chapter 14 prep you
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 group of student nurses have been asked to create written reflections on their clinical practice experiences through the lens of Rest's framework. Which prompt question is most appropriate for these students?
"Am I thinking and behaving like a moral person?"
A nursing student has been providing care for several clients in both community and hospital settings. For which client will the nurse use a concept map when planning and providing care?
community-dwelling client with complex physical and psychosocial needs
A new nursing student has been surprised to learn that reflective journaling is a component of the curriculum. The student states to a colleague, "We would be better off spending our time working on our skills than writing in a journal." What benefit(s) of reflective journaling should the colleague describe to this somewhat frustrated student? Select all that apply.
"It can help you better understand your progress toward your learning goals." "Reflection through journaling can help you draw more learning out of your experiences." "Journaling can bring to mind aspects of a clinical experience that escaped you in the moment."
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."
A nursing student observed a staff nurse change a client's IV dressing. During post-conference, the student remarked to a classmate, "The nurse did not even follow the process we learned in lab!" What is the classmate's most appropriate response?
"You should consider some of the factors that might have influenced the nurse's action.
A novice nurse is being mentored by a more experienced nurse who is able to recognize small but significant client cues and process large amounts of data in a short time. What conclusion(s) should the novice nurse draw about the more experienced nurse's practice? Select all that apply.
-The nurse has a high capacity for cognitive load. -The nurse has well-developed situational awareness.
An experienced nurse who provides care on a busy hospital unit has a well-deserved reputation for having advanced situational awareness. What characteristic(s) of the nurse indicates that they possess situational awareness? Select all that apply.
-The nurse has the ability to recognize subtle client cues. -Other staff members acknowledge this nurse's ability to sort "signal" from "noise." -The nurse can rapidly recognize and process large amounts of client data.
The psychiatric-mental health nurse is planning care for an adult client. Which aspect(s) of the client's circumstances does the nurse consider to be a sign or symptom? Select all that apply
-delayed responses to questions -expressions of hopelessness
The nurse is applying the NCSBN's Clinical Judgment Measurement Model during an encounter with a client. Place the steps of the Clinical Judgment Measurement Model in the correct sequence. Use all options.
-recognize cues analyze cues -prioritize hypotheses -generate solutions -take actions -evaluate outcomes
A community health nurse has recommended a specific, medicated wound-care product to a client with a chronic venous ulcer. A colleague has asserted that the nurse has exceeded the scope of practice. The two nurses should consult resources from what organization to resolve this dispute about the scope of practice?
American Nurses Association
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
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.
A nurse is conscientious in applying the Quality and Safety Education for Nurses (QSEN) competencies to the provision of clinical care. To enact the value of quality improvement, the nurse should perform what action?
Advocate for changes to shift handoff so that the process is more efficient.
A nursing student is progressing through a BSN curriculum that was engineered to align with 10 specific domains of competency and their associated featured concepts. This student's nursing curriculum is directly informed by the:
American Association of Colleges of Nursing's Essentials.
A nurse has just graduated and will be starting a new job in a clinical setting. The nurse states, "I want to be intentional about getting beyond being a novice and eventually progressing to be an expert nurse." Which action will support the nurse's goal?
Become familiar with Benner's model of nurse development.
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 nursing student has conscientiously learned and practiced the procedure for performing a sterile dressing change. In the clinical setting, the student has been surprised to observe that an experienced nurse does not adhere to this procedure. What should the student do in this situation?
Consider the foundational principles and contextual factors that may have informed the nurse's actions.
The nursing student is planning care for a client who has complex needs and a lengthy medical history. To integrate the pathophysiology, evolving clinical manifestations, laboratory values, diagnostic tests, and nursing actions, the student should use which strategy?
Create a concept map.
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.
A new graduate is working in a public health unit that is staffed by several experienced nurses. Which description demonstrates that the nurse has attained the status of "expert" according to Benner's novice-to-expert model of nurse development?
a nurse who can consistently apply intuition to complex nursing situations
A home health nurse has entered a client's home and rapidly noticed some significant characteristics of the client's home setting and the client's appearance. When applying Tanner's model of clinical judgment, what should the nurse do next?
Interpret the data to determine meaning.
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 nurse is participating on a task force that has been formed at a hospital to increase interdisciplinary collaboration. Specifically, the task force is pursuing the competencies of the Interprofessional Education Collaborative (IPEC). What goal indicates achievement of these competencies?
Members of diverse disciplines will collaborate on decision-making in an environment of mutual respect.
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
A student nurse has been benefiting from the experiential learning in the simulation laboratory. In this setting, the student has gained a wide variety of experiences and has the goal of transforming nursing behavior. To link experiences with transformation, what will the student do?
Perform intentional personal reflection.
An experienced nurse uses cognitive continuum theory (CCT) to inform interactions with clients and families. To optimize the component of intuition in this theoretical framework, the nurse will perform what action?
Reflect carefully to uncover personal biases.
A nurse has used Tanner's clinical judgment model to frame the response to a challenging clinical situation. When enacting the final step of this process, what will the nurse do?
Reflect on-action.
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 is involved in a clinical scenario that is ethically complex and requires careful balancing between several conflicting factors. What clinical judgment model or framework will provide the most direct relevance to this nurse's circumstance?
Rest framework
The public health nurse is performing a postpartum home visit to a first-time parent who describes themselves as "awfully anxious." In alignment with Tanner's model of clinical judgment, the nurse has taken notice of the subjective and objective data that are relevant to the client's state of mind. Before responding by providing interventions, which action will the nurse take?
Systematically interpret the meaning of the assessment data.
