139 Chapter 14 Questions

5. A nurse manager is observing a newly hired nurse's behavior while providing care to a client and notes the following: • Recognizes the majority of deviations in clients' status • Occasionally misses the most subtle signs • Continually assesses clients based on findings • Actively seeks out the family for information to support plans Using Lasater's clinical judgment rubric, the manager identifies the nurse as functioning at which level? A. accomplished B. beginning C. developing D. exemplary

A Rationale: According to Lasater's rubric, the nurse's behaviors demonstrate the level of "accomplished," as exhibited by the ability to regularly observe and monitor a variety of data, noticing the most useful information, but possibly missing the most subtle signs, recognizing the most obvious patterns and deviations in data, using them to continually assess, and actively seek subjective information about the client's situation from the client and family to support planning intervention, but occasionally not pursuing important leads. A nurse with beginning competency would be confused by the clinical information and amount and type of data, focusing on one thing at a time and missing most patterns and deviations. A nurse with developing competency attempts to monitor a variety of data but is overwhelmed by the array of data, focusing on the most obvious data and missing some important data. A nurse with exemplary competency focuses observation appropriately and is able to regularly observe and monitor a wide variety of data, recognizing subtle patterns and deviations, using these to guide assessment. Question format: Multiple Choice Chapter 14: Clinical Judgment Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 386

9. A nurse coming on shift receives a handoff report from the outgoing nurse on the status of assigned clients. The nurse exercises clinical judgment, prioritizing the need to see which client first? A. client who was started on oxygen therapy for extreme shortness of breath B. client who had abdominal surgery 2 days ago and requires a dressing change C. client receiving continuous intravenous fluid therapy to treat dehydration D. client who received an antiemetic 4 hours ago for vomiting

A Rationale: Based on the clients described, the nurse would determine that the client who was started on oxygen therapy for extreme shortness of breath is the most acute and most at risk. Therefore, that client should be seen first. The other clients should be seen afterward. Question format: Multiple Choice Chapter 14: Clinical Judgment Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 384

17. A nurse is engaged in experiential learning. Place the actions below in the order in which the nurse would accomplish them. Use all options. A. Obtain concrete experience. B. Conduct reflective observation. C. Develop abstract concepts. D. Experiment with concepts in new situations. E. Integrate concepts.

A, B, C, D, E Rationale: In experiential learning, the cyclic nature of learning is driven by concrete experience, termed prehension, followed by reflective observation, which leads to the formation of abstract concepts that are then tested in new situations through experimentation, the integration of which is termed transformation. Question format: Drag and Drop Chapter 14: Clinical Judgment Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Teaching/Learning Reference: p. 394

2. A nurse educator is conducting an in-service program for a group of newly hired nurses at the facility. The topic addresses the use of critical thinking in the clinical area. The nurse educator determines that additional instruction is needed based on which statement made by the group? A. "There is one universal definition of critical thinking." B. "Critical thinking requires intentional focus." C. "The ability to think critically can be learned." D. "Creativity, intuition, and logic are needed for critical thinking."

A Rationale: Critical thinking has been defined differently by various individuals. In fact, some leaders recognize critical thinking as a concept that does not have one universally accepted definition. Leaders describe critical thinking as a skill that can be developed, often requiring intentional focus and work, and involving problem-solving that is creative, intuitive, logical, and analytic. Question format: Multiple Choice Chapter 14: Clinical Judgment Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 382

31. A nurse is involved in identifying a client's actual health problem. Which action demonstrates clinical judgment? A. prioritizing the problem B. identifying the health problem C. determining the underlying cause D. correlating associated signs and symptoms

A Rationale: Identifying a health problem or need, breaking down the etiological components, and associating the correct signs and symptoms requires critical thinking and clinical reasoning. Prioritizing them based on the situation, acuity, and hierarchy of problems or needs requires clinical judgment. Question format: Multiple Choice Chapter 14: Clinical Judgment Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 390

7. A new graduate nurse asks the preceptor, "Why do we have to identify client outcomes?" Which response by the preceptor is appropriate? A. "They identify thresholds that can be measured." B. "It is important in case the client takes legal action." C. "Outcomes are just something we have to do." D. "Most insurance companies want to see them."

