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A nurse is caring for a patient with type 2 diabetes who has an infected foot ulcer requiring dressing changes. Which nursing action best demonstrates the QSEN competency of patient-centered care?
- A. Asking the patient if they would like their spouse to be present for a teaching session
- B. Researching new procedures to care for foot ulcers when developing a care plan for this patient
- C. Leading a grand rounds or unit-based discussion on complications of diabetes
- D. Using the electronic medical record to review trends of the patient's blood glucose levels
Correct Answer: A
Rationale: Patient-centered care commits to developing caring relationships based on mutual trust to communicate and deliver care based on patient preferences and values. Evidence-based practice integrates the best current evidence for safe practice with clinical expertise. Teamwork and collaboration shares patient information or opportunities for learning with others. Informatics manages patient information, mitigates error, and supports decision making using the electronic medical record and other databases.
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A new graduate nurse phones the surgeon to report their patient is having severe incisional pain. The surgeon asks about vital signs and appearance of the wound, causing the nurse to return to the bedside for additional assessments. Upon reflection with the preceptor, which characteristic of the nursing process should the nurse have remembered?
- A. Centric
- B. Dynamic
- C. Interpersonal
- D. Systematic
Correct Answer: D
Rationale: The nursing process is systematic, iterative, and overlapping. By reporting an isolated symptom, the nurse has overlooked the benefit of systematic and inclusive assessment. While the nursing process is presented as an orderly progression of phases, there is a dynamic interaction and flow of phases into one another.
A nurse uses critical-thinking skills to develop the care plan for an older adult with dementia awaiting placement in a long-term care facility. Which statements describe characteristics of the critical thinking used by nurses engaged in clinical reasoning? Select all that apply.
- A. Functions independently of nursing standards, ethics, and state practice acts
- B. Based on the principles of the nursing process, problem solving, and the scientific method
- C. Driven by patient, family, and community needs as well as nurses' needs to give competent, efficient care
- D. Avoids designs to compensate for problems created by human nature, such as medication errors
- E. Constantly reevaluating, self-correcting, and striving for improvement
- F. Focuses on the big picture rather than identifying the key problems, issues, and risks involved with patient care
Correct Answer: B,C,E
Rationale: Critical thinking applied to clinical reasoning and clinical judgment is guided by standards, policies and procedures, and ethics. When applying principles of nursing process, problem solving, and the scientific method, clinical reasoning identifies the key problems, issues, and risks. This is driven by patient, family, and community needs as well as nurses' needs to give competent, efficient care. It also calls for strategies that make the most of human potential and compensate for problems created by human nature. It is constantly reevaluating, self-correcting, and striving to improve the quality and safety of health care systems.
When implementing a thoughtful, patient-centered care plan, which action does the nurse prioritize?
- A. The patient's loved ones are considered part of the team.
- B. A caring relationship with mutual trust is established.
- C. Measures for safety are visibly incorporated.
- D. Transparent communication is observed.
Correct Answer: C
Rationale: Although developing a thoughtful, patient-centered approach is focused on caring and mutual trust, the nurse uses the nursing process and Maslow's hierarchy of needs to prioritize care. Safety is a higher-level need than love and belonging, and therefore the priority.
A patient who is receiving cancer chemotherapy tells the nurse, 'The treatment for this cancer is worse than the disease itself. I'm stopping treatment.' Which nursing action best promotes a patient-centered, therapeutic relationship?
- A. Determining if the patient database is adequate to address the problem
- B. Considering whether to suggest a counseling session for the patient
- C. Reassessing the patient and determining how to best support them
- D. Identifying possible interventions and critiquing the merit of each option
Correct Answer: C
Rationale: Reassessing the patient allows the nurse and patient to clarify the patient's goal(s) and develop interventions to best meet them. Once the problem is addressed, it is important for the nurse to judge the adequacy of the knowledge, identify potential problems, use helpful resources, and critique the decision.
The nurse uses blended competencies when caring for patients in a rehabilitation facility. Which interventions reflect the use of cognitive skills? Select all that apply.
- A. Monitoring for side effects of medications
- B. Safely administering an injectable medication
- C. Teaching a patient about diabetes and its management
- D. Acting as witness by signing a surgical consent form
- E. Helping a patient identify their progress in physical therapy
- F. Comforting a patient who has received bad news
Correct Answer: A,C
Rationale: Using critical thinking to teach a patient about a disease process and management and monitoring for side effects of medications are cognitive competencies. Performing an injection correctly is a technical skill; witnessing/signing an informed consent form is a legal/ethical action, and comforting a patient is an interpersonal skill.