Clinical Judgement - Chapter 14 - PrepU

Tanner's Clinical Judgement Model

Noticing Interpreting Responding Reflecting

A nursing student has applied the NCSBN's Clinical Judgment Measurement Model (CJMM) to the care of a client. Which aspect(s) of this case should the student consider in layer 4 of this model? Select all that apply. a) student's previous experiences b) cultural characteristics of the client c) student's level of nursing knowledge d) time pressures e) resources available to the student

All of them are correct. Layer 4 of the NCSBN's Clinical Judgment Measurement Model (CJMM) acknowledges the wide variety of individual and environmental factors that influence clinical reasoning. These include environmental factors such as time pressures, culture and available resources, and personal factors such as knowledge and experience.

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? a) "You should consider some of the factors that might have influenced the nurse's action." b) "It is well-known that nurses begin to 'cut corners' as soon as they graduate." c) "It is best to ignore what you see nurses do in practice and instead focus on what we learned." d) "Remember that the end result is the important thing, not the way that it's done."

a) "You should consider some of the factors that might have influenced the nurse's action." It is important to consider contextual factors and the underlying principles when reflecting on differences between what the student nurse learns and what the student nurse observes in practice. This does not entail ignoring what is seen in the clinical setting, but rather reflecting on it. It is an unfair characterization of nurses that they become sloppy after becoming licensed. Finally, the means and method by which nursing care is provided are important; the end result is not the sole consideration.

A nursing student's progression through the curriculum is being evaluated according to 10 domains and their associated competencies. This curriculum is framed around resources from the: a) American Association of Colleges of Nursing. b) National Council of State Boards of Nursing. c) National League for Nursing. d) American Nurses Association.

a) American Association of Colleges of Nursing. Using a competency model originally designed for health care providers, the American Association of Colleges of Nursing (AACN) Essentials outline 10 domains and the associated competencies and subcompetencies. This particular taxonomy of competencies does not exist in the frameworks associated with the American Nurses Association (ANA), National League for Nursing (NLN), or the National Council of State Boards of Nursing (NCSBN).

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? a) Choose an intervention and then evaluate the effect of the intervention. b) Reflect on the situation before performing any further nursing actions. c) Articulate the assessment data and conclusions to the client. d) Analyze the various cues that the client is projecting.

a) Choose an intervention and then evaluate the effect of the intervention. Having performed the steps of noticing and interpreting, the nurse may progress to responding with nursing actions/interventions. Analysis of cues has already taken place during the phase of interpreting. Clear communication with the client is important, but there is no need to describe each assessment datum to the client. Reflection in Tanner's model takes place during and after nursing encounters; the progression toward action does not need to pause for reflection.

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? a) Identify a respected nursing theory to inform care. b) Hypothesize the client's most likely diagnoses and challenges. c) Gather objective and subjective assessment data. d) Select the principles that relate most closely to the client's admitting diagnosis.

a) Gather objective and subjective assessment data. Inductive reasoning requires observing, then drawing conclusions. That is, the process begins with data (such as assessment findings) and then progresses to identification of patterns or explanations. Presupposing the client's challenges or diagnoses would be contrary to this linear process. Beginning with a principle or theory is consistent with deductive reasoning.

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? a) Tanner's clinical judgment model b) The California Critical Thinking Disposition Inventory (CCTDI) c) Benner's novice-to-expert model d)The Developing Nurses' Thinking (DNT) model

a) Tanner's clinical judgment model. Unlike the other listed models, the Lasater Clinical Judgment Rubric is explicitly designed to measure students' achievement of Tanner's model.

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? a) client-centered care b) quality improvement c) accountability and adaptability d) empathic care

a) client-centered care. Adjusting a client's care in response to the client's preferences or abilities is indicative of client-centered care. Quality improvement is focused more broadly on systems and processes. Empathic care and accountability and adaptability are not QSEN competencies.

The nurse has been working with a client for several shifts and the client's adult children have been present at times. The nurse has perceived that one of the children—who has much influence over their parent—may not have the client's best interests at heart, creating an ethical challenge. The nurse is demonstrating what component of Rest's model of moral reasoning? a) moral sensitivity b) moral judgement/reasoning c) moral motivation/focus d) moral character

a) moral sensitivity. Moral sensitivity involves the development of an awareness that there is an ethical issue, such as the one discerned by the nurse. The subsequent three components flow from this initial awareness.