A junior nursing student has learned that clinical and simulation performance will be measured according to the Lasater Clinical Judgment Rubric. This student is in a curriculum that subscribes to what model of clinical judgment?
Tanner's clinical judgment model
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 model
A novice nurse is working with a more experienced nurse who has much more clinical experience. What characteristic of the more experienced nurse demonstrates that they are an "expert," according to Benner's model of nursing development?
The experienced nurse is able to notice subtle cues and navigate complex situations quickly and skillfully.
Which description clearly indicates that the nurse is applying Tanner's Clinical Judgment Model (CJM) in clinical practice?
The nurse engages in a near-constant cycle of noticing, interpreting, and reflecting.
A nurse has been commended by a supervisor for taking prompt action to protect a client whose status declined sharply and unexpectedly. The supervisor noted how the nurse was able to notice small but significant changes in the client's status initially. What characteristic of this nurse is the most accurate descriptor?
The nurse has a well-developed sense of situational awareness.
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 nurse who graduated 4 years ago has been conscientiously building professional development. What characteristic of the nurse best demonstrates the achievement of "moral character" within Rest's model of moral reasoning?
The nurse has fully integrated their personal and professional values and characteristics.
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 progressing through a BSN curriculum that applies the Competency Outcomes and Performance Assessment Model to assess a student's competence. What outcome will provide the clearest indication of the student's competence within this model?
The student provides consistently safe client care.
A nurse has performed an assessment of a hospital client and determined that the client's peripheral IV dressing is wet. After considering various contextual factors, the nurse has chosen to reinforce the dressing and perform client education rather than replace the dressing. When applying Tanner's model of clinical judgment to this situation, at what time should the nurse perform the step of reflection on-action?
after the dressing has been reinforced and the nurse has left the room
The nurse is caring for a client who has an upper gastrointestinal bleed as a result of excessive use of nonsteroidal anti-inflammatory drugs (NSAIDs). The nurse recognizes that the root of the client's health problem is inhibited platelet action. The nurse considers the inhibited platelet action to be:
an etiologic factor.
The home health nurse is performing a home visit to a client who has been diagnosed with postpartum depression. How can the nurse best demonstrate the Quality and Safety Education for Nurses (QSEN) competency of safety during this home visit?
assessing the client's risk for suicidal ideation during the visit
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
A novice nurse has entered a two-bed hospital room to discover a client acting out physically and another client reporting a new onset of chest pain. In addition, the overhead P.A. system is reporting a code blue in a nearby room. These rapid and numerous changes are likely to immediately challenge the nurse's:
cognitive load.
A nurse has used Tanner's clinical judgment model when accepting, assessing, and providing interventions for a client in psychosis who requires chemical restraints to be administered. During what phase of the clinical interaction will reflection-on-action take place?
during the clinical debrief following the incident
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 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 nursing student has drawn on resources from many organizations while learning and practicing as a student nurse. For which action will resources from the American Nurses Association be appropriate?
determining whether an advanced wound care technique is within the scope of practice
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
The nurse applies Tanner's Clinical Judgment Model while providing care on a busy medical unit. Which of the nurse's actions demonstrates reflection-in-action?
gauging the effectiveness of a teaching session by monitoring the client's changing body language
The nurse has applied Rest's framework of moral reasoning to a clinical situation that is ethically complex. In navigating the situation, the nurse has applied each of the components of the model, including moral judgment/reasoning. By acting on this component, the nurse has also exemplified what step in the Clinical Judgment and Measurement Model (CJMM)?
generate solutions
The nurse is providing care for a client who has impaired respiration. What aspect of the client's status is considered an etiologic factor?
increased airway reactivity
For the purposes of planning a client's care, which factor will the nurse categorize as an etiologic factor?
increased mucus production
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
A nurse on a busy intensive care unit has developed a high level of situational awareness (SA) after several years of clinical experience. How will the nurse apply situational awareness to practice?
intervening or notifying another member of the team to intervene
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 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
A nursing student is providing care on a subacute step-down unit. The nursing student has received feedback that they are excessively tied to the rigid, stepwise performance of clinical tasks and fail to notice and accommodate the many contextual factors in client interactions. The nursing student is at what stage of Benner's humanistic-intuitive model of clinical judgment?
novice
Which nurse is most likely to have their situational awareness challenged by the circumstances they are currently experiencing?
novice nurse in a high-stimulation, fast-paced care environment
The community health nurse is participating in a debrief about a critical incident that involved a physical altercation with the client in the client's home. When applying Tanner's model of clinical judgment to this situation, the debriefing exercise constitutes what component of the model?
reflection on-action
A nurse's assessment of the client has revealed that the client is intensely anxious, so the nurse has administered a PRN dose of a prescribed antianxiety medication. Administering this medication constitutes which phase of Tanner's clinical judgment model?
responding
A novice nurse is committed to becoming skilled in clinical judgment. Before exercising sound clinical judgment, the nurse must develop:
situational awareness.
A nurse is navigating a busy morning on a hospital unit and is struggling to finish the necessary tasks in the time available. In response, the nurse has assigned morning hygiene tasks for two clients to an unlicensed assistive personnel (UAP). What QSEN competency is this nurse exemplifying?
teamwork and collaboration
A nursing student is in a baccalaureate nursing program and is developing knowledge and skills through experiential learning. Within the model of experiential learning, which aspect of the student's education will be considered prehension?
the accumulated experiences that the student has had
A nurse has gained extensive practice experience and is progressing through the various stages of Hammond's cognitive continuum theory (CCT). To attain the highest level of proficiency within this model, the nurse must:
uncover and address any personal biases.
