139 Chapter 13 Questions

7. A client comes to the emergency department reporting severe chest pain. The nurse asks the client questions and takes vital signs. Which step of the nursing process is the nurse demonstrating? A. Assessing B. Diagnosing C. Planning D. Implementing

A Rationale: Assessment, the systematic and continuous collection and communication of data, such as asking questions and obtaining vital signs, allows analysis of data to identify problems and strengths of clients, which is diagnosing. During outcome identification and planning, the nurse and client mutually identify expected outcomes and agree on nursing interventions necessary to meet these outcomes. The nurse implements the care plan, adapting it to each person, documenting nursing actions and client responses. After implementation, the nurse and client evaluate the effectiveness of the plan based on achievement of outcomes, and determine whether the plan should be continued, modified, or terminated. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Reference: p. 377

15. What is a systematic way to form and shape one's thinking? A. Critical thinking B. Intuitive thinking C. Trial and error D. Interpersonal values

A Rationale: Critical thinking is defined as "a systematic way to form and shape one's thinking. It functions purposefully and exactingly. It is thought that is disciplined, comprehensive, based on intellectual standards, and, as a result, well-reasoned." Intuitive thinking is a feeling (a sense) that doesn't use rational processes such as facts and data. Intuition comes from years of knowledge and experience that allow a nurse to understand how clients and the world works. Trial and error is a fundamental method of problem solving. It is characterized by repeated, varied attempts that are continued until success or until the agent stops trying. Interpersonal values are the kinds of human relationships that are considered important by the client or nurse. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Remember Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 350

3. A client who has been admitted to the hospital for the treatment of a gastrointestinal bleed requires a transfusion of packed red blood cells. Which aspect of the nurse's execution of this order demonstrates technical skill? A. Starting a new, large-gauge intravenous site on the client and priming the infusion tubing B. Understanding the Rh system that underlies the client's blood type C. Ensuring that informed consent has been obtained and properly filed in the client's chart D. Explaining the process that will be involved in preparing and administering the transfusion

A Rationale: Performing tasks that require manual dexterity is a manifestation of technical skills. Explaining the transfusion process largely depends on interpersonal skills, whereas understanding the theory behind blood types is indicative of cognitive skills. Informed consent lies within the domain of legal/ethical skills. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Integrated Process: Nursing Process Reference: p. 354

2. A nurse has come on day shift and is assessing the client's intravenous setup. The nurse notes that there is a mini-bag of the client's antibiotic hanging as a piggyback, but that the bag is still full. The nurse examines the client's medication administration record (MAR) and concludes that the night nurse likely hung the antibiotic but failed to start the infusion. As a result, the antibiotic is 3 hours late and the nurse has consequently filled out an incident report. In doing so, the nurse has exhibited which type of skills? A. Ethical/legal skills B. Technical skills C. Interpersonal skills D. Cognitive skills

A Rationale: Reporting problems and unacceptable practices is an aspect of ethical/legal skills. Technical skills enable the safe performance of kinesthetic tasks while interpersonal skills are the manifestations of caring. Cognitive skills encompass knowledge and critical thinking. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Safety and Infection Control Integrated Process: Nursing Process Reference: p. 358

23. When the nurse assesses the client's blood glucose level, what is the term for the type of skill the nurse is using? A. Technical B. Cognitive C. Ethical D. Interpersonal

A Rationale: Technical skills involve the performance of psychomotor actions learned through training and practice. Cognitive skills relate to the ability to think critically about a situation. Ethical skills relate to the ability to act in ways that conform to personal, professional, and societal norms. Interpersonal skills pertain to the ability to relate effectively with clients and other members of the health care team. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Reference: p. 354

22. After completing an assessment of a client, which finding should the nurse determine is the priority for care? A. Severe bleeding from a wound B. History of asthma C. Diabetes D. Lack of family support

A Rationale: The client's problem is considered to be of high priority if it is life threatening, requires more intervention time, or has serious consequences. The severe bleeding from a wound would be the highest priority. The client's history of asthma, diabetes, and lack of family support may be important, but the bleeding is the priority. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 366