A Rationale: Identifying the client outcomes makes the outcomes measurable, often focusing on behaviors and attainment of certain thresholds. Identifying outcomes is not just something nurses must do or insurance companies want to see. Documentation is a safeguard in case of legal action. Question format: Multiple Choice Chapter 14: Clinical Judgment Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Communication and Documentation Reference: p. 391

19. A nurse is engaged in experiential learning. Which step would the nurse likely be involved with first? A. obtaining actual hands-on practice B. thinking about actions done C. testing possible solutions D. integrating appropriate actions into care

A Rationale: In experiential learning, the cyclic nature of learning is driven by concrete experience, termed prehension, followed by reflective observation, which leads to the formation of abstract concepts that are then tested in new situations through experimentation, the integration of which is termed transformation. The process then begins anew with the active experimentation affecting the next experience. Actual hands-on experience reflects prehension, the first step. This is followed by thinking about actions (reflective observation), then testing possible solutions, and finally, integrating appropriate solutions into care. Question format: Multiple Choice Chapter 14: Clinical Judgment Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 394

20. A nurse is conducting a review course on learning for nurses working in the community health center. The nurse explains the impact of experiential learning on clinical decision-making and clinical judgment. The nurse determines that the teaching was successful when the group makes which statement? A. "Learning is ongoing and builds on previous experience." B. "The most important aspect of learning is life experience." C. "A person's own beliefs have little effect on learning." D. "What we learned in school must be followed in the real world."

A Rationale: Learning is cumulative such that lessons learned in prerequisite courses inform thinking, perspectives, and learning ethos (guiding beliefs). Although life experience is important, other factors also affect learning, such as educational experience and experience in the health care arena. Each person brings individual beliefs to the situation, adding diversity. Learning in the real world requires some flexibility and adaptation to what may have been learned in the classroom. The key is to be able to adapt while still adhering to the principles. Question format: Multiple Choice Chapter 14: Clinical Judgment Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Teaching/Learning Reference: p. 394

30. A nurse is reading a journal article about the nursing process. Which information is the nurse likely to find in the article about the nursing process? A. a rational reasoning approach to client care B. It is equivalent to a care plan. C. a tool for delivering care D. a list of action steps

A Rationale: One of the most important things to understand is that the nursing process is not the same thing as a care plan. The nursing process outlines the way nurses think (a rational reasoning approach to care), it represents the unique, shared language of nurses. This nursing process represents a mental model (an organized way of thinking that shapes our worldview and helps us to understand complex aspects of a situation) that guides our assessments and behaviors. The care plan is used as a teaching tool to explicate the steps the nurse mentally goes through when developing, delivering, and evaluating a client's individualized plan of care. Nurses organize their thoughts using assessment, diagnosing or identifying an actual or potential problem, planning, identifying interventions with rationale, and evaluation (ADPIE). Question format: Multiple Choice Chapter 14: Clinical Judgment Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 390

28. A group of nurses is engaged in a debriefing session following an emergency that occurred on the unit. During the debriefing, the group is discussing what happened and how they can learn from the situation. Applying Tanner's clinical judgment model, the nurses are engaged in which process? A. reflection on-action B. noticing C. interpreting D. responding

A Rationale: Reflection on-action mirrors a debrief or postconference and occurs after the situation and drives clinical learning. Noticing refers to the initial grasp and perceptions of the situation that are impacted by context, the nurse's practical experience, knowledge of expected versus unexpected data, ethical perspectives, and the nurse-client relationship. Interpreting involves attributing meaning to the data through multiple reasoning patterns. Responding involves deciding on an action (or inaction) and monitoring outcomes. Question format: Multiple Choice Chapter 14: Clinical Judgment Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 385

25. A nurse is assessing an older adult client with mobility issues in the home and notes the following: • Multiple throw rugs on the floors from the living room to the kitchen. • Several extension cords running across the floor in the client's path to the restroom. • Bags of old circulars and junk mail scattered about the living room. • Limited lighting in hallway from the door to the main living space. The nurse determines that the client's risk for falling is increased. The nurse is demonstrating which concept? A. situational awareness B. cognitive load C. reflection D. responding

