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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.
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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 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.
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.
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 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.