PrepU Ch. 13: Blended Competencies

A nurse providing care to a client questions judgments and considers other ways of thinking about the client's situation. Which behavior is the nurse demonstrating in the care of the client?

Critical reflectivity

A nurse should have critical thinking attitudes to develop critical thinking skills. One attitude the nurse should possess is orderly thinking to do what is best. Which term best suits this attitude description?

Discipline

When using the nursing process, the nurse notes that there is a great deal of overlapping of the steps, with each step flowing into the next. What is the term for this characteristic of the nursing process?

Dynamic

A nurse manager is developing a program for the unit staff to foster critical thinking. Which activity would the nurse manager implement to promote theoretical knowledge?

Encouraging staff to read current journal articles

The type of intervention that the nurse performs when he or she observes the spouse of a postoperative client performing the client's dressing change is described as

Supervisory

A client, who has limited finances and limited capacity for education, requires home health care for a chronic illness. For the nurse to provide a high level of care to this client, the nurse must first:

implement critical thinking skills.

The nurse enters the room of the client diagnosed with a cerebral hemorrhage and immediately states, "This client is getting worse." This is an example of the experienced nurse using:

intuitive problem identification.

A nurse is engaged in the most basic level of reflection. Which question would the nurse most likely ask?

"What happened?"

Which are characteristics of a critical thinker? Select all that apply.

Being open to all points of view Thinking outside the box Resisting easy answers to client problems

Select the best description of how the nurse applies the nursing process in caring for clients. The nurse:

uses critical thinking to direct care for the individual client.

The novice nurse demonstrates proper understanding of collaborative problems by making which statement?

"A medical diagnosis of heart failure with the possible consequence of fluid in the lungs could lead to the collaborative problem of pulmonary edema."

A nurse is working with a group of staff members to address the needs of a client as they develop the client's interdisciplinary plan of care. Which question if asked by the nurse addresses the standard of breadth when judging the group's thinking?

"Is there another way to look at this situation?"

The nurse is providing education to a group of middle school students regarding cold weather safety. One of the students asks the nurse how cold her body will get when it is cold outside waiting for the school bus. The nurse responds:

"We are warm blooded so our body temperature remains relatively unchanged when exposed to cold weather for a small period of time."

At 0730, the nurse notes that the client states that pain is a 7 on a scale of 0 to 10. Based on this assessment, the nurse administers pain medication to the client. At 0800, the nurse evaluates the client and finds that pain is a 4 on a scale of 0 to 10. Which example of documentation most clearly communicates the initial morning assessment?

0730: Client reports pain is a 7 on a scale of 0-10. Morphine sulfate 2 mg IV administered.

Which is an example of a subjective finding that the nurse would likely obtain when performing a review of systems (ROS)?

A client report of shooting pain up the left leg

To implement the most effective care for clients in an acute care facility, which is the most appropriate action for a new nurse to take?

Apply theoretical knowledge to present clinical situations

A nurse is conducting focused data collection and recognizes the existence of cues. The nurse is most likely involved in which phase of the nursing process?

Assessment

Which step in the nursing process includes the careful taking of a history and a nursing examination?

Assessment

A nurse is caring for a postoperative client 1 day after a total abdominal hysterectomy. Which nursing intervention best demonstrates caring in this situation?

Assisting the client to sit up in a chair

Which statements are true about the implementation phase of the nursing process? Select all that apply.

Care provided during implementation should be documented in the client's chart. Implementation is the process of carrying out the plan of care. This phase promotes wellness and restores health.

A nurse is conducting a client interview and gathers information from secondary sources. Which sources might the nurse use? Select all that apply.

Client's children Client's caregiver Client's physcian Client's previous admission record

The nurse has entered the room of a newly admitted client who immediately reports feeling short of breath. After identifying this as the client's problem, the nurse uses the process of scientific problem solving. Place the steps in the order the nurse would follow.