A Rationale: Situational awareness is "the perception of the elements in the environment in a volume of time and space, the comprehension of their meaning, and the projection of their status in the near future." The nurse picked up on clues that could impact the client's status now and in the future. Cognitive load is a term used to reference the amount of information a person can hold in their memory at one time. The practice of reflection involves thinking about a situation in the past and how the nurse responded to it. Responding involves deciding on an action (or inaction) and monitoring outcomes. Question format: Multiple Choice Chapter 14: Clinical Judgment Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Safety and Infection Control Integrated Process: Nursing Process Reference: p. 384

21. A new graduate nurse is shadowing an experienced nurse providing care to a client. The new graduate nurse is observing the experienced nurse as they perform a sterile dressing change. The new graduate nurse notices that the experienced nurse is not following the exact steps that the new graduate nurse learned in school. Which response by the new graduate nurse is appropriate? A. "I noticed you put the supplies on the left side, not the right." B. "I am really upset. You are not doing the steps correctly." C. "You need to stop what you are doing." D. "There is no reason to do the dressing change like you did it."

A Rationale: Striking the balance between integrating previous experience in health care to provide context for beginning nursing practice and allowing preconceived notions and role-specific knowledge to interfere with development as a nurse requires intentionality. Instead of thinking, "That's not the way we learned it," the new graduate nurse needs to reframe their thinking to consider the underlying principles. Although the experienced nurse is not following the exact steps that the new graduate nurse learned in school, the new graduate nurse needs to consider if the experienced nurse adhered to the principles of sterility, the situational constraints (e.g., room set-up, available equipment, client anatomy, nurse's dominant hand), and client physical and psychological safety. It is important for the new graduate nurse to speak up and ask questions, but the tone and words matter. Telling the experienced nurse to stop, indicating that they are not "doing the steps correctly," or that there is "no need to do the dressing change the way you did it" is accusatory and does not consider the circumstances of the situation. The new graduate nurse needs to learn to adapt while at the same time adhering to the underlying principles. This demonstrates clinical judgment. Question format: Multiple Choice Chapter 14: Clinical Judgment Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 396

16. A nurse is working to develop clinical judgment and is researching various theories, models, and frameworks. Based on this research, the nurse decides to focus on ethics and moral reasoning. Which approach is the nurse likely to integrate? A. Rest framework B. humanistic-intuitive approach C. information-processing model D. cognitive continuum theory

A Rationale: The Rest framework focuses on ethics and moral reasoning and the cognitive processes that precede moral action with the person acting as a moral agent. The humanistic-intuitive approach focuses on thinking that expands from novice (makes clinical judgments that do not consider all the contextual elements and relies on concrete, analytic methods and planning for decision-making) and eventually culminates in intuitive responses as an expert. The information-processing model is a cognitive model that informs decision-making similar to a computer processor. The information-processing model requires memory that is classified as sensory (collects and transforms), short-term (temporary), and long-term (more permanently stored). The model proposes a sequential way of thinking that involves encoding/input, storage, and retrieval/output (information-processing model). This cognitive theory proposes a straightforward way of considering the human response to a stimulus that results in a response. The cognitive continuum theory acknowledges and integrates both intuitive and analytical cognitive characteristics. The recognition that intuition influences clinical decision-making supports the delivery of creative, individualized, holistic, person-centered care. Question format: Multiple Choice Chapter 14: Clinical Judgment Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 394

12. A client is being transferred to a rehabilitation facility. The nurse is giving a handoff report to the receiving nurse at the facility and provides detailed information about the client's status, care, and progress to ensure that the receiving nurse has all the information needed to provide a seamless transition. The nurse is demonstrating which Quality and Safety Education for Nurses (QSEN) competency? A. teamwork and collaboration B. patient-centered care C. evidence-based practice D. quality improvement

A Rationale: The nurse is demonstrating competency with teamwork and collaboration, using clear communication practices to minimize risks associated with handoffs among providers and across transitions of care. Competencies involving patient-centered care focus on having the client be the source of control and full partner in the care, taking into consideration the client's preferences, values, and needs. Competencies involving evidence-based practice focus on integrating the best current evidence with clinical expertise and client preferences for optimal care. Competencies involving quality improvement involve monitoring the outcomes of care and using methods to foster improvement. Question format: Multiple Choice Chapter 14: Clinical Judgment Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 393

18. A nurse is providing care to a client and identifies an ethical conflict. When determining the appropriate actions, which approach to clinical decision-making is the nurse likely to use? A. Rest framework B. humanistic-intuitive approach C. information-processing model D. cognitive continuum theory

