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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.
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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.
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 nursing philosophy in an acute care hospital includes a commitment to deliver thoughtful, person-centered care. Which description of the nursing process best supports this commitment?
- A. Systematic
- B. Interpersonal
- C. Dynamic
- D. Universally applicable in nursing situations
Correct Answer: B
Rationale: Interpersonal. All other options are characteristics of the nursing process but focus on the patient best illustrates the interpersonal dimension of the nursing process.
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.
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.