39. The nurse prepares a concept map for a client who is newly diagnosed with atrial fibrillation. According to the concept map pictured above, what is the highest prioritized nursing diagnosis? A. Decreased cardiac output B. Anxiety C. Deficient knowledge D. Risk for bleeding

A Rationale: The highest prioritized nursing diagnosis is labeled #1, and that is Decreased Cardiac Output. This is according to Maslow's hierarchy of needs. Cardiac output is a physiologic need. Anxiety, Deficient Knowledge, and Risk for Fall or Bleeding can be considered safety needs, with anxiety being a concern over one's safety. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 371

1. The nurse uses evidence-based practice findings in the development of a care plan. This is an example of which type of nursing skill? A. Cognitive skill B. Technical skill C. Interpersonal skill D. Ethical or legal skill

A Rationale: The nurse is demonstrating the use of cognitive skills, which are characterized by identifying scientific rationales for the client's plan of care, selecting nursing interventions that are most likely to yield the desired outcomes, and using critical thinking to solve problems. Technical skills focus on manipulating equipment skillfully to produce a desired outcome. Interpersonal skills are used to establish and maintain a caring relationship. Ethically and legally skilled nurses conduct themselves in a manner consistent with their personal moral code and professional role responsibilities. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 350

17. A nurse is asked to perform a skill for which the nurse is not prepared. When using the method of critical thinking, what would be the first step to resolve the situation? A. Purpose of thinking B. Adequacy of knowledge C. Potential problems D. Helpful resources

A Rationale: The nurse's first step when thinking critically about a situation is to identify the purpose or goal of the thinking. This helps the nurse to direct all thoughts toward the goal. The skills needed to be able to think critically include observation, analysis, interpretation, reflection, evaluation, inference, explanation, problem solving, and decision making. Knowledge is necessary to interpret the analysis. Potential problems and helpful resources are useful in the process but follow identification of the purpose of thinking. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 377

4. In which situation would the nurse be most justified in implementing trial-and-error problem solving? A. The nurse is attempting to landmark the apical pulse for a client whose BMI higher than 30. B. The nurse is attempting to determine the range of motion of a client's hip joint following hip surgery. C. The nurse is attempting to determine which as-needed analgesic to offer a client who is in pain. D. The nurse is attempting to determine whether a client has a swallowing deficit after experiencing a stroke.

A Rationale: Trial-and-error problem solving can be dangerous to the client. Testing range of motion by trial-and-error could result in dislocation, trial-and-error drug administration could result in over- or undermedicating, trial-and-error assessment of a potential swallowing deficit could result in aspiration. Each of these situations warrants more systematic problem solving. Trial-and-error landmarking of an anatomically difficult point, such as the apex of a client's heart, does not pose a threat to the client and a reasonable amount of "hunting" for the apical pulse may be necessary. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 362

29. Which statements are examples of the nurse's reflections in action? Select all that apply. A. The client's monitor exhibits an abnormal rhythm. I will assess the client now. B. The client states, "I am going to kill myself with a gun.'' I immediately ask, 'Do you have access to a gun?" C. The client had been crying and tried to hide it from me. I kept quiet. Next time I will ask about the crying. D. I started an intravenous access site on a client who has been on long-term steroid therapy. I was excited to be successful. E. I almost made a medication error. I did not realize how easy this is to do. Now I am afraid I will make an error.

A, B Rationale: Reflections in action happen now. The correct options are the nurse immediately assessing the client who has an abnormal rhythm and the nurse asking the client whether the client has access to a gun. Reflections on action occur after the fact and involve thinking through a situation that occurred in the past. Examples of reflections on action include the nurse who was excited to be successful at starting an intravenous access site and the nurse who almost made a medication error and is now afraid about making another error. Reflection for action is thinking about future actions after thinking through a situation. An example of reflection for action is the nurse who will ask the client about crying. Question format: Multiple Select Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 371

35. The nurse uses the nursing process to provide care to clients. What are the nursing benefits when the nurse does this? Select all that apply. A. The plan is clear and efficient to other health care professionals who read it. B. Best results can be achieved for the client. C. The nurse obtains satisfaction by impacting the client's life in a positive manner. D. Minimal growth is obtained as a professional. E. The agency makes a greater profit by charging the client more to implement the plan.