A Rationale: The Rest framework of moral reasoning is the approach best suited for clinical decision-making. This framework emphasizes the development of a person as a moral agent and consists of the following steps: • Moral sensitivity: development of an awareness that there is an ethical issue, requires empathy and perspective-taking • Moral judgment/reasoning: consideration of several courses of action to account for the potential impact on those involved (person-centered), occurs along with clinical decision-making and informs clinical judgment • Moral motivation/focus: the cognitive process of decision-making that involves prioritizing (often) competing values • Moral character: implementing a plan of action, related to professional identity formation The humanistic-intuitive approach focuses on the development of thinking as the person progresses from novice to expert. The information-processing model approaches clinical decision-making similar to that of a computer processor that relies on memory and viewing human responses to stimulate, leading to a response. The cognitive continuum theory integrates both intuitive (acknowledgment of biases and thoughtful use) and analytical characteristics into decision-making to reduce risk and error. Question format: Multiple Choice Chapter 14: Clinical Judgment Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 394

13. When providing care, a new graduate nurse makes clinical decisions based strictly on concrete assessment findings, including the client's vital signs and statements made by the client. Which process for decision-making is the nurse using? A. humanistic-intuitive approach B. information-processing model C. cognitive continuum theory D. Rest framework

A Rationale: The actions of the nurse reflect a novice nurse who makes clinical judgments that do not consider all the contextual elements and rely on concrete, analytic methods and planning for decision-making. This concept reflects the humanistic-intuitive approach, such that thinking expands and eventually culminates in intuitive responses. The information-processing model is a cognitive model that informs decision-making similar to a computer processor. The information-processing model requires memory that is classified as sensory (collects and transforms), short-term (temporary), and long-term (more permanently stored). The model proposes a sequential way of thinking that involves encoding/input, storage, and retrieval/output (information-processing model). This cognitive theory proposes a straightforward way of considering human response to a stimulus that results in a response. The cognitive continuum theory acknowledges and integrates both intuitive and analytical cognitive characteristics. The recognition that intuition influences clinical decision-making supports the delivery of creative, individualized, holistic, person-centered care. The Rest framework focuses on moral reasoning and the cognitive processes that precede moral action, with the person acting as a moral agent. Question format: Multiple Choice Chapter 14: Clinical Judgment Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 393

24. A group of nurses is involved in a debriefing following participation in a resuscitation simulation. The nurse manager is acting as the facilitator. Which question is appropriate for the nurse manager to ask to address the group's future clinical judgment? A. "What learning will you apply to your practice?" B. "What did you do first?" C. "What made you do the next action?" D. "What thoughts prompted you to act that way?"

A Rationale: The debrief and/or reflection provides the space and mechanism for focusing on the process of clinical reasoning ("What did you do first? What did you do next? What were you thinking when you made that decision?") to guide nurses in their ability to make sound clinical decisions based on clinical judgment ("How are you going to apply what you learned to your clinical practice?"). Question format: Multiple Choice Chapter 14: Clinical Judgment Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference:

10. During assessment, a client verbalizes specific preferences for communication and care to the nurse. The nurse communicates this information to other members of the health care team. The nurse is demonstrating which QSEN competency? A. patient-centered care B. evidence-based practice C. quality improvement D. safety

A Rationale: The nurse is demonstrating a skill related to patient-centered care (recognition that the client or designee is the source of control and a full partner in providing compassionate and coordinated care based on respect for the client's preferences, values, and needs). Evidence-based care involves integrating the best current evidence with clinical expertise and client/family preferences and values for the delivery of optimal health care. Quality improvement involves using data to monitor outcomes of care processes and using improvement methods to design and test changes in order to continuously improve the quality and safety of health care systems. Safety involves minimizing risk for harm to clients. Question format: Multiple Choice Chapter 14: Clinical Judgment Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 393

4. A nurse has completed an initial assessment of a client with a history of respiratory distress. Upon entering the client's room later in the day, the nurse finds the client is short of breath and leaning forward to breathe. The nurse gathers additional information and notes rapid shallow breaths, a decrease in oxygen saturation levels, and diminished breath sounds. The nurse determines that these are significant changes in the client's condition and calls the client's health care provider to report the situation. The nurse is demonstrating which behavior? A. clinical judgment B. critical thinking C. clinical reasoning D. knowledge integration

