-label=\"Footnote 22\"><sup class=\"footnote\">[22]<\/sup><\/a><\/sup><\/p>\n<div class=\"textbox\">\n<p class=\"arrow\">Read additional information about the nursing process in the &#8220;<a href=\"https:\/\/wtcs.pressbooks.pub\/nursingfundamentals\/chapter\/4-2-basic-concepts\/\" target=\"_blank\" rel=\"noopener\">Nursing Process<\/a>&#8221; chapter of Open RN <em>Nursing Fundamentals<\/em>.<\/p>\n<\/div>\n<h3>Standards of Professional Performance<\/h3>\n<p>ANA&#8217;s Standards of Professional Performance describe a competent level of behavior for nurses, including activities related to ethics, culturally congruent practice, communication, collaboration, leadership, education, evidence-based practice, and quality of practice.<sup><a class=\"footnote\" title=\"American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.\" id=\"return-footnote-65-23\" href=\"#footnote-65-23\" aria-label=\"Footnote 23\"><sup class=\"footnote\">[23]<\/sup><\/a><\/sup><\/p>\n<p>The ANA defines <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_65_547\">culturally congruent practice<\/a><\/strong> as the application of evidence-based nursing that is in agreement with the preferred cultural values, beliefs, worldview, and practices of the health care consumer and other stakeholders. <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_65_550\">Cultural competence<\/a><\/strong> represents the process by which nurses demonstrate culturally congruent practice. Nurses must assess the cultural beliefs and practices of their clients and implement culturally congruent interventions when administering medications and teaching about them. Additional information about cultural implications for medication administration is further discussed in the \u201c<a href=\"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/chapter\/2-4-cultural-and-social-determinants-related-to-medication-administration\/\" target=\"_blank\" rel=\"noopener\">Cultural and Social Determinants Related to Medication Administration<\/a>\u201d section later in this chapter.<\/p>\n<div class=\"__UNKNOWN__\">\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<h2>Critical Thinking Activity 2.2b<br \/>\n<img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-55\" src=\"https:\/\/pressbooks.ccconline.org\/accdigitalmarketing\/wp-content\/uploads\/sites\/219\/2019\/09\/ORN-Icons_lightbulb-300x300-1.png\" alt=\"Image of a lightbulb inside a circle\" width=\"200\" height=\"200\" srcset=\"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-content\/uploads\/sites\/219\/2019\/09\/ORN-Icons_lightbulb-300x300-1.png 300w, https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-content\/uploads\/sites\/219\/2019\/09\/ORN-Icons_lightbulb-300x300-1-150x150.png 150w, https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-content\/uploads\/sites\/219\/2019\/09\/ORN-Icons_lightbulb-300x300-1-65x65.png 65w, https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-content\/uploads\/sites\/219\/2019\/09\/ORN-Icons_lightbulb-300x300-1-225x225.png 225w\" sizes=\"auto, (max-width: 200px) 100vw, 200px\" \/><\/h2>\n<\/header>\n<div class=\"textbox__content\" style=\"text-align: left;\">\n<p>A nurse is preparing to administer metoprolol, a cardiac medication, to a client and implements the nursing process:<\/p>\n<p><strong>ASSESSES<\/strong> the vital signs prior to administration and discovers the heart rate is 48.<\/p>\n<p><strong>DIAGNOSES<\/strong> that the heart rate is too low to safely administer the medication per the parameters provided. Establishes the <strong>OUTCOME<\/strong> to keep the client&#8217;s heart rate within normal range of 60-100.<\/p>\n<p><strong>PLANS<\/strong> to call the provider, as well as report this incident in the shift handoff report.<\/p>\n<p>Implements <strong>INTERVENTIONS<\/strong> by withholding the metoprolol at this time, documenting the incident that the medication is withheld, and notifying the provider.<\/p>\n<p>Continues to <strong>EVALUATE<\/strong> the client status throughout the shift after not receiving the metoprolol.<\/p>\n<p>The nurse is providing health teaching to a client about the medication before discharge. The nurse provides a handout with instructions, as well as a list of the current medications.<\/p>\n<p>What other information should be provided to the client?