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? a) noticing the significant aspects of the client's condition b) establishing trust and rapport with the client c) engaging in reflection d) prioritizing hypotheses that may explain the client's condition

a) noticing the significant aspects of the client's condition. Tanner's iterative model begins with noticing; this takes place on the basis of the nurse's initial grasp of the situation and precedes hypothesizing. Reflection takes place during and after interactions but after the initial step of noticing. Trust and rapport are key aspects of care but do not represent the initial stage of Tanner's model.

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? a) teamwork and collaboration b) informatics c) evidence-based practice d) safety e) quality improvement f) client-centered care

a) teamwork and collaboration. Although this action is consistent with all the QSEN competencies, delegation is a practical example of the competency of collaboration and teamwork in the clinical setting.

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? a) "I agree. The model is elegant for its simplicity and has been clinically linked to better client outcomes." b) "It is definitely a clear model, but it does not really capture all of the complexities and the human element of nursing." c) "That model was dominant in nursing for decades but has recently been replaced by more nuanced models." d) "Absolutely. Many of the other models are evidence-based but excessively complex."

b) "It is definitely a clear model, but it does not really capture all of the complexities and the human element of nursing." The information-processing model is attractive by virtue of its simplicity and linear nature. However, there is no significant drive to apply this model to nursing practice, because nursing is psychosocially complex and cannot be reduced to a simple equation of input and output. For this reason, it has never been predominant in nursing, even in past decades. It has not been proven to achieve better client outcomes in the literature.

A student nurse observed an experienced nurse performing a scheduled dressing change for a client with an abdominal incision. When describing the event to the clinical group, the student nurse states, "The experienced nurse rushed and did not do anything like what we have learned in the skills and sim labs." What characteristic of the experienced nurse's action justifies using the technique as described? a) The experienced nurse explained that there are many ways of performing any particular skill. b) The experienced nurse adhered to the core principles of medical asepsis. c) The experienced nurse minimized the time that the field and the wound were exposed to room air. d) The nurse has more than 15 years of nursing experience in diverse settings.

b) The experienced nurse adhered to the core principles of medical asepsis. Variances from standard practices should be evaluated in light of how well they align with the basic principles of sound nursing care—in this case, medical asepsis. Experience alone cannot justify a particular action, and speed will not independently reduce the risk of contamination or maximize client outcomes. It is true that there are many techniques for performing common nursing tasks, but stating this fact does not guarantee that the nurse's action was acceptable.

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? a) The nurse influences the ways that care is organized and provided. b) The nurse integrates experience and reflections into new forms of practice. c) The nurse's actions influence other nurses and nursing students who are less skilled. d) The nurse's awareness of ethical and moral issues in nursing becomes heightened.

b) The nurse integrates experience and reflections into new forms of practice. Transformation encompasses meaningful change that results from integrating new experiences with reflections. This may result in practice improvements, increased awareness of ethics, or influence on others, but it is the convergence of experience and reflection that most clearly indicates personal transformation.

What circumstance best shows that the nurse possesses advanced situational awareness (SA)? a) The nurse maintains a high level of alertness throughout their hospital shift. b) The nurse is able to rapidly discern between important and unimportant data while assessing a new client. c) The nurse practices reflection-in-action and reflection-on-action during and after assisting a client with a transfer. d) The nurse is able to multitask between three clients.

b) The nurse is able to rapidly discern between important and unimportant data while assessing a new client. Situational awareness (SA) is "the perception of the elements in the environment in a volume of time and space, the comprehension of their meaning, and the projection of their status in the near future" (Endsley, 1995). That is, being able to rapidly determine salient data from benign data. This goes beyond simply multitasking, alertness, or high arousal, and involves skilled differentiation of constantly changing data. Reflection, in its different forms, is a marker of a skilled nurse, but this is not synonymous with SA.

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? a) The student nurse adopted a position of likely being wrong rather than expecting to be right. b) The student nurse thought systematically and reflectively before deciding what to do. c) The student nurse identified every available option before choosing an action. d) The student nurse respectfully criticized the actions of student nurses who did not choose the recommended approach.

b) The student nurse thought systematically and reflectively before deciding what to do. Although there are many definitions of what constitutes critical thinking, there is broad agreement that the process involves intentional, reflective thinking to inform an action. This approach does not presume that one will likely be wrong. It often leads to an examination of various options, but it is not realistic to identify every possible option. Critical thinking is not synonymous with criticizing others.