A Rationale: The nurse is demonstrating clinical judgment by calling the health care provider and subsequently clinical decision-making, the foundation of which is based on critical thinking, knowledge from nursing and other disciplines, and clinical reasoning. The actions the nurse took to arrive at the decision to call the provider reflect the processes of critical thinking, integration of knowledge, and clinical reasoning. The nurse used critical thinking by identifying the change in the client's condition, recognizing a problem, and then gathering additional data. The nurse integrated knowledge by using what was previously known about the client and considered the current findings. Using clinical reasoning, the nurse took the information that was gathered and arrived at a conclusion: the decision to call the provider. Question format: Multiple Choice Chapter 14: Clinical Judgment Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Reference: p. 384

22. A nurse is thinking back on a clinical situation that occurred several days ago and how they responded to that situation. Upon entering the client's room, the nurse observed the client experiencing extreme shortness of breath. The nurse identified this as a significant change in the client's status and assessed the client further. The nurse responded by elevating the head of the bed for the client and administering supplemental oxygen at a low flow rate. The nurse also notified the health care provider about the client's status and received additional orders. The nurse's actions constitute which process? A. reflection B. journaling C. critical thinking D. clinical reasoning

A Rationale: The nurse is engaged in reflection, which involves thinking about a given situation and the response to that situation. Reflection is different from journaling in that it is focused, intentional, directed, and purposeful. Critical thinking is a skill that can be developed and requires intentional focus and work along with the ability to think, reason, consider options, and problem-solve. Clinical reasoning is defined as "thought processes that allow health care providers to arrive at a conclusion." The nurse used critical thinking and clinical reasoning during the situation but is now reflecting on that situation. Question format: Multiple Choice Chapter 14: Clinical Judgment Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Reference: p. 397

11. A nurse is reading an article about competencies developed by numerous professional organizations as a single entity. For which purpose will the nurse integrate knowledge of this information when providing client care? A. to foster teamwork B. to enhance documentation C. to maintain client confidentiality D. to improve assessment

A Rationale: The nurse is reading about the Interprofessional Education Collaborative (IPEC) core competencies developed by a team of interprofessional health care collaborators. These competencies focus on interprofessional collaboration. Thus, the nurse will integrate understanding of these competencies for the purpose of fostering teamwork. Although each discipline is involved with documentation, client confidentiality, and assessment, these are not the focus of the IPEC competencies. Collaboration, and therefore teamwork, is. Question format: Multiple Choice Chapter 14: Clinical Judgment Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 393

3. A nurse accesses the electronic health record of a client and reviews the client's history for results of previous laboratory studies completed. Then the nurse accesses the record for current laboratory study results, comparing them to better understand a client's status before deciding if there is a need to contact the health care provider. The nurse's actions demonstrate which concept? A. clinical reasoning B. clinical judgment C. backward reasoning D. critical thinking

A Rationale: The nurse is using clinical reasoning. Clinical reasoning refers to the "thought processes that allow health care providers to arrive at a conclusion" and "as the process of thinking that results in a clinical judgment." Critical thinking may be used to access the electronic health record and to learn to navigate through the screens, but clinical reasoning is used to decide what the nurse should review, when to review it, and how each piece of data relates to the others to create a clinical picture. In this case, the nurse is comparing the data prior to determining if the health care provider should be notified. Clinical judgment is the result or observed outcome of critical thinking and decision-making. Backward reasoning is deductive reasoning that relies on applying widely accepted knowledge and principles to a model or a combination of models to solve problems. Question format: Multiple Choice Chapter 14: Clinical Judgment Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Reference: p. 384

35. While assessing a client who had abdominal surgery yesterday, a nurse notes the following: • Grimacing when turning from the supine to side-lying position • Holding their abdominal area • Pulse: increased from baseline of 80 beats/min to 92 beats/min when turning • Rating pain as 7 out of 10 The nurse suspects that the client is experiencing pain and checks the medication record for the last time the client received the prescribed pain medication. The nurse's actions demonstrate which concept? A. forward reasoning B. deductive reasoning C. situational awareness D. cognitive load

