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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.
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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.
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.
The nurse is formulating a care plan for a patient in a long-term care facility who has lost 12 lb in the last 2 months. To arrive at a patient-centered nursing judgment, what will the nurse do first?
- A. Ensure the patient is receiving foods they like, including favorites.
- B. Make sure the patient's dentures are clean and inserted at mealtimes.
- C. Assess the patient's food intake and hydration over the last 1 to 3 days.
- D. Request that the nursing assistant feed the client at mealtime.
Correct Answer: C
Rationale: The nurse uses the nursing process to arrive at a clinical judgment. After analyzing the assessment data, the nurse determines, through clinical reasoning, whether the related factors in the patient's weight loss, such as dislike of menu options, lack of dentition, or inability to perform activities of daily living such as feeding, should be the focus of interventions.
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.
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.