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) a nurse who is engaged in clinical practice, teaching, and scholarship b) a nurse who can consistently apply intuition to complex nursing situations c) a nurse who has provided care in numerous community-based and inpatient settings over several years d) a nurse who has 10 years of clinical experience

b) a nurse who can consistently apply intuition to complex nursing situations. Although all of the listed nurses may potentially have attained the level of expert, a hallmark of an expert nurse in Benner's model is the ability to discern subtle cues and apply intuition to complex situations.

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? a) documenting the administration of the analgesia b) evaluating the client's pain 30 minutes after administering the analgesia c) reflecting on the decision-making process d) modifying the nursing care plan to prioritize the client's risk for pain

b) evaluating the client's pain 30 minutes after administering the analgesia. Evaluating outcomes is the final step in the CJMM. All of the actions listed are appropriate, but evaluation is the most direct indication of this sixth and final step.

A nurse is applying Tanner's clinical judgment model to the care they provide. What action characterizes the first step in this process? a) speculating about the likely causes for the client's health challenges b) noticing what is significant about the client's status and circumstances c) partnering with the client and with other members of the care team d) clustering data into meaningful groups

b) noticing what is significant about the client's status and circumstances. While Tanner's model is cyclical, a common starting point is characterized as "noticing" (i.e., recognizing cues, which may often be subtle). This must precede any subsequent actions such as analyzing or clustering data, or hypothesizing issues and causes. Partnering with the client and the care team is important, but this is not an explicit component of Tanner's model.

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? a) National League for Nursing b) American Association of Colleges of Nursing c) American Nurses Association d) National Council of State Boards of Nursing

c) American Nurses Association. The American Nurses Association (ANA) produces and maintains Nursing: Scope and Standards of Practice. This resource is considered the authority on scope of practice. The other listed organizations all inform nursing education and nursing practice in different ways, but none delineate the scope of practice.

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? a) National Council of State Boards of Nursing b) American Association of Colleges of Nursing c) American Nurses Association d) National League for Nursing

c) American Nurses Association. While each of the listed organizations provides resources and information of different types, this dispute is directly related to scope of practice, which is delineated by the American Nurses Association's Nursing: Scope and Standards of Practice.

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? a) California Critical Thinking Disposition Inventory (CCTDI) b) Developing Nurses' Thinking (DNT) model c) Tanner's clinical judgment model d) The Lasater clinical judgment rubric

c) Tanner's clinical judgment model. Although the nurse's actions are not inconsistent with any of the listed models, the integration of the specific steps of noticing, interpreting, responding, and reflecting demonstrates Tanner's clinical judgment model.

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? a) The nurse is highly regarded by peers and colleagues. b) The nurse readily accepts the most complex client assignments. c) The nurse is able to apply intuition to complex clinical scenarios. d) The nurse has been providing care for over 10 years in the same setting.

c) The nurse is able to apply intuition to complex clinical scenarios. Cognitive continuum theory (CCT) acknowledges and integrates both intuitive and analytical cognitive characteristics. These values supersede years of service, reputation, or willingness to take on difficult work.

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? a) The nurse failed to understand the importance of clinical judgment and clinical reasoning. b) The nurse's situational awareness increased throughout the event. c) The speed and complexity of the situation overwhelmed the nurse's cognitive load. d) The nurse applied inductive reasoning at a time when deductive reasoning would have been preferable.

c) The speed and complexity of the situation overwhelmed the nurse's cognitive load. Overstimulation in this case overwhelmed the nurse's cognitive load, leading to a failure to recognize, process, and act upon information. This is unrelated to the differences between inductive and deductive reasoning. The nurse's situational awareness decreased once overwhelmed, not increased. It is unlikely that this nurse's response was related to a lack of understanding that clinical judgment and clinical reasoning are important.