A Rationale: The nurse is using forward reasoning or inductive reasoning. Inductive reasoning requires observing then drawing conclusions—this is referred to as forward reasoning. Inductive reasoning processes require the ability to recognize patterns (the assessment findings gathered), make connections (pain being manifested by grimacing, holding the area, increased pulse rate), and form hypotheses and theories (suspicion that the client is experiencing pain). This reasoning led the nurse to check the medication record to determine if a dose of pain medication is needed. Deductive reasoning relies on applying widely accepted knowledge and principles to a model or a combination of models to solve problems—this is referred to as backward reasoning. Proving a point by testing identified theories or hypotheses and predicting consequences utilizes deduction. Situational awareness involves perceiving environmental elements, understanding their meaning, and how they impact status in the near future. Cognitive load refers to the amount of information that a person can hold in their memory over time. Question format: Multiple Choice Chapter 14: Clinical Judgment Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Reference: p. 384

14. A nurse conducts a self-examination to determine if they have any cultural biases that might affect the care of assigned clients. Based on this self-examination, the nurse identifies a trend toward stereotyping when working with clients from other cultures. Subsequently, the nurse integrates this knowledge into client care situations to reduce the possibility of stereotyping to provide optimal care. The nurse's actions reflect which clinical decision-making process? A. cognitive continuum theory B. humanistic-intuitive approach C. information-processing model D. Rest framework

A Rationale: The nurse's actions reflect the cognitive continuum theory, which requires acknowledgment of potential bias and thoughtful use in conjunction with analysis to mitigate risk and errors. The humanistic-intuitive approach focuses on thinking that expands from novice to expert, culminating in intuitive responses that seamlessly sort data and consider a holistic approach. The information-processing model proposes a sequential way of thinking that involves encoding/input, storage, and retrieval/output. This cognitive theory proposes a straightforward way of considering human response to a stimulus that results in a response. The Rest framework focuses on moral reasoning and captures the cognitive processes that precede moral action and emphasizes the development of a person as a moral agent. Question format: Multiple Choice Chapter 14: Clinical Judgment Cognitive Level: Apply Client Needs: Psychosocial Integrity Integrated Process: Nursing Process Reference: p. 394

6. A nurse enters a client's room and observes the client sitting in a chair looking out the window. The nurse obtains the client's vital signs and gathers information about the client's current level of pain. Based on this information, the nurse identifies a potential problem with pain control and decides to call the provider to obtain a prescription for an analgesic. The nurse is engaged in which action? A. using the nursing process B. care planning C. concept mapping D. evaluating

A Rationale: The nursing process outlines the way nurses think, it represents the unique, shared language of nurses. The care plan is used as a teaching tool to explicate the steps the nurse mentally goes through when developing, delivering, and evaluating a client's individualized plan of care. Nurses organize their thoughts using assessment, diagnosing or identifying an actual or potential problem, planning, identifying interventions with rationale, and evaluation (ADPIE). This nursing process represents a mental model (an organized way of thinking that shapes nurses' worldview and helps them to understand complex aspects of a situation) that guides assessments and behaviors. A concept map provides a means of integrating pathophysiology, evolving clinical manifestations, laboratory values and diagnostics, and elements of the traditional care plan. Evaluating is a step of the nursing process whereby outcome achievement is determined. Question format: Multiple Choice Chapter 14: Clinical Judgment Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 390

26. When providing care to a client, which action(s) reflects forward reasoning by a nurse? Select all that apply. A. recognizing trends in the client's vital signs, indicating a change in status B. prioritizing assessment data based on essential client needs C. implementing evidence-based actions to prevent pressure injury D. trying an intervention based on suspicion of a problem E. using documented findings to confirm the client's problem

A, B Rationale: Inductive reasoning requires observing, then drawing conclusions—this is referred to as forward reasoning. Inductive reasoning processes require the ability to recognize patterns and connections and form hypotheses and theories. Inductive reasoning requires experience, knowledge, a holistic view, intuition, and organized thinking. Deductive reasoning relies on applying widely accepted knowledge and principles to a model or a combination of models to solve problems—this is referred to as backward reasoning. Proving one's point by testing identified theories or hypotheses and predicting consequences utilizes deduction. Question format: Multiple Select Chapter 14: Clinical Judgment Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Teaching/Learning Reference: p. 384

32. A new nurse is being evaluated for competency using the Competency Outcomes Performance Assessment (COPA) model. Which area is included when evaluating the nurse's leadership skills? Select all that apply. A. collaboration B. professional accountability C. problem-solving D. client advocacy E. cultural respect

