CHAPTER 15 REVIEW QUESTIONS

MATCH. TERM: A. ANTICIPATE HOW A PT MIGHT RESPOND TO A TREATMENT B. ORGANIZE ASSESSMENT ON THE BASIS OF PT PRIORITIES C. BE OBJECTIVE IN ASKING QUESTIONS OF A PT D. BE TOLERANT OF THE PT'S VIEWS AND BELIEFS CONCEPT: 1. TRUTH SEEKING 2. OPEN-MINDEDNESS 3. ANALYCITY 4. SYSTEMATICITY

Answer: 1 c, 2 d, 3a, 4 b.

A NURSE ON A BUSY MED UNIT IS ASSIGNED TO FOUR PTS. IT IS 10AM. TWO PTS HAVE MEDS DUE AND ONE OF THOSE HAS A SPECIMEN OF URINE TO BE COLLECTED. ONE PT IS HAVING COMPLICATIONS FROM SURGERY AND IS BEING PREPARED TO RETURN TO THE OPERATING ROOM. THE FOURTH PT REQUIRES INSTRUCTIONS ABOUT ACTIVITY RESTRICTIONS BEFORE GOING HOME THIS AFTERNOON. WHICH OF THE FOLLOWING SHOULD THE NURSE USE IN MAKING CLINICAL DECISIONS APPROPRIATE FOR THE PATIENT GROUP? (SELECT ALL THAT APPLY) 1. CONSIDER AVAILABILITY OF ASSISTIVE PERSONNEL TO OBTAIN THE SPECIMEN 2. COMBINE ACTIVITIES TO RESOLVE MORE THAN ONE PT PROBLEM 3. ANALYZE THE DIAGNOSES/PROBLEMS AND DECIDE WHICH ARE MOST URGENT BASED ON PATIENT'S NEEDS 4. PLAN A FAMILY CONFERENCE FOR TOMORROW TO MAKE DECISIONS ABOUT RESOURCES THE PT WILL NEED TO GO HOME 5. IDENTIFY THE NURSING DIAGNOSES FOR THE PT GOING HOME

Answer: 1,2,3. Analyzing urgency of problems helps in prioritization as does considering the resources that are available (such as assistive personnel) to complete patient care activities. Deciding on how to combine activities is good time management. Holding a family conference is a good idea but in this case would be too late to be beneficial to the patient. The nurse must identify nursing diagnoses for all patients in order to determine priorities.

WHICH OF THE FOLLOWING DESCRIBES A NURSE'S APPLICATION OF A SPECIFIC KNOWLEDGE BASE DURING CRITICAL THINKING? (SELECT ALL THAT APPLY) 1.INITIATIVE IN READING CURRENT EVIDENCE FROM LITERATURE 2. APPLICATION OF THE NURSING THEORY 3. REVIEWING POLICY AND PROCEDURE MANUAL 4. PREVIOUS TIME CARING FOR A SPECIFIC GROUP OF PTS

Answer: 1,2,4. A nurse's specific knowledge base will vary but includes basic nursing education, continuing education courses, and additional college degrees. In addition, it includes the knowledge gained from a nurse reading the nursing literature, and acquiring information and theory from the basic sciences, humanities, behavioral sciences, and nursing. Nurse's knowledge base also involves a different way of thinking holistically about patient problems.

IN WHICH OF THE FOLLOWING EXAMPLES IS A NURSE APPLYING CRITICAL THINKING SKILLS IN PRACTICE? (SELECT ALL THAT APPLY) 1. THE NURSE THINKS BACK ABOUT A PERSONAL EXPERIENCE BEFORE ADMINISTERING A MED SUBCUTANEOUSLY 2. THE NURSE USES A PAIN-RATING SCALE TO MEASURE A PT'S PAIN 3. THE NURSE EXPLAINS A PROCEDURE STEP BY STEP FOR GIVING AN ENEMA TO A PT CARE TECHNICIAN 4. THE NURSE GATHERS DATA ON A PT WITH A MOBILITY LIMITATION TO IDENTIFY A NURSING DIAGNOSIS 5. A NURSE OFFERS SUPPORT TO A COLLEAGUE WHO HAS WITNESSED A STRESSFUL EVENT

Answer: 1,2,4. Reflection, using a pain rating scale to be precise and specific, and nursing assessment (the first step of the nursing process) are examples of critical thinking skills. Explaining a procedure based on policy is not critical thinking - however performing a procedure following policy is basic critical thinking. Offering support to a colleague is an important way to assist another in managing stress but is not a critical thinking skill.

