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A class of nursing students is in their first semester of nursing school. The instructor explains that one of the changes they will undergo while in nursing school is learning to think like a nurse. What is the most current model of this thinking process?
- A. Critical-thinking Model
- B. Nursing Process Model
- C. Clinical Judgment Model
- D. Active Practice Model
Correct Answer: C
Rationale: To depict the process of thinking like a nurse, Tanner (2006) developed a model known as the clinical judgment model.
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While developing the plan of care for a new patient on the unit, the nurse must identify expected outcomes that are appropriate for the new patient. What resource should the nurse prioritize for identifying these appropriate outcomes?
- A. Community Specific Outcomes Classification (CSO)
- B. Nursing-Sensitive Outcomes Classification (NOC)
- C. State Specific Nursing Outcomes Classification (SSNOC)
- D. Department of Health and Human Services Outcomes Classification (DHHSOC)
Correct Answer: B
Rationale: Resources for identifying appropriate expected outcomes include the NOC and standard outcome criteria established by health care agencies for people with specific health problems. The other options are incorrect because they do not exist.
A recent nursing graduate is aware of the differences between nursing actions that are independent and nursing actions that are interdependent. A nurse performs an interdependent nursing intervention when performing which of the following actions?
- A. Auscultating a patients apical heart rate during an admission assessment
- B. Providing mouth care to a patient who is unconscious following a cerebrovascular accident
- C. Administering an IV bolus of normal saline to a patient with hypotension
- D. Providing discharge teaching to a postsurgical patient about the rationale for a course of oral antibiotics
Correct Answer: C
Rationale: Although many nursing actions are independent, others are interdependent, such as carrying out prescribed treatments, administering medications and therapies, and collaborating with other health care team members to accomplish specific, expected outcomes and to monitor and manage potential complications. Irrigating a wound, administering pain medication, and administering IV fluids are interdependent nursing actions and require a physicians order. An independent nursing action occurs when the nurse assesses a patients heart rate, provides discharge education, or provides mouth care.
Your older adult patient has a diagnosis of rheumatoid arthritis (RA) and has been achieving only modest relief of her symptoms with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). When creating this patients plan of care, which nursing diagnosis would most likely be appropriate?
- A. Self-care deficit related to fatigue and joint stiffness
- B. Ineffective airway clearance related to chronic pain
- C. Risk for hopelessness related to body image disturbance
- D. Anxiety related to chronic joint pain
Correct Answer: A
Rationale: Nursing diagnoses are actual or potential problems that can be managed by independent nursing actions. Self-care deficit would be the most likely consequence of rheumatoid arthritis. Anxiety and hopelessness are plausible consequences of a chronic illness such as RA, but challenges with self-care are more likely. Ineffective airway clearance is unlikely.
A nurse provides care on an orthopedic reconstruction unit and is admitting two new patients, both status post knee replacement. What would be the best explanation why their care plans may be different from each other?
- A. Patients may have different insurers, or one may qualify for Medicare.
- B. Individual patients are seen as unique and dynamic, with individual needs.
- C. Nursing care may be coordinated by members of two different health disciplines.
- D. Patients are viewed as dissimilar according to their attitude toward surgery.
Correct Answer: B
Rationale: Regardless of the setting, each patient situation is viewed as unique and dynamic. Differences in insurance coverage and attitude may be relevant, but these should not fundamentally explain the differences in their nursing care. Nursing care should be planned by nurses, not by members of other disciplines.
A patient with migraines does not know whether she is receiving a placebo for pain management or the new drug that is undergoing clinical trials. Upon discussing the patients distress, it becomes evident to the nurse that the patient did not fully understand the informed consent document that she signed. Which ethical principle is most likely involved in this situation?
- A. Sanctity of life
- B. Confidentiality
- C. Veracity
- D. Fidelity
Correct Answer: C
Rationale: Telling the truth (veracity) is one of the basic principles of our culture. Three ethical dilemmas in clinical practice that can directly conflict with this principle are the use of placebos (nonactive substances used for treatment), not revealing a diagnosis to a patient, and revealing a diagnosis to persons other than the patient with the diagnosis. All involve the issue of trust, which is an essential element in the nursepatient relationship. Sanctity of life is the perspective that life is the highest good. Confidentiality deals with privacy of the patient. Fidelity is promise-keeping and the duty to be faithful to ones commitments.