<\/p>\n<p>Note: Answers to the Critical Thinking activities can be found in the \u201cAnswer Key\u201d sections at the end of the book.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<p>Figure 2.1 is an image from <em>Nursing: Scope and Standards of Practice<\/em> by the ANA that illustrates how the scope of practice, standards of practice, and code of ethics form the \u201cbase\u201d of nursing practice.<sup><a class=\"footnote\" title=\"American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). American Nurses Association.\" id=\"return-footnote-65-24\" href=\"#footnote-65-24\" aria-label=\"Footnote 24\"><sup class=\"footnote\">[24]<\/sup><\/a><\/sup> Nursing practice is further guided by the Nurse Practice Act in the state in which a nurse works, federal and state rules and regulations, institutional policies and procedures, and self-determination by the individual nurse. All these components are required to provide quality, safe client care that is evidence-based. These components will be further discussed in the remaining sections of this chapter.<\/p>\n<figure style=\"width: 903px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"\" title=\"&quot;Nursing\u202f: Scope and Standards of Practice&quot; image retrieved from http:\/\/search.ebscohost.com\/login.aspx?direct=true&amp;db=nlebk&amp;AN=1077002&amp;site=eds-live&amp;scope=site\" src=\"https:\/\/pressbooks.ccconline.org\/accdigitalmarketing\/wp-content\/uploads\/sites\/219\/2019\/10\/image8-2.png\" alt=\"Image showing American Nursing Association Model of Professional Nursing Practice Regulation\" width=\"903\" height=\"926\" \/><figcaption class=\"wp-caption-text\">Figure 2.1 ANA Model of Professional Nursing Practice<\/figcaption><\/figure>\n<h2>NCLEX and the Clinical Judgment Model<\/h2>\n<p>The National Council Licensure Examination (NCLEX) is the national exam that graduates must pass successfully to obtain their nursing license after graduating from a nursing program of study. The NCLEX-PN is taken to become a licensed practical\/vocational nurse (LPN\/VN), and the NCLEX-RN is taken to become a licensed registered nurse (RN). The purpose of the NCLEX is to evaluate if a nursing graduate demonstrates the ability to provide safe, competent, entry-level nursing care. The NCLEX is developed by the National Council of State Boards of Nursing (NCSBN), an independent, nonprofit organization composed of the 50 state boards of nursing and other regulatory agencies.<sup><a class=\"footnote\" title=\"NCSBN. https:\/\/www.ncsbn.org\/nclex.htm\" id=\"return-footnote-65-25\" href=\"#footnote-65-25\" aria-label=\"Footnote 25\"><sup class=\"footnote\">[25]<\/sup><\/a><\/sup><\/p>\n<p>A new edition of the NCLEX was launched in April 2023 that contains \u201cNext Generation\u201d questions. The Next Generation NCLEX (NGN) assesses how well the candidate can think critically and use clinical judgment. The NCSBN defines clinical judgment as &#8220;the observed outcome of critical thinking and decision-making. It is an iterative process with multiple steps that uses nursing knowledge to observe and assess presenting situations, identify a prioritized client concern and generate the best possible evidence-based solutions in order to deliver safe client care.&#8221;<\/p>\n<p>The NCLEX uses the NCSBN&#8217;s Clinical Judgment Measurement Model (NCJMM) to assess the candidate&#8217;s ability to use safe clinical judgment when providing nursing care.<sup>\u00a0<\/sup>Exam questions used to assess clinical judgment may be contained in a case study or as individual stand-alone items. A case study contains six questions that are associated with the same client scenario and addresses the following steps in clinical judgment<sup><a class=\"footnote\" title=\"NCSBN. (n.d.). 2023 NCLEX-RN test plan. https:\/\/www.ncsbn.org\/exams\/testplans.page\" id=\"return-footnote-65-26\" href=\"#footnote-65-26\" aria-label=\"Footnote 26\"><sup class=\"footnote\">[26]<\/sup><\/a><\/sup>:<\/p>\n<ul>\n<li><strong>Recognize cues:<\/strong> Identify relevant and important information from different sources (e.g., medical history, vital signs).<\/li>\n<li><strong>Analyze cues:<\/strong> Organize and connect the recognized cues to the client\u2019s clinical presentation.<\/li>\n<li><strong>Prioritize hypotheses: <\/strong>Evaluate and prioritize hypotheses (based on urgency, likelihood, risk, difficulty, time constraints, etc.).