A nurse just started working at a well-baby clinic. One of her recent experiences was to help a mother learn the steps of breastfeeding. During the first clinic visit the mother had difficulty positioning the baby during feeding. After the visit the nurse considers what affected the inability of the mother to breastfeed, including the mother's obesity and inexperience. The nurse's review of the situation is called: A. Reflection. B. Perseverance. C. Intuition. D. Problem solving.

Answer: 1. The mother had difficulty the first time breast feeding. The nurse relied on reflection to consider her previous actions, review what was successful and the opportunities for improvement. The nurse has not yet problem solved but might do so after reflection and anticipating the patient's next clinic visit.

A NURSE IS PREPARING MEDS FOR A PT. THE NUSRE CHECKS MED ON THE DR'S ORDER. AT THE BEDSIDE THE. NURSE CHECKS THE PT'S NAME AGAINST THE MED ORDER AS WELL. THE NURSE IS FOLLOWING WHICH CRITICAL THINKING ATTITUDE: 1. RESPONSIBLE 2. COMPLETE 3. ACCURATE 4. BROAD

Answer: 1. The nurse is demonstrating responsibility for correct medication and patient identification. The other three choices are critical thinking intellectual standards.

Two patient deaths have occurred on a medical unit in the last month. The staff notices that everyone feels pressured and team members are getting into more arguments. As a nurse on the unit, what will best help you manage this stress? 1. Keep a journal 2. Participate in a unit meeting to discuss feelings about the patient deaths 3. Ask the nurse manager to assign you to less difficult patients 4. Review the policy and procedure manual on proper care of patients after death

Answer: 2. By connecting and meeting with staff colleagues, the nurse can talk about the experiences of caring for dying patients and learn that her feelings are likely shared by others. A journal is helpful but not the best way to relieve stress. A policy and procedure manual will not help the nurse examine and understand the nature of the stress. Asking for a different assignment is no guarantee that another stressful experience will develop.

A nurse changed a patient's surgical wound dressing the day before and now prepares for another dressing change. The nurse had difficulty removing the gauze from the wound bed yesterday, causing the patient discomfort. Today he gives the patient an analgesic 30 minutes before the dressing change. Then he adds some sterile saline to loosen the gauze for a few minutes before removing it. The patient reports that the procedure was much more comfortable. Which of the following describes the nurse's approach to the dressing change? (Select all that apply.) 1. Clinical inference 2. Basic critical thinking 3. Complex critical thinking 4. Experience 5. Reflection

Answer: 3,4. The nurse relies on experience and the ability to adapt a procedure such as a dressing change (complex critical thinking) to make it successful.

By using known criteria in conducting an assessment such as reviewing with a patient the typical characteristics of pain, a nurse is demonstrating which critical thinking attitude? 1. Curiosity 2. Adequacy 3. Discipline 4. Thinking independently

Answer: 3. Discipline is being thorough in whatever you do. Using known criteria for assessment and evaluation, as in the case of pain, is an example of discipline.

An aspect of clinical decision making is knowing the patient. Which of the following is the most critical aspect of developing the ability to know the patient? 1. Working in multiple health care settings 2. Learning good communication skills 3. Spending time establishing relationships with patients 4. Relying on evidence in practice

Answer: 3. Knowing the patient relates to a nurse's experience with caring for patients, time spent in a specific clinical area and having a sense of closeness with them. However a critical aspect to knowing the patient and thus being able to make timely and appropriate decisions is spending time establishing relationships with patients.