A, B, C Rationale: Humans benefit from the use of the nursing process. Benefits include satisfaction in positively impacting another's life and achieving best results for the client. The plan is clear and efficient to nurses and other health care professionals. The nurse achieves growth as a professional. The nursing process is a cost-effective plan for the client and agency. Question format: Multiple Select Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 369

24. Which nursing actions are potential errors in the decision-making process? Select all that apply. A. Placing emphasis on the first data received B. Avoiding information contrary to one's opinion C. Selecting alternatives to maintain status quo D. Being predisposed to multiple solutions E. Prioritizing problems in order of importance

A, B, C Rationale: Potential errors in decision making include bias. This would be placing emphasis on the first data received, avoiding information contrary to one's opinion, and selecting alternatives to maintain status quo. Being predisposed to multiple solutions will help to prevent errors in the decision-making process. When the nurse prioritizes problems in order of importance, the nurse is considering the total situation. This also helps to prevent errors in the decision-making process. Question format: Multiple Select Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Remember Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 351

27. Which statements describe the nurse applying critical thinking to clinical reasoning and judgment in nursing practice? Select all that apply. A. The nurse is guided by standards, policies and procedures, ethics codes, and the state nurse practice act. B. The nurse demonstrates use of nursing process, problem solving, and the scientific method. C. The nurse identifies key problems, issues, and risks involved. D. The nurse includes the client only in the decision making process. E. The nurse accepts the results of decisions made and does not open his or her mind to other options.

A, B, C Rationale: The nurse who applies critical thinking to clinical reasoning and judgement is guided by standards, policies and procedures, ethics codes, and laws (states' nurse practice acts). The nurse uses nursing process, problem solving, and the scientific method when making decisions. The nurse also identifies the key problems, issues, and risks involved. Clients, families, and major care providers are involved in decision making. The nurse is constantly re-evaluating, self-correcting, and striving to improve. The nurse keeps his or her mind open to other options. Question format: Multiple Select Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 360

30. Using the nursing process, place in order the steps in concept map care planning. Use all options. A. Develop a graph that has boxes for key problems and nursing diagnoses. B. Analyze and categorize the client data, including prioritizing nursing diagnoses. C. Analyze relationships among the nursing diagnoses and draw lines among the boxes. D. Identify goals or outcomes and interventions for each nursing diagnosis. E. Evaluate the client's response.

A, B, C, D, E Rationale: A concept map is a visual diagram that includes the client's medical and nursing diagnoses and pertinent assessment data. The first step is to develop a basic skeleton diagram. The next step is to analyze and categorize data. The nurse next analyzes relationships among nursing diagnoses. Next, the nurse identifies goals or outcomes, as well as interventions. The last step is to evaluate the client's responses. Question format: Drag and Drop Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 370

26. The client has experienced a fasting blood sugar in excess of 300 mg/dl (16.65 mmol/l) and is now diagnosed as having diabetes. The nurse plans care for this client based on the nursing concern of the client's knowledge deficit. Place in order the actions of using the nursing process for this client. Use all options. A. The client's blood sugar is over 300 mg/dl (16.65 mmol/l). The client is diagnosed as having diabetes. The nurse assesses the client's understanding as having no previous exposure to diabetes or care to manage health problems. B. The nurse analyzed the data and determined this client has multiple problems requiring education. The nurse writes one of the nursing concerns is a knowledge deficit related to client's lack of exposure as evidenced by verbalizing inaccurate information. C. The nurse addresses the client's learning needs by writing outcomes and education plans that involve disease process, self-monitoring of blood glucose, medications, diet, and checking the feet daily. D. The nurse teaches the client addressing all domains—affective, cognitive, and psychomotor. E. The nurse evaluates the client as achieving or not achieving each outcome.

