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A nursing student is committed to providing thoughtful, person-centered care. Which nursing actions demonstrate this type of care? Select all that apply.
- A. Assisting patients to select meals based on their cultural observances
- B. Providing nursing care based on patients' needs and preferences
- C. Documenting nursing interventions in the electronic health record
- D. Reviewing fingerstick blood glucose levels with the primary nurse
- E. Listening to a patient's concern for their ill significant other
Correct Answer: A,B,E
Rationale: The nursing process ensures that nurses are person centered rather than task centered. Attending to cultural preferences and needs and listening to a patient's concerns are patient-centered actions. Documentation and communication with other members of the health care team are not specifically patient centered.
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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.
A nurse working in a long-term care facility reviews the electronic health records of patients who have fallen in the last month to determine if there is a common risk factor. Which QSEN competency is the nurse demonstrating?
- A. Patient-centered care
- B. Evidence-based practice
- C. Teamwork and collaboration
- D. Informatics
Correct Answer: D
Rationale: Informatics uses information and technology to communicate, manage knowledge, mitigate error, and support decision making. Thoughtful, patient-centered care emphasizes recognition of the patient or designee as the source of control and full partner in compassionate and coordinated care, based on respect for patients' preferences, values, and needs. Evidence-based practice integrates the best current evidence with clinical expertise and patient and family preferences and values to deliver optimal health care. Teamwork and collaboration refer to effective functioning within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care.
A staff nurse tells a new graduate nurse not to bother studying too hard, since most clinical reasoning becomes second nature and intuitive once they begin practicing. Which response by the student is appropriate?
- A. Intuitive problem solving comes with years of practice and observation based on nursing knowledge and science.
- B. For nursing to remain a science, nurses must continue to be vigilant about avoiding intuitive reasoning.
- C. The emphasis on logical, scientific, evidence-based reasoning has held nursing back; we need intuitive, creative thinkers.
- D. The nurse's preference dictates whether they are logical, scientific thinkers or intuitive, creative thinkers.
Correct Answer: A
Rationale: When intuition is used alone, increased risks and fewer benefits may occur. Beginning nurses must use nursing knowledge and scientific problem solving as the basis of care; intuitive problem solving comes with years of practice and observation. If the beginning nurse has an intuition about a patient, that information should be discussed with the faculty member, preceptor, or supervisor. There is a place for intuitive reasoning in nursing, but it will augment, not replace logical, scientific reasoning. Critical thinking is contextual and changes depending on the circumstances, not on personal preference.
An oncology nurse is analyzing a patient's strengths and finds the patient is well educated, learns quickly, and is resilient. In which phase of the nursing process will the nurse use this information?
- A. Diagnosing
- B. Evaluating
- C. Planning
- D. Implementing
Correct Answer: C
Rationale: Assessing for strengths and weaknesses is the first step of the nursing process, which has been completed. Next, the nurse clusters cues and develops diagnoses that give rise to interventions. Evaluating the plan is followed by completing or modifying the plan.
The nursing assessment of a patient with a diagnosis of anorexia nervosa reveals the patient consumes a vegan diet of 700 calories daily and has lost 30 lb in 4 months. The nurse's recommendation to meet with a nutritionist is the outcome of which process?
- A. Clinical judgment
- B. Nursing process
- C. Clinical reasoning
- D. Critical thinking
Correct Answer: A
Rationale: Clinical judgment is the outcome of critical thinking and clinical reasoning, using the nursing process as a framework. Clinical reasoning refers to ways of thinking about patient care issues including weighing and validating options (determining, preventing, and managing patient problems). Critical thinking includes reasoning both outside and inside of the clinical setting.