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? a) asking the client questions to establish trust and rapport b) weighing the infant during the visit and comparing to the most recent values c) assessing the client's risk for suicidal ideation during the visit d) suggesting online support groups for parents in similar circumstances

c) assessing the client's risk for suicidal ideation during the visit. Assessing for suicidality is a direct and tangible expression of safety. Each of the other listed actions is consistent with safety but in a less direct manner. Rapport-building and offering support are most closely aligned with client-centered care. Assessment is also related to safety but in a less direct manner than determining suicide risk.

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? a) moral sensitivity b) moral character c) moral judgement/reasoning d) moral motivation/focus

c) moral judgement/reasoning. Moral judgment/reasoning involves consideration of several courses of action to account for the potential impact on those involved. This is tantamount to generating solutions. Moral sensitivity involves awareness of ethics. Moral motivation is the cognitive process of decision-making. Moral character is the actual implementation of a plan.

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? a) "Am I practicing within my legal scope in every way?" b) "How are my clients' outcomes, in their own words?" c) "Am I trusting my intuition in my nursing care?" d) "Am I thinking and behaving like a moral person?"

d) "Am I thinking and behaving like a moral person?" Rest's framework is focused particularly on the nurse as a moral agent. The model is consistent with the use of intuition, but this is not a central component of the model. Similarly, legal scope and clients' desired outcomes are important, but not the foundations of this framework.

An adult client with renal cancer, weighing 38 kg, is to receive ondansetron. The order is for 25 mcg per kg (25mcg/kg) administered intramuscularly (IM). The ondansetron is available in 2mg/ml vials. What is the dosage of ondansetron that the nurse should administer to the client daily in milliliters (round answer to the nearest tenth)? a) .5 mL b) 50 mL c) 0.9 mg d) 0.5 mL e) 1.9 mL

d) 0.5 mL 38kg x 25mcg= 950mcg/1000= 0.95mg /2mg = 0.475mg/1ml = 0.475mL = 0.5mL

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? a) Teach a client about the rationale for cardiac telemetry and link it to the client's diagnosis. b)Notify the health care provider when a fetal heart rate declerates suddenly. c) Establish rapport with a pregnant client before recommending specific actions. d) Advocate for changes to shift handoff so that the process is more efficient.

d) Advocate for changes to shift handoff so that the process is more efficient. Process improvements, such as changes to communications like handoff, are indicative of quality improvement. Rapport-building is primarily associated with client-centered care and informing the team about a threat to health (e.g., decelerations) demonstrates safety as well as teamwork and collaboration. Client teaching is consistent with all the QSEN competencies but primarily with client-centered care.

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: a) reflection-in-action. b) Rest's model of moral reasoning. c) the American Nurses Association (ANA) Nursing: Scope and Standards of Practice. d) Interprofessional Education Collaborative (IPEC) core competencies.

d) Interprofessional Education Collaborative (IPEC) core competencies. Interprofessional Education Collaborative (IPEC) core competencies emphasize the need for interdisciplinary teamwork and collaboration, as demonstrated by working directly with a member of another health discipline. Reflection-in-action is a form of introspection and analysis within Tanner's model of clinical judgment, but there is no obvious indication that the nurse is doing this. The nurse's action is consistent with Rest's framework but this framework focuses on moral action, which is not described in the scenario. The nurse's action is well within the ANA Scope of Practice, but the focus on collaboration and teamwork is a more clear and apparent function.

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? a) National Councili of State Boards of Nursing b) The Joint Commission c) National League for Nursing d) Interprofessional Education Collaborative

d) Interprofessional Education Collaborative. Active collaboration between health professions is the cornerstone of the Interprofessional Education Collaborative (IPEC) competencies. The actions are wholly consistent with the values of the other listed organizations, but the interdisciplinary nature of this action is a direct and practical example of IPEC 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? a) American Association of Colleges and Universities b) Department of Health and Human Services c) Centers for Disease Control and Prevention d) National League for Nursing

d) National League for Nursing. The competencies identified by the National League for Nursing include human flourishing, nursing judgment, professional identity, and spirit of inquiry. None of the other listed organizations share this particular taxonomy of competencies.

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? a) Reflect on the nature of the visit after leaving the client's home. b) Continue to monitor the client throughout the home visit. c) Reassess the client during the next visit, after ensuring the client's safety. d) Respond by selecting the appropriate interventions.

d) Respond by selecting the appropriate interventions. The continuum of nursing actions within Tanner's model progress from noticing (perceiving the client's behavior), interpreting (making meaning of the behaviors), to responding. Responding is characterized by choosing appropriate actions. Reflection is central to the model, but passive monitoring would not be a sufficient response to the client's behavior, which warrants the nurse's input.

