Fundamentals Week 1 Exam 1: Clinical Judgment in Nursing Practice, Exams of Nursing

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NR226 FUNDAMENTALS WEEK 1 EXAM 1 QUESTIONS

WITH COMPLETE SOLUTIONS

Clinical Judgment in Nursing Practice - VERIFIED ANSWER✔✔-Registered nurses (RNs) are responsible for making accurate and appropriate clinical decisions or judgments. Nurses must learn to question, wonder, and explore different perspectives and interpretations to find a solution that benefits the patient. critical thinking - VERIFIED ANSWER✔✔-The ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process A continuous process characterized by open-mindedness, continual inquiry, and perseverance, combined with a willingness to look at each unique patient situation and determine which identified assumptions are true and relevant Recognizing that an issue exists, analyzing information, evaluating information, and drawing conclusions Reflection - VERIFIED ANSWER✔✔-The ability to act on the basis of critical thinking comes with experience. Turning over a subject in the mind and thinking about it seriously. Is not intuitive. reflection - VERIFIED ANSWER✔✔-When you care for patients, begin by thinking about previous situations and considering relevant issues: What did I notice before? How did I act? What could I have done differently? What should I do next time in the same situation?

Research shows that when nurses reflect on past experiences, they perceive that their knowledge increases and their critical thinking moves to a higher level. Reflection involves playing back a situation in your mind and taking time to honestly review everything you remember about it. Reflective reasoning improves the accuracy of making diagnostic conclusions. By reviewing your previous actions you see successes and opportunities for improvement. Always be cautious in using reflection. Reliance on it can block thinking and not allow you to look at newer evidence or subtle aspects of situations that you have not encountered. levels of critical thinking - VERIFIED ANSWER✔✔-level 1 basic level 2 complex level 3 commitment basic critical thinking - VERIFIED ANSWER✔✔-thinking is concrete and based on a set of rules or principles. the nursing student uses a hospital procedure manual to confirm how to change an IV dressing. You follow step by step. complex critical thinking - VERIFIED ANSWER✔✔-begin to separate themselves from the experts ex. while inserting a feeding tube you recognize that your pt. cannot swallow easily. thus you adapt how you insert it.

fairness- deal with situations justly, no bias or prejudice enter into a decision responsibility and accountability- correctly performing nursing care activities on the basis of standards and practice. risk taking-willingness to take risks when trying different ways to solve problems discipline- miss few details and is orderly or systematic when collecting data, making decisions, or taking action perserverance- find effective solutions to pt care problems. especially when problems remain unresolved or recur. creativity- you find solutions outside the standard routine of care while still following standards of practice curiosity- favorite question Why? investigate a clinical situation so you get all the information you need to make a decision integrity- hones and willing to admit mistakes or inconsistencies. humility- admit your limitations in your knowledge and skill. a pts safety are at risk Critical Thinking Competencies - VERIFIED ANSWER✔✔-General critical thinking Specific critical thinking general critical thinking - VERIFIED ANSWER✔✔-Scientific method Problem solving

Decision making specific critical thinking - VERIFIED ANSWER✔✔-Diagnostic reasoning and inference Clinical decision making diagnostic reasoning - VERIFIED ANSWER✔✔-the analytical process for determining a pts health problems inference - VERIFIED ANSWER✔✔-the process of drawing conclusions from related pieces of evidence and previous experience with the evidence A Critical Thinking Model for Clinical Decision Making - VERIFIED ANSWER✔✔-Specific knowledge base Experience Nursing process competency Attitudes for critical thinking Professional standards clinical decison making - VERIFIED ANSWER✔✔-requires careful reasoning choosing the options for the best pt outcomes on the basis of a pts condition and the priority of the problem Critical Thinking Synthesis - VERIFIED ANSWER✔✔-Critical thinking and the nursing process go hand-in- hand in making quality decisions about patient care. Reflective journaling - VERIFIED ANSWER✔✔-Define and express clinical experiences in your own words Meeting with colleagues - VERIFIED ANSWER✔✔-Discuss and examine work experiences and validate decisions Concept mapping - VERIFIED ANSWER✔✔-Visual representation of patient problems and interventions that shows their relationships to one another