<\/li>\n<li><strong>Generate solutions:<\/strong> Identify expected outcomes and use hypotheses to define a set of interventions for the expected outcomes.<\/li>\n<li><strong>Take action:<\/strong> Implement the solution(s) that address the highest priority.<\/li>\n<li><strong>Evaluate outcomes:<\/strong> Compare observed outcomes to expected outcomes.<\/li>\n<\/ul>\n<p>Throughout this book, learning activities are provided to assist students in learning how to apply the nursing process (i.e., ANA&#8217;s Standards of Care) to answer NGN-style questions that evaluate clinical judgment. Some of these activities are written, with answers in the Answer Key at the end of the book, and others are interactive and require use of the online book.<\/p>\n<hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-65-1\">American Nurses Association. (2019). <em>About ANA.<\/em> <a href=\"https:\/\/www.nursingworld.org\/ana\/about-ana\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/ana\/about-ana<\/a>\/ <a href=\"#return-footnote-65-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-65-2\">American Nurses Association. (2015). <em>Code of ethics for nurses with interpretive statements.<\/em> <a href=\"https:\/\/www.nursingworld.org\/coe-view-only\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/coe-view-only<\/a> <a href=\"#return-footnote-65-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-65-3\">American Nurses Association. (2015). <em>Code of ethics for nurses with interpretive statements.<\/em> <a href=\"https:\/\/www.nursingworld.org\/coe-view-only\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/coe-view-only<\/a> <a href=\"#return-footnote-65-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><li id=\"footnote-65-4\">American Nurses Association. (2015). <em>Code of ethics for nurses with interpretive statements.<\/em> <a href=\"https:\/\/www.nursingworld.org\/coe-view-only\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/coe-view-only<\/a> <a href=\"#return-footnote-65-4\" class=\"return-footnote\" aria-label=\"Return to footnote 4\">&crarr;<\/a><\/li><li id=\"footnote-65-5\">American Nurses Association. (2015). <em>Code of ethics for nurses with interpretive statements.<\/em> <a href=\"https:\/\/www.nursingworld.org\/coe-view-only\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/coe-view-only<\/a> <a href=\"#return-footnote-65-5\" class=\"return-footnote\" aria-label=\"Return to footnote 5\">&crarr;<\/a><\/li><li id=\"footnote-65-6\">American Nurses Association. (2021). <em>Nursing: Scope and standards of practice<\/em> (4th ed.). American Nurses Association. <a href=\"#return-footnote-65-6\" class=\"return-footnote\" aria-label=\"Return to footnote 6\">&crarr;<\/a><\/li><li id=\"footnote-65-7\">American Nurses Association. (2021). <em>Nursing: Scope and standards of practice<\/em> (4th ed.). American Nurses Association. <a href=\"#return-footnote-65-7\" class=\"return-footnote\" aria-label=\"Return to footnote 7\">&crarr;<\/a><\/li><li id=\"footnote-65-8\">American Nurses Association. (2021). <em>Nursing: Scope and standards of practice<\/em> (4th ed.). American Nurses Association. <a href=\"#return-footnote-65-8\" class=\"return-footnote\" aria-label=\"Return to footnote 8\">&crarr;<\/a><\/li><li id=\"footnote-65-9\">American Nurses Association. (2021). <em>Nursing: Scope and standards of practice<\/em> (4th ed.). American Nurses Association. <a href=\"#return-footnote-65-9\" class=\"return-footnote\" aria-label=\"Return to footnote 9\">&crarr;<\/a><\/li><li id=\"footnote-65-10\">American Nurses Association. (n.d.). <em>The nursing process<\/em>. <a href=\"https:\/\/www.nursingworld.org\/practice-policy\/workforce\/what-is-nursing\/the-nursing-process\/\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/practice-policy\/workforce\/what-is-nursing\/the-nursing-process\/<\/a> <a href=\"#return-footnote-65-10\" class=\"return-footnote\" aria-label=\"Return to footnote 10\">&crarr;<\/a><\/li><li id=\"footnote-65-11\">American Nurses Association. (2021). <em>Nursing: Scope and standards of practice<\/em> (4th ed.). American Nurses Association. <a href=\"#return-footnote-65-11\" class=\"return-footnote\" aria-label=\"Return to footnote 11\">&crarr;<\/a><\/li><li id=\"footnote-65-12\">American Nurses Association. (2021). <em>Nursing: Scope and standards of practice<\/em> (4th ed.). American Nurses Association. <a href=\"#return-footnote-65-12\" class=\"return-footnote\" aria-label=\"Return to footnote 12\">&crarr;<\/a><\/li><li id=\"footnote-65-13\">American Nurses Association. (n.d.). <em>The nursing process.