Collect assessment data. Formulate a hypothesis. Make a plan for action. Perform hypothesis testing. Evaluate.

Recording prioritized outcomes in the plan of care ensures which benefit?

Continuity of care can be provided to the client.

Which action exemplifies the purpose of evaluation in the nursing process?

Decide whether to continue, modify, or terminate client care.

A nurse administers intravenous fluids to a client diagnosed with dehydration. After the fluids are completed, the client's blood pressure is increased and pulse is decreased. During the final phase of the nursing process, what should the nurse do?

Determine whether the prescribed treatment was effective.

The nurse is attentive and responsive to the health care needs of individual clients and ensures the continuity of care when leaving these clients. What interpersonal skill is the nurse displaying?

Developing accountability

Which action should the nurse associate with outcome identification and planning in the nursing process?

Develops an individualized plan of nursing care

The nurse analyzes client data to identify client strengths and health problems that independent nursing interventions can prevent or resolve. Which step of the nursing process is the nurse performing?

Diagnosing

A nurse identifies the following: "Impaired skin integrity related to immobility as evidenced by reddened areas on the sacrum." The nurse is most likely in which phase of the nursing process?

Diagnosis

Which step of the nursing process involves reporting or analysis of data to identify and define health problems?

Diagnosis

A nurse demonstrates clinical reasoning during which phases of the nursing process? Select all that apply.

Diagnosis Assessment Implementation Evaluation Planning

Which action is performed in the implementation step in the nursing process?

Documenting the nursing care and client responses

Place the nursing activities in the order that they would most likely occur when a health care professional uses the nursing process.

Establishing the database Interpreting and analyzing client data Establishing priorities Carrying out the plan of care Measuring how well the client has achieved desired outcomes Modifying the plan of care (if indicated)

A client is admitted to the hospital with an abscess on the leg that will not heal after multiple treatment options as an outpatient. The nurse knows from past experiences that the appearance of this type of wound in clients heavily suggests a resistant bacterial infection and the need for contact isolation and intravenous antibiotics. The nurse begins to prepare for this admission. What type of problem solving does this exhibit?

Intuitive

The nurse assesses a client's blood pressure, which is 160/90 mm Hg. Two hours following the administration of hydrochlorothiazide, the nurse reassesses the blood pressure, finding it to be 140/78 mm Hg. Which action has the nurse implemented?

Evaluating

Educating a client on the pathophysiology of diabetes mellitus is the implementation of which skill?

Intellectual

Which statement best conveys the role of intuition in nurses' problem solving?

Intuition can be a clinically useful adjunct to logical problem solving.

Which statements about the nursing process are accurate? Select all that apply.

It is important for providing individualized care to each client. It is an orderly way of solving client problems. It helps to emphasize the client's active role in making decisions.

Which are characteristics of critical thinking? Select all that apply.

It requires a conscious and deliberate effort. It requires a systematic and logical approach It involves judgments based on evidence.

What type of learning best takes place in the nursing laboratory?

Kinesthetic learning

An adolescent with diabetes has a nursing diagnosis of noncompliance related to activities that interfere with the treatment plan as evidenced by elevated blood glucose levels. The outcome for this client is to maintain blood glucose levels between 70 and 110 mg/dL (3.89 and 6.11 mmol/L). The main intervention is to educate the client about the effects of abnormal blood glucose level on the body and ensure that the client has the resources to be compliant. Evaluation reveals that the client's blood glucose level remains elevated and that the outcome has not been met. What is the most appropriate action by the nurse?

Modify the plan of care to find alternative ways to meet client needs.

Which students study the best in a group setting?

People-oriented learners

A nurse is engaged in the assessment phase of the nursing process. When completing the physical exam, which techniques would the nurse likely use? Select all that apply.

Percussing Auscultating Inspecting Palpating

A nurse is examining alternatives and judging the worth of evidence as part of preparing the plan of care for a client. The nurse would most likely be involved in which phase of the nursing process?

