Nokea
An audit of a large, university medical center reveals that four patients in the hospital have current orders for restraints. You know that restraints are an intervention of last resort, and that it is inappropriate to apply restraints to which of the following patients?
- A. A postlaryngectomy patient who is attempting to pull out his tracheostomy tube
- B. A patient in hypovolemic shock trying to remove the dressing over his central venous catheter
- C. A patient with urosepsis who is ringing the call bell incessantly to use the bedside commode
- D. A patient with depression who has just tried to commit suicide and whose medications are not achieving adequate symptom control
Correct Answer: C
Rationale: Restraints should never be applied for staff convenience. The patient with urosepsis who is frequently ringing the call bell is requesting assistance to the bedside commode; this is appropriate behavior that will not result in patient harm. The other described situations could plausibly result in patient harm; therefore, it is more likely appropriate to apply restraints in these instances.
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A group of students have been challenged to prioritize ethical practice when working with a marginalized population. How should the students best understand the concept of ethics?
- A. The formal, systematic study of moral beliefs
- B. The informal study of patterns of ideal behavior
- C. The adherence to culturally rooted, behavioral norms
- D. The adherence to informal personal values
Correct Answer: A
Rationale: In essence, ethics is the formal, systematic study of moral beliefs, whereas morality is the adherence to informal personal values.
The nurse, in collaboration with the patients family, is determining priorities related to the care of the patient. The nurse explains that it is important to consider the urgency of specific problems when setting priorities. What provides the best framework for prioritizing patient problems?
- A. Availability of hospital resources
- B. Family member statements
- C. Maslows hierarchy of needs
- D. The nurses skill set
Correct Answer: C
Rationale: Maslows hierarchy of needs provides a useful framework for prioritizing problems, with the first level given to meeting physical needs of the patient. Availability of hospital resources, family member statements, and nursing skill do not provide a framework for prioritization of patient problems, though each may be considered.
The nurse is providing care for a patient with chronic obstructive pulmonary disease (COPD). The nurses most recent assessment reveals an SaO2 of 89%. The nurse is aware that part of critical thinking is determining the significance of data that have been gathered. What characteristic of critical thinking is used in determining the best response to this assessment finding?
- A. Extrapolation
- B. Inference
- C. Characterization
- D. Interpretation
Correct Answer: D
Rationale: Nurses use interpretation to determine the significance of data that are gathered. This specific process is not described as extrapolation, inference, or characterization.
A patient admitted with right leg thrombophlebitis is to be discharged from an acute-care facility. Following treatment with a heparin infusion, the nurse notes that the patients leg is pain-free, without redness or edema. Which step of the nursing process does this reflect?
- A. Diagnosis
- B. Analysis
- C. Implementation
- D. Evaluation
Correct Answer: D
Rationale: The nursing actions described constitute evaluation of the expected outcomes. The findings show that the expected outcomes have been achieved. Analysis consists of considering assessment information to derive the appropriate nursing diagnosis. Implementation is the phase of the nursing process where the nurse puts the care plan into action. This nurses actions do not constitute diagnosis.
Achieving adequate pain management for a postoperative patient will require sophisticated critical thinking skills by the nurse. What are the potential benefits of critical thinking in nursing?
- A. Enhancing the nurses clinical decision making
- B. Identifying the patients individual preferences
- C. Planning the best nursing actions to assist the patient
- D. Increasing the accuracy of the nurses judgments
- E. Helping identify the patients priority needs
Correct Answer: A,C,D,E
Rationale: Independent judgments and decisions evolve from a sound knowledge base and the ability to synthesize information within the context in which it is presented. Critical thinking enhances clinical decision making, helping to identify patient needs and the best nursing actions that will assist patients in meeting those needs. Critical thinking does not normally focus on identify patient desires; these would be identified by asking the patient.