<\/em> <a href=\"https:\/\/www.nursingworld.org\/practice-policy\/workforce\/what-is-nursing\/the-nursing-process\/\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/practice-policy\/workforce\/what-is-nursing\/the-nursing-process\/<\/a> <a href=\"#return-footnote-65-13\" class=\"return-footnote\" aria-label=\"Return to footnote 13\">&crarr;<\/a><\/li><li id=\"footnote-65-14\">American Nurses Association. (2021). <em>Nursing: Scope and standards of practice<\/em> (3rd ed.). American Nurses Association. <a href=\"#return-footnote-65-14\" class=\"return-footnote\" aria-label=\"Return to footnote 14\">&crarr;<\/a><\/li><li id=\"footnote-65-15\">American Nurses Association. (n.d.) <em>The nursing process.<\/em> <a href=\"https:\/\/www.nursingworld.org\/practice-policy\/workforce\/what-is-nursing\/the-nursing-process\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/practice-policy\/workforce\/what-is-nursing\/the-nursing-process<\/a>\/ <a href=\"#return-footnote-65-15\" class=\"return-footnote\" aria-label=\"Return to footnote 15\">&crarr;<\/a><\/li><li id=\"footnote-65-16\">American Nurses Association. (2021). <em>Nursing: Scope and standards of practice<\/em> (4th ed.). American Nurses Association. <a href=\"#return-footnote-65-16\" class=\"return-footnote\" aria-label=\"Return to footnote 16\">&crarr;<\/a><\/li><li id=\"footnote-65-17\">American Nurses Association. (2021). <em>Nursing: Scope and standards of practice<\/em> (4th ed.). American Nurses Association. <a href=\"#return-footnote-65-17\" class=\"return-footnote\" aria-label=\"Return to footnote 17\">&crarr;<\/a><\/li><li id=\"footnote-65-18\">American Nurses Association. (2021). <em>Nursing: Scope and standards of practice<\/em> (4th ed.). American Nurses Association. <a href=\"#return-footnote-65-18\" class=\"return-footnote\" aria-label=\"Return to footnote 18\">&crarr;<\/a><\/li><li id=\"footnote-65-19\">American Nurses Association. (2021). <em>Nursing: Scope and standards of practice<\/em> (4th ed.). American Nurses Association. <a href=\"#return-footnote-65-19\" class=\"return-footnote\" aria-label=\"Return to footnote 19\">&crarr;<\/a><\/li><li id=\"footnote-65-20\">Institute of Medicine. (2007). <em>Preventing medication errors.<\/em> The National Academies Press. <a href=\"https:\/\/doi.org\/10.17226\/11623\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/doi.org\/10.17226\/11623<\/a> <a href=\"#return-footnote-65-20\" class=\"return-footnote\" aria-label=\"Return to footnote 20\">&crarr;<\/a><\/li><li id=\"footnote-65-21\">American Nurses Association. (2021). <em>Nursing: Scope and standards of practice<\/em> (4th ed.). American Nurses Association. <a href=\"#return-footnote-65-21\" class=\"return-footnote\" aria-label=\"Return to footnote 21\">&crarr;<\/a><\/li><li id=\"footnote-65-22\">American Nurses Association. (n.d.). <em>The nursing process.<\/em> <a href=\"https:\/\/www.nursingworld.org\/practice-policy\/workforce\/what-is-nursing\/the-nursing-process\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.nursingworld.org\/practice-policy\/workforce\/what-is-nursing\/the-nursing-process<\/a>\/ <a href=\"#return-footnote-65-22\" class=\"return-footnote\" aria-label=\"Return to footnote 22\">&crarr;<\/a><\/li><li id=\"footnote-65-23\">American Nurses Association. (2021). <em>Nursing: Scope and standards of practice<\/em> (4th ed.). American Nurses Association. <a href=\"#return-footnote-65-23\" class=\"return-footnote\" aria-label=\"Return to footnote 23\">&crarr;<\/a><\/li><li id=\"footnote-65-24\">American Nurses Association. (2015). <em>Nursing: Scope and standards of practice<\/em> (3rd ed.). American Nurses Association. <a href=\"#return-footnote-65-24\" class=\"return-footnote\" aria-label=\"Return to footnote 24\">&crarr;<\/a><\/li><li id=\"footnote-65-25\">NCSBN. <a href=\"https:\/\/www.ncsbn.org\/nclex.htm\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ncsbn.org\/nclex.htm<\/a> <a href=\"#return-footnote-65-25\" class=\"return-footnote\" aria-label=\"Return to footnote 25\">&crarr;<\/a><\/li><li id=\"footnote-65-26\">NCSBN. (n.d.).