A, B, C, D, E Rationale: The nurse follows the nursing process guidelines when working with a client who has learning needs. Assessment is first. Then, the nurse analyzes the data and determines nursing concerns that are appropriate for this client. The nurse makes a plan that includes outcomes and interventions. The next step is to intervene. After teaching the client, the nurse evaluates effectiveness and determines if the learned outcome has been achieved. Question format: Drag and Drop Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 366

33. The nurse is using the nursing process when providing care to a client. Place in order the nurse's actions. Use all options. A. The nurse assesses the client as having difficulty with speech, swallowing, and right eye drooping. A computed tomography scan indicates decreased perfusion to the brain. B. The nurse analyzes the data and identifies the nursing concern as altered perfusion of cerebral tissue related to ischemia. C. The nurse writes the outcome "Cerebral perfusion will be maintained prior to discharge" and plans interventions that include monitoring vital signs, pulse oximetry, and pupil response, completing a stroke scale, keeping head of bed elevated to 30 degrees, and administering an antihypertensive medication. D. The nurse intervenes by administering an antihypertensive medication. E. The nurse evaluates that vital signs are within normal limits, oxygen saturation level is 94% (0.94), pupils are equal and reactive, client's speech, swallowing, and eye drooping have not worsened. Cerebral perfusion is maintained. Continue with the plan.

A, B, C, D, E Rationale: The nursing process, in order, is: assessing, diagnosing, outcome identification and planning, implementing, and evaluating. Thus, the nurse first assesses the client's problem of difficulty. Next, the nurse develops a nursing concern in relation to the client's problem. The third step is identifying an outcome and planning appropriate interventions such as assessments, administration of medications and treatments, teaching, and collaborating with other health care professionals. The fourth step is implementing, such as administration of a medication. The last step in the nursing process is evaluating effectiveness of the nursing care plan. Question format: Drag and Drop Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 366

34. The nurse uses the nursing process to provide care to clients. What are the benefits for the clients? Select all that apply. A. The client receives care that is evidence-based. B. Care is individualized for the client. C. The nurse collaborates only with other nurses to provide care. D. The nurse provides care that is consistent for the client. E. Care is specialized and focuses on one main problem of the client.

A, B, D Rationale: The client benefits from the nurse's use of the nursing process. Benefits for the client include nursing care that is researched, based on evidence, and individualized. Nursing care is planned and consistent. When using the nursing process, the nurse collaborates with the client about the client's care and care is holistic, not focused solely on one main problem. Question format: Multiple Select Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Remember Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 369

40. The nurse is caring for a client who has left-sided weakness due to a recent cerebrovascular accident (CVA). The client has been admitted to the hospital for a urinary tract infection and has been experiencing urinary incontinence. The client prefers to walk without mobility aids. When preparing the client's nursing care plan, which actual and potential problem(s) will the nurse include? Select all that apply. A. impaired urinary elimination due to urinary tract infection as evidenced by urinating in bed and while ambulating B. risk for fall related to left-sided weakness and ambulating without mobility aids C. risk for pyelonephritis related to urinary tract infection D. impaired compliance with use of ambulatory aids to assist with walking E. risk for disturbed sleep pattern related to urinary urgency and frequency

A, B, E Rationale: A problem-focused nursing diagnostic statement contains three parts, sometimes referred to as PES: (1) P: Name of the health-related issue or problem as identified in the list, (2) E: Etiology (the problem's cause), and (3) S: Signs and symptoms, also called defining characteristics. In risk nursing diagnoses, the signs or symptoms have not yet manifested. The factors that place the client at risk, however, are identified in the nursing assessment documentation. Syndrome diagnoses and health promotion diagnoses are not linked with an etiology or signs and symptoms. From the data provided, the nurse can identify both actual problems (nursing diagnoses) and potential problems (risk diagnoses). It is not within the nursing scope of practice to identify a potential medical diagnosis within the nursing diagnosis, even if it is documented as a risk diagnosis. The problem "impaired compliance" is not recognized as a nursing diagnosis. Further to this, instead of documenting this as an actual client problem, the nurse would seek to uncover the basis for the client's lack of use of mobility aids. With this, the nurse may identify a knowledge deficit or need for referral to an allied health care provider to educate the client on effective use of the device. Question format: Multiple Select Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 366