sources of data - VERIFIED ANSWER✔✔-Pt (interview, observation, physical exam)-the best source of information family and significant other (pt agrees first) Health care teams medical records scientific literature data base nurses experience ch 16 - VERIFIED ANSWER✔✔-ch 16 Types of Assessments - VERIFIED ANSWER✔✔-the patient-centered interview during a nursing health history. a physical examination. the periodic assessments you make during rounding or administering care. patient-centered interview - VERIFIED ANSWER✔✔-relationship based and is an organized conversation focused on learning about the well and the sick as they seek care. Motivational interviewing - VERIFIED ANSWER✔✔-is used often in counseling that allows you to become a helper in the change process.

Effective communication - VERIFIED ANSWER✔✔-requires courtesy, comfort, connection, and confirmation. interview preparation - VERIFIED ANSWER✔✔-Before you begin an interview, be prepared. Review a patient's medical record when information is available and the previous medical or nurse's note entry. Were problems identified that perhaps need clarification or follow-up? Does the patient's admitting diagnosis or other diagnoses suggest lines of questions for you to ask? Hand-off information may frame a clinical problem about which you want to learn more. phases of an interview - VERIFIED ANSWER✔✔-An initial interview involves collecting a nursing health history and gathering information about a patient's condition. Later interviews assess more about a patient's presenting situation and discuss specific problem areas. orientation and setting and agenda - VERIFIED ANSWER✔✔-Begin by introducing yourself, your position, explaining the purpose of the interview. Explain why you are collecting data and assure patients that all of the information will be confidential. Ask the patient for his or her list of concerns or problems. The professionalism and competence that you show when interviewing patients strengthens the nurse- patient relationship. working phase- - VERIFIED ANSWER✔✔-collecting assessment or nursing health history ask open-ended questions. Use attentive listening and other therapeutic communication techniques that encourage a patient to tell his or her story. Do not rush a patient. Initial interviews are more extensive. Gather information about a patient's concerns and then complete all relevant sections of the nursing history. An ongoing interview allows you to update a patient's status and concerns, focus on changes previously identified, and review new problems. Termination of an interview - VERIFIED ANSWER✔✔-requires skill. Summarize your discussion with a patient and check for accuracy of the information collected. Give your patient a clue that the interview is coming to an end. End the interview in a friendly manner, telling the patient when you will return to provide care. interview techniques - VERIFIED ANSWER✔✔-Observation Open-ended questions Leading questions Back channeling

If you are unsure about what a patient is saying, ask for clarification to prevent making the wrong diagnostic conclusion. Components of the Nursing Health History - VERIFIED ANSWER✔✔-Biographical information Reason for seeking health care Patient expectations Present illness or health concerns Health history Family history Spiritual health Review of systems Psychosocial history Biographical information - VERIFIED ANSWER✔✔-: age, address, occupations, marital status, health care insurance. Chief concern or reason for seeking health care - VERIFIED ANSWER✔✔-: You learn the patient's chief concerns or problems. Record the patient's response in quotations to indicate the subjective response. Clarification of a patient's perception identifies potential needs for symptom management, education, counseling, or referral to community resources Patient expectations - VERIFIED ANSWER✔✔-: Find out what patients expect to happen to them while seeking treatments for their health. Assess whether expectations have been met. If not met, patients consider care as poor Present illness or heath concerns: - VERIFIED ANSWER✔✔-Determine when the problems began, how severe, intensity, quality, what makes them worse, and what makes them better. Use PQRST: provokes, quality, radiate, severity, time.

