Chapter 14 Clinical Judgment

A nurse is applying Tanner's clinical judgment model in the care of a postpartum client. Which action by the nurse will constitute the first step in this process?

noticing the significant aspects of the client's condition

A nurse is applying Tanner's clinical judgment model to the care they provide. What action characterizes the first step in this process?

noticing what is significant about the client's status and circumstances

The nurse is applying the Clinical Judgment Measurement Model (CJMM) to the care of a client who has been expressing anxiety. The nurse has recognized and analyzed the various cues that the client is exhibiting, has prioritized hypotheses that may explain the client's anxiety, and is now generating possible solutions. In this particular stage of the CJMM, the nurse is demonstrating which component of Rest's framework of moral reasoning?

moral judgment/reasoning

A group of student nurses has been encouraged by their instructors to be intentional and deliberate about applying clinical decision-making models to their practice. A student tells a colleague, "The model that makes the most sense to me is the information-processing model, because it seems the most straightforward." How should the colleague best respond to this student?

"It is definitely a clear model, but it does not really capture all of the complexities and the human element of nursing."

In which clinical scenario(s) has the nurse likely applied inductive reasoning? Select all that apply.

-The nurse has crafted a theory of parental-infant attachment after many years of seeing new parents interact with their infants. -The nurse has proposed a model for shift handoff after participating in thousands of handoffs over the years.

An experienced nurse has determined that the clinical flowsheet that is used on the unit for assessing and treating pressure injuries is out of date and puts clients at risk. The nurse has reviewed the literature available and proposed an alternative that will ultimately reduce clients' risks and subject them to fewer disruptive assessments. The nurse has enacted which Quality and Safety Education for Nurses (QSEN) competency(ies)? Select all that apply.

-client-centered care -teamwork and collaboration -evidence-based practice -quality improvement -safety -informatics

The nurse is applying Tanner's Clinical Judgment Model in the care of a client. Building off the context and background information, place the components of the model in the correct sequence. Use all options.

-noticing -interpreting -responding -reflecting

A nurse has recommended a regimen of over-the-counter medications for a client who has seasonal allergies. A colleague contends that the nurse has exceeded the scope of nursing practice by recommending medications to a client. To resolve this difference of opinion, the nurses should consult resources from what organization?

American Nurses Association

The nurse has entered a client's hospital room and noticed that the client is grimacing and reporting bladder fullness despite the presence of an indwelling urinary catheter. The nurse has collected and interpreted assessment data and believes that the catheter is occluded. When applying Tanner's model of clinical judgment, what should the nurse do next?

Choose an intervention and then evaluate the effect of the intervention.

A novice nurse has witnessed the value of critical thinking in planning and responding to clients. Which principle should inform the nurse's practice?

Critical thinking is a skill that can be learned and developed.

An experienced nurse has received a new client and will apply the principles of inductive reasoning in the care-planning process. What action will the nurse perform first when applying this form of clinical reasoning?

Gather objective and subjective assessment data.

The nurse is participating in a client conference for a client who has complex health needs. The client's psychiatrist, occupational therapist, and social worker are also participating in the conference. The nurse is most clearly demonstrating the values of what organization?

Interprofessional Education Collaborative

A skilled nurse is providing care for a client with mental health needs who is recovering from a stroke. The client is experiencing dysphagia (difficulty swallowing), so the nurse is working together with the speech-language pathologist (SLP) to ensure the client's cooperation with a swallowing assessment. This nurse's action best demonstrates:

Interprofessional Education Collaborative (IPEC) core competencies.

A nursing student is excited to begin the first semester of the program and has learned that the competencies embedded in the program include human flourishing, nursing judgment, professional identity, and spirit of inquiry. What is the source of these competencies?

National League for Nursing

The community nurse has entered a client's home and noticed that the client is agitated and exhibits restless body language. The nurse has interpreted these behaviors as a sharp departure from the client's usual behavior and has discerned that the behavior is related to a recent family conflict. Within Tannner's model of clinical judgment, what will the nurse do next?