A, B Rationale: Leadership skills include collaboration and professional accountability. Problem-solving is evaluated as part of critical thinking skills. Client advocacy and cultural respect are associated with human caring and relationship skills. Question format: Multiple Select Chapter 14: Clinical Judgment Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 391

1. A nurse is providing care to several clients. Which situation(s) reflects the nurse using clinical judgment? Select all that apply. A. deciding on appropriate actions based on the facility's approved algorithm B. providing evidence to revise a current protocol for intravenous insertion C. gathering additional assessment findings to support changes in a client's status D. referring to any female client using the "she" pronoun E. holding off on notifying a health care provider about the deterioration in a client's status until family members arrive

A, B, C Rationale: Critical thinking, clinical reasoning, and clinical judgment occur in the quiet moments. Framing the approach to a client using their identified pronouns rather than making a generalization (e.g., referring to any female client as "she") requires a measure of clinical judgment. Identifying and then using an algorithm or protocol based on clinical findings requires clinical judgment. Reviewing the evidence and contributing to the development or revision of that algorithm or protocol requires clinical judgment. Nurses also use clinical judgment to determine whether to immediately call the health care provider or to determine if there are additional assessments that are needed to formulate a recommendation. However, waiting to notify the provider about a deterioration in the client's condition until family members arrive would be inappropriate. Question format: Multiple Select Chapter 14: Clinical Judgment Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 382

23. A nurse is engaged in reflection. Place the activities listed below in the order that the nurse would likely have completed them during reflection on using Tanner's clinical judgment model. Use all the options. A. The nurse looks at previous encounters with the client. B. The nurse describes the assessment finding related to the client. C. The nurse determines that the client was experiencing an emergency. D. The nurse contacts the health care provider about the client's status.

A, B, C, D Rationale: Using Tanner's clinical judgment model, a framework for reflection, the nurse would first address the background, such as previous encounters with the client that established a baseline. Next, the nurse would describe what was noticed (assessment findings), and then interpret the situation (client experiencing an emergency, which then leads to a response—calling the health care provider). Question format: Drag and Drop Chapter 14: Clinical Judgment Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Reference: p. 398

34. A nurse is working as part of a multidisciplinary team. Which behavior(s) by a nurse demonstrates competency associated with interprofessional collaboration? Select all that apply. A. Treats individuals involved in client care with respect. B. Implements actions based on appropriate roles and responsibilities. C. Includes other health care team members in client and family discussions. D. Uses electronic health record (EHR) to document assessment findings. E. Integrates evidence-based practice into interventions.

A, B, C Rationale: Interprofessional educational competencies include: • Working with individuals of other professions to maintain a climate of mutual respect and shared values (Values/Ethics for Interprofessional Practice) • Using knowledge of one's own role and those of other professions to appropriately assess and address the health care needs of clients and to promote and advance the health of populations (Roles/Responsibilities) • Communicating with clients, families, communities, and professionals in health and other fields in a responsive and responsible manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease (Interprofessional Communication) • Applying relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan, deliver, and evaluate client/population-centered care and population health programs and policies that are safe, timely, efficient, effective, and equitable (Teams and Teamwork) Documentation in the electronic health record and implementing evidence-based care are not associated with interprofessional educational competencies. Question format: Multiple Select Chapter 14: Clinical Judgment Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 393

29. A nurse manager is evaluating the clinical judgment of several new graduates using Lasater's rubric. The nurse manager determines that which new graduate(s) is demonstrating competencies at the developing level? Select all that apply. A. Nurse B: demonstrates ability to identify obvious patterns but misses some important information B. Nurse C: demonstrates difficulty identifying what information requires further investigation C. Nurse D: demonstrates significant hesitancy to assume the "leader" role in client situations D. Nurse A: demonstrates consistent ability to regularly observe and monitor a variety of data E. Nurse E: demonstrates clear communication with clients, providing careful explanations

A, B, C Rationale: Nurses B, C, and D demonstrate behavior reflecting the developing level of clinical judgment. According to Lasater's rubric, the developing level of clinical judgment is reflected by the following behaviors: • Ability to identify obvious patterns but will miss some important information • Trouble identifying what information to seek out further • Tentativeness in the leader role The accomplished level is demonstrated by the ability to regularly observe and monitor a variety of data and communicate well with clear explanations. Question format: Multiple Select Chapter 14: Clinical Judgment Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 386

33. When caring for a client, a nurse demonstrates behaviors reflecting the Quality and Safety Education for Nurses (QSEN) competency for client-centered care. Which behavior(s) is the nurse likely demonstrating? Select all that apply. A. Interviews the client to identify their needs and values. B. Provides pain relief measures based on client's preferences. C. Maintains appropriate boundaries in the nurse-client relationship. D. Identifies potential medical problems based on assessment findings. E. Identifies strengths and limitations of others involved in the client's care.