38. The nurse is writing a concept map. Which data are related to assessment and identified as such on the concept map? Select all that apply. A. Lung sounds clear B. Has a history of diabetes C. Encourage use of an incentive spirometer every 2 hours D. Sit in a chair for all meals, assist to the bathroom E. Incision intact and without redness, drainage

A, B, E Rationale: Assessment data are information gathered from performing assessments on the client and include lung sounds, history of diabetes, and incision description. All provide information about the client's health status. The use of an incentive spirometer and instructions to have the client sit in a chair and be assisted to the bathroom are nursing interventions, not assessment data. They would be written as nursing interventions for the client problems. Question format: Multiple Select Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 371

32. What are attributes of a professional nurse? Select all that apply. A. Is willing to learn from clients B. Advocates for only those clients who deserve the nurse C. Is aware of how beliefs and values influence others D. Is motivated to provide the best of one's abilities E. Accepts responsibility for one's actions

A, C, D, E Rationale: Attributes of a professional nurse include the willingness to learn from clients, awareness of how beliefs and values influence others, motivation to provide the best of one's abilities, and acceptance of responsibility for one's own actions. The professional nurse is an advocate for all clients and believes all clients are deserving of the nurse's care. Question format: Multiple Select Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Remember Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 349

36. Which statements are accurate regarding the concept of caring? Select all that apply. A. There is no universally accepted definition of caring. B. Caring is limited to providing for physical needs. C. Caring is being sensitive to self and others. D. Nursing education, practice, and research are guided by caring. E. Caring creates a climate for establishing a commitment to healing.

A, C, D, E Rationale: There are many theories about the concept of caring. There is no universally accepted definition for caring. Caring is being sensitive to self and others. Caring guides nursing education, practice, and research. Caring creates a climate for establishing a commitment to healing. Caring encompasses all dimensions of humanity—physical, psychological, socioeconomic, cultural, and spiritual. Question format: Multiple Select Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Remember Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Caring Reference: p. 348

8. After examining a child 2 years of age and based on findings, the nurse identifies a potential problem with normal growth and development. Which step of the nursing process does this identification of a potential problem represent? A. Assessing B. Diagnosing C. Planning D. Implementing

B Rationale: After assessing the need for nursing care, the nurse clearly identifies client strengths and actual and potential problems in diagnoses, which is the step of diagnosing in the nursing process. Assessment is careful observation and evaluation of a client's health status. Planning involves setting priorities, defining expected (desired) outcomes (goals), determining specific nursing interventions, and recording the plan of care. Implementation means carrying out the written plan of care, performing interventions, monitoring the client's status, and assessing and reassessing the client before, during, and after treatments. Evaluation is the assessment and review of the quality and suitability of the care given and the client's responses to that care. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Reference: p. 364

13. A nurse interviews a pregnant adolescent client and documents the answers on the client record. At the same time, the nurse responds to the client's concerns and makes a referral for counseling and prenatal care. Of which characteristic of the nursing process is this an example? A. systematic B. dynamic C. outcome-oriented D. universally applicable

B Rationale: Although the nursing process is an orderly, systematic progression of steps, there is also great interaction and overlapping among the five steps. No one step in the nursing process is a one-time phenomenon. Each step flows into the next step. In some nursing situations, all five steps occur almost simultaneously and are considered dynamic. Dynamic is characterized by constant change, activity, or progress, as illustrated in this scenario, in which the nurse assesses the client, diagnoses (informally) the client's concerns, and plans and implements interventions all in the same visit. Outcome-oriented describes the evaluation phase of the nursing process, which is not depicted in this scenario. Universally applicable is another characteristic not depicted in this situation. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 367

5. What nursing organization first legitimized the use of the nursing process? A. National League for Nursing B. American Nurses Association C. International Council of Nursing D. State Board of Nursing

B Rationale: Although the term "nursing process" was first used by Lydia Hall in 1955, and nursing theorists delineated specific steps in a process approach to nursing, use of the nursing process was legitimized in 1973, when the American Nurses Association's Congress for Nursing Practice developed Standards of Practice to guide nursing performance. The National League for Nursing is a national organization for faculty nurses and leaders in nurse education. The International Council of Nurses is a federation of more than 130 national nurses associations. State boards of nursing accredit nursing schools. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Remember Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 364