Planning

What is the most beneficial use of the nursing process in addressing the needs of the client?

Provides a universally applicable framework for nursing activities

In the clinical setting, a nurse is working on developing higher-level reflection skills. With which activity would the nurse most likely be engaged?

Reevaluating experience in light of ideas

Which are characteristics of one who has developed critical thinking skills?

Self-aware, honest, persistent, and authentic

When the nurse assesses the client's blood glucose level, what is the term for the type of skill the nurse is using?

Technical

The nurse is caring for a mother and newborn baby couplet. The mother has a nursing diagnosis of insufficient breast milk but wants to continue to breast feed. The client outcome is to increase milk supply and assure that the infant gains weight. The nurse and lactation consultant work with the mother to implement measures to increase the mother's production of breast milk and assure that the infant is getting the nutrition that is required. At the follow-up visit, the mother's milk production has increased and the baby is gaining weight. What is the most appropriate action by the nurse at this time?

Terminate the plan of care because evaluation reveals that the outcome has been met.

The nurse is caring for a pediatric client with respiratory distress. Upon assessment the client has increased respirations and work of breathing (WOB). Breath sounds are adventitious and the client has thick yellow/green drainage coming from the nose. Based on these findings, the nurse determines that this client has an ineffective airway clearance related to copious amounts of thick secretions and proceeds to perform nasopharyngeal suctioning to relieve some of the secretions. If the nurse were documenting the evaluation of this intervention, what would be documented?

The amount and type of drainage suctioned from the nares, and the client's response

Which outcome should the nurse recognize as being the most appropriate for a client with a nursing diagnosis of risk for infection?

The client has a normal temperature and no signs or symptoms of infection.

The ability to communicate clearly through documentation is a critical nursing skill. Which statements accurately describe the role of documenting in the nursing process? Select all that apply.

The client record is the chief means of communication among members of the interdisciplinary team. A nursing action not documented is a nursing action not performed. It is helpful to practice documentation while learning any given nursing activity. The content of the client report and nursing documentation helps to establish nursing priorities in practice.

The nurse is preparing to document the nursing diagnoses for a client. What is the most appropriate outcome for the nursing diagnosis of impaired gas exchange?

The client will maintain a pulse oximeter reading of greater than 94% (0.94 L).

Which statements describe the common use of problem solving in the nursing process? Select all that apply.

The scientific problem-solving method is closely related to the more general problem-solving process (the nursing process) commonly used by health care professionals as they work with clients. Today, nurses acknowledge the positive role of intuitive thinking in clinical decision making. Critical thinking in nursing can be intuitive or logical or a combination of both.

What is the purpose of the diagnosis phase of the nursing process?

To develop a prioritized list of client-centered problems

The nurse is admitting a client to the acute care unit with a diagnosis of dehydration. The client's skin turgor is poor and the mucous membranes are pale and dry. What is the rationale for the next phase in the nursing process?

To develop a prioritized list of current and possible health problems

The Canadian Nurses Association (CNA) has published the standards of care for which the nurse is responsible. The Standards of Practice are:

assessment, diagnosis, outcome identification, planning, implementation, and evaluation.

A client newly diagnosed with diabetes has been sent home after in-depth education regarding the diabetes management plan. Because the client is newly diagnosed, the nurse included in the plan of care a risk for unstable glucose. What is the most appropriate short-term outcome for this nursing diagnosis in the client? The client will:

maintain a blood sugar between 70 mg/dL (3.89 mmol/L) and 110 mg/dL (6.11 mmol/L).

What result is the most appropriate outcome for the nursing diagnosis of Impaired Urinary Elimination? The client will:

maintain urine output of 30 mL/hr.

Nurses use the nursing process to plan care for clients. In which cases is the nursing process applicable? Select all that apply.

when nurses work with clients who are able to participate in their care when families are clearly supportive and wish to participate in care when clients are totally dependent on the nurse for care when families are not supportive and do not wish to participate in care.