A, B, C Rationale: Quality and Safety Education for Nurses (QSEN) competencies outline the knowledge, skills, and attitudes (KSAs) essential for prelicensure (and graduate) nurses and focus on six areas: • Client-centered care • Teamwork and collaboration • Evidence-based practice • Quality improvement • Safety • Informatics Identifying client needs and values, providing pain relief based on client preferences, and maintaining appropriate boundaries in the nurse-client relationship reflect key behaviors associated with client-centered care. This competency recognizes the client as the source of control, acting as a full partner in care that is based on respect for the client's preferences, values, and needs. Identifying possible medical problems is more closely associated with diagnosing, which is not a QSEN competency and is also outside the scope of nursing practice. Identifying strengths and limitations of others is not client-centered. Question format: Multiple Select Chapter 14: Clinical Judgment Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 393

27. After teaching a refresher class to a group of staff nurses about clinical judgment, the nurse determines that the teaching was successful when the group identifies which characteristic(s) as key? Select all that apply. A. cue recognition B. hypotheses generation C. outcome evaluation D. diangosis generation E. pathophysiologic identification

A, B, C Rationale: Similar to the nursing process, clinical judgment refers to the skill of recognizing cues regarding a clinical situation, generating and weighing hypotheses, taking action, and evaluating outcomes for the purpose of arriving at a satisfactory clinical outcome. Generating diagnoses and identifying pathophysiologic issues, although possibly involved in recognizing cues, are not characteristics typically associated with clinical judgment. Question format: Multiple Select Chapter 14: Clinical Judgment Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Teaching/Learning Reference: p. 384

15. A nurse uses the Rest framework to support clinical decision-making. Place the steps listed below in the order that the nurse would use them. Use all options. A. Uses empathy leads to awareness of an ethical issue. B. Looks at the potential effects different actions may have. C. Prioritizes competing values. D. Forms a professional identity based on a plan of action.

A, B, C, D Rationale: The Rest framework emphasizes the development of a person as a moral agent and consists of the following steps: • Moral sensitivity: development of an awareness that there is an ethical issue, requires empathy and perspective-taking • Moral judgment/reasoning: consideration of several courses of action to account for the potential impact on those involved (person-centered), occurs along with clinical decision-making and informs clinical judgment • Moral motivation/focus: the cognitive process of decision-making that involves prioritizing (often) competing values • Moral character: implementing a plan of action, related to professional identity formation. Question format: Drag and Drop Chapter 14: Clinical Judgment Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 394

8. When providing care to a client, a new graduate nurse develops a therapeutic nurse-client relationship, incorporating the client's beliefs and values into the client's plan of care and demonstrating empathy for the client, advocating for the client when necessary. When providing client education, the nurse ensures that any teaching materials match the client's health literacy level. The nurse also uses a mechanical lift and asks for assistance from other team members when moving and transferring the client. The new graduate nurse is demonstrating competency in which area(s)? Select all that apply. A. person-centered care B. quality and safety C. malpractice D. diagnosis and treatment E. professionalism

A, B, E Rationale: Competency domains include: • knowledge for nursing practice • person-centered care • population health • scholarship for nursing practice • quality and safety • interprofessional partnerships • systems-based practice • information and health care technologies • professionalism • personal, professional, and leadership development Therapeutic relationships, incorporation of beliefs and values, empathy, and advocacy reflect the competencies of person-centered care and professionalism. The use of health literacy-appropriate educational materials reflects the competency of person-centered care. Use of a mechanical lift and additional personnel when moving and transferring the client reflects the competency of quality and safety. Malpractice and diagnosis and treatment are not competency domains. Question format: Multiple Select Chapter 14: Clinical Judgment Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 392