16. Which step in the nursing process is most closely associated with cognitively skilled nurses? A. Assessing B. Planning C. Implementing D. Evaluating

B Rationale: Cognitively skilled nurses are critical thinkers and are able to select those nursing interventions that are most likely to yield the desired outcomes, which occurs in the planning stage of the nursing process. Assessment requires a combination of interpersonal and technical skills in gathering objective and subjective data. Implementation relies heavily on technical, psychomotor, and teaching/communicating skills. Evaluation requires critical thinking, as well, in evaluating how well the plan of care was implemented and whether changes occurred, but not as much as planning, in which the outcomes that are measured in the evaluation phase are developed. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 350

9. A home health nurse reviews the nursing care plan with the client and family. Then they mutually discuss the expected outcomes of the nursing care to be provided. Which step of the nursing process is the nurse illustrating? A. Diagnosing B. Planning C. Implementing D. Evaluating

B Rationale: During the planning step, the nurse identifies expected outcomes of the plan of care. The plan of care should be holistic and individualized, specify desired client goals and related outcomes, and identify the nursing interventions most likely to meet those expected outcomes. Assessment is careful observation and evaluation of a client's health status. Implementation means carrying out the written plan of care, performing interventions, monitoring the client's status, and assessing and reassessing the client before, during, and after treatments. Evaluation is the assessment and review of the quality and suitability of the care given and the client's responses to that care. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 364

14. On walking into the room of a client, an experienced nurse has a strong sense that something is going wrong with the client. Which type of clinical decision making is the nurse demonstrating? A. Trial-and-error problem solving B. Intuitive thinking C. Scientific problem solving D. Methodical reasoning

B Rationale: Nurses today acknowledge the role of intuitive thinking in clinical decision making. Many veteran nurses can describe situations in which an "inner prompting" led to a quick nursing intervention that saved a client's life. However, intuitive problem solving comes with years of practice and observation. Trial-and-error problem solving is characterized by repeated, varied attempts which are continued until success. An example of this is a nurse placing an intravenous catheter. Scientific problem solving is a step-by-step approach consisting of (1) identifying and defining a problem, (2) accumulating relevant data, (3) formulating a tentative hypothesis, (4) conducting experiments to test the hypothesis, (5) interpreting the results objectively, and (6) repeating the steps until an acceptable solution is achieved. Methodical problem solving uses concepts such as paradigm, theoretical model, phases, and quantitative or qualitative techniques. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Understand Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Reference: p. 362

21. The nurse, after gathering data, analyzes the information to derive meaning. The nurse is involved in which phase of the nursing process? A. Planning B. Diagnosis C. Implementation D. Outcome identification

B Rationale: The diagnosis phase involves the analysis of information and deriving the meaning from the analysis. The planning phase involves preparing a care plan and directing the nursing staff in providing care. The implementation phase involves initiation, evaluation of response to the plan, record of nursing actions, and client response to actions. Outcome identification involves formulating and documenting measurable, realistic, client-focused goals. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 366

37. The Quality and Safety Education for Nurses (QSEN) project has developed quality and safety competency categories. What are the quality and safety competency categories that students are encouraged to develop during prelicensure education? Select all that apply. A. Nursing process B. Patient-centered care C. Therapeutic communication D. Teamwork and collaboration E. Evidence-based practice F. Quality improvement

B, D, E, F Rationale: QSEN has identified quality and safety competency categories for education. In prelicensure nursing programs, students learn using the quality and safety competency categories of patient-centered care, teamwork and collaboration, evidence-based practice, and quality improvement. Nursing process and therapeutic communication were not identified as quality and safety competency categories. Question format: Multiple Select Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Remember Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 358

19. For a new nurse, what is essential to the mastery of technical skills, such as giving an injection? A. Read the steps of the procedure before clinical assignments. B. Act as if one knows how to perform the skill. C. Practice performing the skill in a safe environment until comfortable doing it. D. Tell the charge nurse that the nurse will never be able to give an injection.