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? a) The nurse committed a medication error by administering an immediate-release opioid rather than an extended-release opioid. b) The nurse is unaware of the specifics of the nursing scope of practice and code of ethics. c) The nurse expresses frustration with clients who are vague or indecisive in their reports. d) The nurse has difficulty identifying the less obvious changes in clients' conditions.

d) The nurse has difficulty identifying the less obvious changes in clients' conditions. Being able to identify and address rapid changes in client status (especially subtle changes) is the hallmark of situational awareness. Medication errors can happen for many reasons and not necessarily because of a lack of situational awareness. Lack of knowledge about scope and lack of patience with clients are concerning lapses, but do not necessarily stem from a lack of situational awareness.

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? a) The nurse demonstrates ethical practice according to Rest's four-component model of moral reasoning. b) The nurse has developed moral sensitivity and moral judgment. c)The nurse has expanded beyond the American Nurses Association scope of practice. d) The nurse is an expert, according to Benner's novice-to-expert model of development.

d) The nurse is an expert, according to Benner's novice-to-expert model of development. Intuition is a marker of an "expert" in Benner's model. Rest's framework (which contains moral sensitivity and moral judgment) focuses on ethics rather than information-processing and meaning-making. Expert nurses do not practice beyond their legally defined scope.

For which scenario will the nurse consult resources from the American Nurses Association? a) The nurse is unsure how to frame feedback to a preceptor student. b) The nurse needs to provide updated NCLEX information to a group of students. c) The nurse is seeking guidance on QSEN competencies. d) The nurse is unsure whether a particular intervention is in the nursing scope of practice.

d) The nurse is unsure whether a particular intervention is in the nursing scope of practice. The American Nurses Association (ANA) produces Nursing: Scope and Standards of Practice. The National Council of State Boards of Nursing (NCSBN) administers the NCLEX. Quality and Safety Education in Nursing (QSEN) competencies are not within the purview of the ANA. Various organizations provide information and guidance on working with students, but this is not specific to the ANA.

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? a) by eliciting input from a trusted professional mentor b) by gaining the widest possible variety of learning experiences c) by reducing the amount of time elapsed from previous experiences to new experiences d) by engaging in frequent and thoughtful reflection

d) by engaging in frequent and thoughtful reflection. In experiential learning, there is a progression from experiences to reflection to transformation. Without reflection, new learning cannot be gleaned from experiences and used to inform future actions. Simply increasing the pace or quantity of learning is not sufficient, nor can a mentor's guidance replace this vital step.

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? a) client who has presented to the clinic for a scheduled immunization b) client who requires discharge teaching related to surgical wound care c) client who has just been admitted to the emergency department with shortness of breath d) community-dwelling client with complex physical and psychosocial needs

d) community-dwelling client with complex physical and psychosocial needs. Although concept maps can inform care in a wide variety of circumstances, they are especially helpful when planning care for clients who have longstanding, complex needs. Concept maps have less utility in time-dependent circumstances like emergencies or in clients whose needs are more finite, such as clients needing specific teaching or a single immunization.

What action by the nurse in a hospital setting best exemplifies the goals of the Interprofessional Education Collaborative (IPEC) core competencies? a) administering a medication that was just prescribed by a health care provider b) taking a course about intimate partner violence that was created by a social worker c) reporting a sudden decline in a client's status to the health care provider d) coordinating with the physical therapist to amend a client's activity orders in the plan of care

d) coordinating with the physical therapist to amend a client's activity orders in the plan of care. Interprofessional Education Collaborative (IPEC) competencies go beyond carrying out orders from another profession, reporting to a member of another profession, or one-way learning from another profession. Active collaboration on client care, such as working together on activity orders, demonstrates the participatory nature of the competencies.

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? a) precompetent b) novice c) orientee d) advanced beginner

d) novice. Reliance on rote procedures and unawareness of contextual factors are the hallmarks of a novice. Advanced beginners have started to move away from this concrete thinking and performing. Benner's model does not include categories of precompetent or orientee.