Respond by selecting the appropriate interventions.

A nurse has entered a client's home and noticed the client's disheveled state and several fall risks in the home. The nurse has interpreted these data as indications of a need for increased home support for the client and responded by arranging for care. The nurse reflected on the client's response to this suggestion, as well as reflected on the course of this interaction after the fact. The nurse has most clearly exemplified what model?

Tanner's clinical judgment mode

A novice nurse has received feedback from a peer that describes the nurse as lacking situational awareness. What observation by the peer likely led to this conclusion?

The nurse has difficulty identifying the less obvious changes in clients' conditions.

A novice nurse has been growing in skill, largely as a result of experiential learning in the clinical setting. Within the model of experiential learning, what outcome would most clearly indicate that the nurse has achieved the stage of transformation?

The nurse integrates experience and reflections into new forms of practice.

A community health nurse has a reputation that is described as "stellar" by peers and colleagues. Apart from the nurse's years of experience, the nurse's skillfulness is the attribute most described by others. According to cognitive continuum theory (CCT), what characteristic of the nurse suggests that the nurse has achieved the highest level of competence?

The nurse is able to apply intuition to complex clinical scenarios.

A nurse who has just accepted a position providing end-of-life care is applying the Rest framework of moral reasoning. What characteristic of the nurse indicates that they have attained moral sensitivity within this framework?

The nurse is able to perceive ethical issues even when these are subtle.

A student nurse who is soon to graduate is completing a preceptorship with a nurse who has many years of clinical experience. The student has marveled at the nurse's ability to derive meaning from complex and rapidly changing situations, relying heavily on nurse intuition. What characteristic of this nurse does this ability demonstrate most clearly?

The nurse is an expert, according to Benner's novice-to-expert model of development.

For which scenario will the nurse consult resources from the American Nurses Association?

The nurse is unsure whether a particular intervention is in the nursing scope of practice.

A nurse is distraught that she failed to intervene promptly in a situation where a client's status declined sharply. The client was becoming agitated and aggressive. The nurse states, "There was just too much going on, all at once, and I basically froze and then panicked." What interpretation of this event is most accurate?

The speed and complexity of the situation overwhelmed the nurse's cognitive load.

A student nurse has been challenged to apply the principles of critical thinking during laboratory simulations. What characteristic of the student nurse's actions suggests that the student nurse engaged in critical thinking?

The student nurse thought systematically and reflectively before deciding what to do.

A nursing student is moving through a curriculum that emphasizes the value of experiential learning. The nursing student is consciously linking previous experiences with new and transformative practices. How will the nursing student link experiences with transformative behaviors?

by engaging in frequent and thoughtful reflection

A hospital client who requires assistance with hygiene has expressed a preference for receiving a bed bath after lunch rather than in the morning. The nurse has consequently changed the nursing care plan. The nurse's action reflects which QSEN competency?

client-centered care

What action by the nurse in a hospital setting best exemplifies the goals of the Interprofessional Education Collaborative (IPEC) core competencies?

coordinating with the physical therapist to amend a client's activity orders in the plan of care

The nurse is describing a clinical encounter, stating, "I entered the room, gathered assessment data, and then provided the interventions specified in standard operating procedures." The nurse is applying which conceptualization of clinical decision-making?

information-processing model

The nurse has provided analgesia to a client who was reporting pain, and the nurse used the NCSBN Clinical Judgment Measurement Model (CJMM) to inform the process. What action by the nurse represents the final step in this model?

evaluating the client's pain 30 minutes after administering the analgesia

For the purposes of planning a client's care, which factor will the nurse categorize as an etiologic factor?

increased mucus production

A nursing student is learning to apply the Clinical Judgment Action Model (CJAM) in clinical practice. When applying this model, the nursing student will be encouraged to align the steps of the Clinical Judgment Measurement Model with the:

situational and contextual factors surrounding the client.