C Rationale: Before attempting to perform a technical skill with or on a client, the nurse must practice that skill until the nurse feels confident doing it. Practicing the skill in a safe environment is recommended prior to performing the skill on a client. Telling the instructor that the nurse will never be able to give an injection is not appropriate. Nurses are expected to perform a variety of skills in the health care setting. The nurse should not pretend to know what to do if the nurse does not feel comfortable performing the skill. The nurse should read the steps for the injection process prior to practicing the skill, but the practicing is what is essential to mastering the skill. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Safety and Infection Control Integrated Process: Nursing Process Reference: p. 354

10. Based on an established plan of care, a nurse turns a client every 2 hours. Which part of the nursing process is the nurse using? A. Assessing B. Planning C. Implementing D. Evaluating

C Rationale: During the implementing step of the nursing process, the nurse carries out interventions that were developed during the planning step. Assessing is collecting information, such as vital signs and laboratory values. Planning is developing interventions focused on the assessment. Evaluating is the last stage, in which the nurse evaluates the plan of care. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Apply Client Needs: Physiological Integrity: Basic Care and Comfort Integrated Process: Nursing Process Reference: p. 364

41. A nurse cares for a client with congestive heart failure. The nurse administers a prescribed dose of furosemide intravenously after noting an increase in dyspnea and audible wheezing. The nurse's action demonstrates which step in the nursing process? A. assessment B. planning C. implementation D. evaluation

C Rationale: Implementation refers to the action phase of the nursing process, in which nursing care is provided. After noting the symptoms of acute pulmonary edema, the nurse has made a clinical decision to administer a medication that is intended to decrease the hypervolemia that has led to a buildup of fluid in the lungs causing respiratory distress in the client. The working of gathering the data about the cluster of clinical symptoms is the assessment step in the nursing process. It is here where the nurse notices abnormalities and gathers a set of data and make a decision about which interventions are required. Planning is the step in between gathering the data (assessment) and taking an action (implementation). In this step the nurse is using the cluster of data to formulate and execute the appropriate intervention. Evaluation occurs after intervention to determine the effectiveness of nursing care and need for adjustment or further action. In this step, after administering the furosemide, the nurse would conduct another assessment of the client's airway, circulation and breathing to determine if the intervention was effective. If the problem is not alleviated, the nurse will engage in the nursing process cycle again, using either the same or alternative interventions with the aim of achieving care plan goals. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 366

12. How should the nurse ensure that care is not legally negligent? A. Verbally reporting assessments to the client's physician B. Keeping private notes about the care given to each assigned client C. Documenting the nursing actions in the client's record D. Tape recording complete information for each oncoming shift

C Rationale: Legally speaking, a nursing action not documented in the client's record is a nursing action not performed. Unless the record contains written (not verbal, tape-recorded, or private notes) documentation of care provided, the court would have no reason to accept a nurse's claim that the care was given. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Communication and Documentation Reference: p. 368

31. The client is being seen in an outpatient clinic. The client reports experiencing vomiting and diarrhea for several days. The nurse completes the assessment and advises the client to drink an oral electrolyte solution. Which type of problem solving has the nurse used? A. Creative thinking B. Trial-and-error C. Scientific D. Intuitive

C Rationale: Scientific problem solving is a systematic process. Nursing process is an example of scientific problem solving that involves making decisions based on evidence. The nurse advising the client to drink an oral electrolyte solution following assessment is an example of scientific problem solving. Drinking an oral electrolyte solution to replace fluids lost in vomiting and diarrhea has been researched. Trial-and-error problem solving is testing various solutions until a viable one is found. An oral electrolyte solution is an effective treatment for dehydration. Intuitive problem solving is "gut instinct." However, the nurse has been educated about evidence-based treatments for dehydration. Creative thinking may be used when conventional solutions have not resolved the situation. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Reference: p. 362

6. Which group of terms best describes the nursing process? A. Nursing goals, medical terminology, linear B. Nurse-centered, single focus, blended skills C. Patient-centered, systematic, outcome-oriented D. Family-centered, single point in time, intuitive