Concomitant symptoms: Does the patient experience other symptoms along with the primary symptom? Health history: - VERIFIED ANSWER✔✔-Provides you with information regarding the patient's past history. Has there been a hospitalization? A procedure? Medication uses? Prescription, over the counter, herbal, natural? Use of alcohol, tobacco, caffeine, recreational drugs? Sleeping patterns? Exercise habits? Nutritional habits? Family history: Blood relative health issues? Recent losses? Religious influences? Relationships? Allergies? Also, include patient habits and lifestyle patterns Family history: - VERIFIED ANSWER✔✔-Data about immediate and blood relatives, which determines risks of a genetic or familial nature Environmental history - VERIFIED ANSWER✔✔-: Home environment? Workplace environment? Exposure to pollutants? Psychosocial history: - VERIFIED ANSWER✔✔-Support system? Spouse? Children? Friends? Family members? Stress coping mechanisms? Spiritual health: - VERIFIED ANSWER✔✔-Review with patients their beliefs about life, their source for guidance in acting on beliefs, and the relationship they have with family in exercising their faith. Also assess rituals and religious practices that patients use to express their spirituality. Review of systems (ROS) - VERIFIED ANSWER✔✔-: A systematic approach for collecting subjective information from patients about the presence or absence of health-related issues in each body system. During the ROS ask the patient about the normal functioning of each body system and any noted changes Observation of Patient Behavior - VERIFIED ANSWER✔✔-It is important to closely observe a patient's verbal and nonverbal behaviors. Adds depth to objective database

Record objective information in accurate terminology. Record any subjective information by using quotation marks. Do not generalize or form judgments through written communication when entering data. Conclusions about such data become nursing diagnoses and thus must be factual and accurate. Concept mapping - VERIFIED ANSWER✔✔-Visual representation that allows you to graphically show the connections among a patient's many health problems Concept maps foster - VERIFIED ANSWER✔✔-reflection and help students evaluate critical thinking patterns and see the reasons for nursing care. Your first step in concept mapping is to organize the assessment data you collect. Placing all of the cues together into the clusters that form patterns leads you to the next step of the nursing process, nursing diagnosis. Through concept mapping you obtain a holistic perspective of your patient's health care needs, which ultimately leads you to making better clinical decisions chapter 17 - VERIFIED ANSWER✔✔-chapter 17 nursing diagnosis - VERIFIED ANSWER✔✔-is a clinical judgment vulnerability for that response by an individual, family, or community that a nurse is licensed and competent to treat. Patients are actively involved. _______________are ever changing on the basis of a patient's needs. collaborative problem - VERIFIED ANSWER✔✔-is an actual or potential physiological complication that nurses monitor to detect the onset of changes in a patient's health status

Interprofessional collaboration - VERIFIED ANSWER✔✔-is a partnership between a team of health care providers (such as nurses, therapists, dietitians, and physicians) and a patient in a participatory collaborative and coordinated approach for shared decision making around health issues Diagnostic conclusions - VERIFIED ANSWER✔✔-include problems treated primarily by nurses (nursing diagnoses) and those treated by several disciplines (collaborative problems). Together, nursing diagnoses and collaborative problems represent the range of patient conditions that require nursing care. Nursing diagnosis, the second step of the nursing process, classifies health problems within the domain of nursing. Purposes of standard formal diagnostic statements: - VERIFIED ANSWER✔✔-Provides a precise definition of a patient's responses to health problems that gives nurses and other members of the health care team a common language for understanding a patient's needs. Allows nurses to communicate (e.g., written and electronic) what they do among themselves with other health care professionals and the public. Distinguishes the nurse's role from that of other health care providers. Helps nurses focus on the scope of nursing practice. Fosters the development of nursing knowledge. Promotes creation of practice guidelines that reflect the essence and science of nursing. NANDA-I (2014) nursing diagnoses include: - VERIFIED ANSWER✔✔-Problem-focused Risk