<em> 2023 NCLEX-RN test plan<\/em>. <a href=\"https:\/\/www.ncsbn.org\/exams\/testplans.page\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ncsbn.org\/exams\/testplans.page<\/a> <a href=\"#return-footnote-65-26\" class=\"return-footnote\" aria-label=\"Return to footnote 26\">&crarr;<\/a><\/li><\/ol><\/div><div class=\"glossary\"><span class=\"screen-reader-text\" id=\"definition\">definition<\/span><template id=\"term_65_537\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_65_537\"><div tabindex=\"-1\"><p>The transfer of any legally prescribed controlled substance from the individual for whom it was prescribed to another person for any illicit use.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_65_538\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_65_538\"><div tabindex=\"-1\"><p>Causing harm to patients.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_65_539\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_65_539\"><div tabindex=\"-1\"><p>To \u201cdo good.\u201d<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_65_540\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_65_540\"><div tabindex=\"-1\"><p>Laws enacted by state legislature setting professional standards of nursing care to which nurses are held accountable by the State Board of Nursing.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_65_541\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_65_541\"><div tabindex=\"-1\"><p>Poverty, education, safe medication, and other health care disparities that affect a patient\u2019s health.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_65_542\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_65_542\"><div tabindex=\"-1\"><p>The protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations, as defined by the American Nurses Association.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_65_543\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_65_543\"><div tabindex=\"-1\"><p>An individual who is educationally prepared and licensed by a state to practice as a registered nurse.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_65_545\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_65_545\"><div tabindex=\"-1\"><p>Authoritative statements of duties by the American Nursing Association that all registered nurses, regardless of role, population, or specialty, are expected to perform competently. Standards of Practice include: Assessment, Diagnosis, Outcome Identification, Planning, Implementation, and Evaluation components of providing patient care.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_65_547\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_65_547\"><div tabindex=\"-1\"><p>The application of evidence-based nursing that is in agreement with the preferred cultural values, beliefs, worldview, and practices of the health care consumer and other stakeholders.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_65_550\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_65_550\"><div tabindex=\"-1\"><p>The process by which nurses demonstrate culturally congruent practice.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><\/div>","protected":false},"author":83,"menu_order":2,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[48],"contributor":[],"license":[],"class_list":["post-65","chapter","type-chapter","status-publish","hentry","chapter-type-numberless"],"part":61,"_links":{"self":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/65","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/wp\/v2\/users\/83"}],"version-history":[{"count":2,"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/65\/revisions"}],"predecessor-version":[{"id":741,"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/65\/revisions\/741"}],"part":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/parts\/61"}],"metadata":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/65\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/wp\/v2\/media?parent=65"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/chapter-type?post=65"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/wp\/v2\/contributor?post=65"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/wp\/v2\/license?post=65"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}