Place the steps of the scientific method in their correct order with number 1 being the first step of the process. 1. Formulate a question or hypothesis. 2. Evaluate results of the study. 3. Collect data. 4. Identify the problem. 5. Test the question or hypothesis.

Answer: 4, 3, 1, 5, 2. The correct order of the steps of the scientific method are: 1. Identifying the problem, 2. Collecting data, 3. Formulating a question or hypothesis, 4. Testing the question or hypothesis, and 5. Evaluating results of the test or study.

A NURSE PREPARES TO INSERT A Foley catheter. THE PROCEDURE MANUAL CALLS FOR THE PATIENT TO LIE IN THE DORSAL RECUMBENT POSITION. THE PT COMPLAINS IF HAVING BACK PAIN WHEN YING ON HER BACK. DESPITE THIS, THE NURSE POSITIONS THE PT SUPINE WITH KNEES FLEXED AS THE MANUAL RECOMMENDS AND BEGINS TO INSERT THE CATHETER. THIS IS AN EXAMPLER OF: 1. ACURRACY 2. REFLECTION 3. RISK TAKING 4. BASIC CRITICAL THINKING

Answer: 4. Basic critical thinking is concrete and based on a set of rules or principles, such as the guidelines in a hospital procedure manual. The nurse's approach is not accurate, as accuracy requires use of all of the facts (e.g. the patient's discomfort). A critical thinker is willing to take risks in trying different ways to solve problems; following one basic approach is not risk taking. This is also not an example of reflection.

A NURSE ENTERS A 72- YEAR OLD PT'S HOME AND BEGINS TO OBSERVE HER BEHAVIORS AND EXAMINE HER PHYSICAL CONDITION. THE NURSE LEARNS THAT THE PT LIVES ALONE AND NOTICES BRUISING ON THE PT'S LEG. WHEN WATCHING THE PT WALK, THE NURSE NOTES THAT SHE HAS AN UNSTEADY GAIT AND LEANS TO ONE SIDE. THE PT ADMITS TO HAVING FALLEN IN THE PAST. THE NURSE IDENTIFIES THE PT AS HAVING THE NURSING DIAGNOSIS OF RISK FOR FALLS. THIS SCENARIO IS AN EXAMPLE OF: 1. INFERENCE 2. BASIC CLINICAL THINKING 3. EVALUATION 4. DIAGNOSTIC REASONING

Answer: 4. Diagnostic reasoning begins when you interact with a patient or make physical or behavioral observations. An expert nurse sees the context of a patient situation (e.g., Patient lives alone, has fallen in past, observes patterns and themes and makes a diagnostic decision.

A NURSE HAS SEEN MANY CANCER PATIENTS STRUGGLE WITH PAIN MANAGEMENT BECAUSE THEY ARE AFRAID OF BECOMING ADDICTED TO THE MEDICINE. PAIN CONTROL IS A PRIORITY FOR CANCER CARE. BY HELPING PATIENTS FOCUS ON THEIR VALUES AND BELIEFS ABOUT PAIN CONTROL, A NURSE CAN BEST MAKE CLINICAL DECISION. THIS IS AN EXAMPLE OF: 1. CREATIVITY 2. FAIRNESS 3. CLINICAL REASONING 4. APPLYING ETHICAL CRITERIA

Answer: 4. The use of ethical criteria for nursing judgment allows a nurse to focus on a patient's values and beliefs. Clinical decisions are then just, faithful to the patient's choices, and beneficial to the patient's well-being.

FILL IN THE BLANK. WHEN A NURSE TRIES TO UNDERSTAND A PT'S AND FAMILY CAREGIVER'S PERSPECTIVE OF WHY A PT IS FALLING AT HOME, THE NURSE APPLIES THE INTELLECTUAL STANDARD OF ________ TO UNDERSTAND ALL VIEWPOINTS.

Answer: Broad. The intellectual standard of 'broad' covers multiple viewpoints.