The diagnoses have only defining characteristics, although a related factor may be used to improve understanding of the diagnosis. ex. readiness for enhanced knowledge, readiness for enhanced nutrition The diagnostic process - VERIFIED ANSWER✔✔-requires you to use critical thinking . Helps to be thorough, comprehensive, and accurate when identifying nursing diagnoses that apply to your patients. The diagnostic reasoning process - VERIFIED ANSWER✔✔-involves using the assessment data gathered about a patient to logically explain a clinical judgment or a nursing diagnosis. data cluster - VERIFIED ANSWER✔✔-is a set of cues, the signs or symptoms gathered during assessment. are compared with standards to reach a conclusion about a patient's response to a health problem ex: clustering the cues you learn from the pt, analyze the cues, and recognize the pattern of the specific problem Each clinical criterion - VERIFIED ANSWER✔✔-is an objective or subjective sign, symptom, or risk factor that, when analyzed with other criteria, leads to a diagnostic conclusion. Data Interpretation - VERIFIED ANSWER✔✔-It is critical to select the correct diagnostic label for a patient's need. When comparing patterns, judge whether the grouped signs and symptoms are expected for a patient (e.g., consider current condition, history) and whether they are within the range of healthy responses. By isolating any defining characteristics not within healthy norms, you can identify a specific problem.

Formulating a Nursing Diagnosis Statement - VERIFIED ANSWER✔✔-Identify the correct diagnostic label with associated defining characteristics or risk factors and a related factor. A related factor allows you to individualize a nursing diagnosis for a specific patient Most settings use a two-part format in labeling health promotion and problem-focused nursing diagnoses. Some agencies prefer a three-part nursing diagnostic label: Problem Etiology Symptoms examples: impaired physical mobility (diagnostic label) Acute incisional pain (etiology) problem (NANDA) - VERIFIED ANSWER✔✔-ex. impaired physical mobility Etiology - VERIFIED ANSWER✔✔-related factor ex. incisional pain symptoms - VERIFIED ANSWER✔✔-defining characteristics that show evidence of the health problem. ex. impaired physical mobility (problem) r/t incisional pain (etiology) as evidenced by restricted turning and positioning (symptoms) Cultural Relevance of Nursing Diagnoses - VERIFIED ANSWER✔✔-Consider patients' cultural diversity when selecting a nursing diagnosis.

4. Identify the problem caused by the treatment or diagnostic study rather than the treatment or study itself.
5. Identify the patient response to the equipment rather than the equipment itself.
6. Identify the patient's problems rather than your problems with nursing care.
7. Identify the patient problem rather than the nursing intervention.
8. Identify the patient problem rather than the goal of care.
9. Make professional rather than prejudicial judgments.
10. Avoid legally inadvisable statements.
11. Identify the problem and its cause to avoid a circular statement.
12. Identify only one patient problem in the diagnostic statement. Documentation and Informatics - VERIFIED ANSWER✔✔-Once you identify a patient's nursing diagnoses, enter them either on the written plan of care or in the electronic health information record (EHR) of the agency. Computer helps organize data into clusters Enhances ability to select accurate diagnoses When initiating an original care plan, place the highest-priority nursing diagnosis first.

Nursing Diagnosis: Application to Care Planning - VERIFIED ANSWER✔✔-By learning to make accurate nursing diagnoses, your care plan will help communicate the patient's health care problems to other professionals. A nursing diagnosis will ensure that you select relevant and appropriate nursing interventions chapter 18 - VERIFIED ANSWER✔✔-chapter 18 Establishing Priorities - VERIFIED ANSWER✔✔-Ordering of nursing diagnoses or patient problems uses determinations of urgency and/or importance to establish a preferential order for nursing interventions. Organization of a vision of desired outcomes. Classification of priorities: High—Emergent Intermediate—non-life-threatening Low—Affect patient's future well-being highest priorities - VERIFIED ANSWER✔✔-Nursing diagnoses that, if untreated, result in harm to a patient or others (e.g., those related to airway status, circulation, safety, and pain) Intermediate - VERIFIED ANSWER✔✔--priority nursing diagnoses involve nonemergent, non-life- threatening needs of patients. Low-priority - VERIFIED ANSWER✔✔-nursing diagnoses are not always directly related to a specific illness or prognosis but affect a patient's future well-being. Establishing Priorities - VERIFIED ANSWER✔✔-The order of priorities changes as a patient's condition changes.