C Rationale: The nursing process is a patient-centered, systematic, outcome-oriented method of caring that provides a framework for nursing practice. It is nursing practice in action. It is not nurse- or family-centered. It is focused on client, not nursing, goals. It has multiple foci, not just one focus. Although the nursing process is presented as an orderly and linear progression of steps, in reality, there is great interaction and overlapping among the five steps. No single step in the nursing process is a one-time phenomenon, each step flows into the next step. In some nursing situations, all five stages occur almost simultaneously. Nursing practice requires the use of blended competencies, not blended skills. The nursing process is systematic, not intuitive. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 366

20. Which interpersonal skill is essential to the practice of nursing? A. Performing technical skills knowledgeably and safely B. Maintaining emotional distance from clients and families C. Keeping personal information among shared clients confidential D. Promoting the dignity and respect of clients as people

D Rationale: Characteristics of interpersonal caring that are essential to the practice of nursing include promoting the dignity and respect of clients as people, the centrality of the caring relationship, and a mutual enrichment of both participants in the nurse-client relationship. Keeping emotional distance is not part of the caring component of nursing. Keeping clients' personal information confidential is an ethical and legal skill. Performing technical skills is essential, but technical skills are not interpersonal skills. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Apply Client Needs: Psychosocial Integrity Integrated Process: Nursing Process Reference: p. 355

11. Which statement indicates that a plan to assist a client in developing and following an exercise program has been effective? A. "I have just been too busy to do my daily exercises." B. "I guess I will begin the activity we discussed next week." C. "I know I should exercise, but my health is not very good." D. "I have lost 10 pounds (4.5 kg) because I walk 2 miles (3.2 km) every day."

D Rationale: During the evaluation step of the nursing process, the nurse evaluates the effectiveness of the plan of care in terms of client goal achievement. Only the client statement indicating positive and measurable results provides evidence that the exercise program has been effective. Excuses for not exercising and statements indicating procrastination do not provide evidence that the exercise program has been effective. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 366

28. The nurse maintains a journal in which to reflect on the nurse's clinical practice. Which entry is an example of reflection for action? A. "The client's son reported to me that the client needed medication for postoperative pain." B. "It has been over 4 hours since I have medicated the client for pain." C. "I obtained the medication. When I got to the room, the client was sleeping. I refused to give the medication." D. "Next time I will assess the client before obtaining the medication."

D Rationale: The entry which indicates reflection for action is the one in which the nurse writes about future actions. This is the nurse writing, "next time..." All of the other entries are reflection on action. The reflections on action are after the fact and involve thinking through a situation. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 371

25. What is the most important reason for the nurse to develop critical thinking and clinical reasoning? A. To be able to employ the nursing process in client care B. To meet the requirements of the licensing examination C. To become the experts in care whom clients deserve D. To provide quality care with nursing ability and knowledge

D Rationale: The goal of all nursing is to meet the standard of quality care. All of the answers contain valid reasons for developing clinical reasoning and critical thinking, but the most important goal in health care is to provide quality nursing care to clients. The nursing licensing examination is a an exam to assess the safety of nursing care using critical thinking for a generalist who graduates from a nursing program. The nursing process guides the development of care plans using critical thinking in the process. Over time, a beginning nurse develops into an expert nurse. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 360

18. Many members of the staff on a hospital unit are critical of a client's family, who has different cultural beliefs about health and illness. A new nurse assigned to the client, however, does not agree with the other members of the staff, based on the nurse's own experience in caring for the client and family. Which critical thinking attitude is the nurse demonstrating? A. Being curious and persevering B. Being creative C. Demonstrating confidence D. Thinking independently

D Rationale: The nurse is thinking independently. Nurses who are independent thinkers are careful not to let the status quo or a persuasive individual control their thinking. Being curious, persevering, creative, and having confidence are all components of critical thinking but are not most pertinent in this scenario. Question format: Multiple Choice Chapter 13: Blended Competencies, Clinical Reasoning and Processes of Person-Centered Care Cognitive Level: Apply Client Needs: Psychosocial Integrity Integrated Process: Nursing Process Reference: p. 351