Alexandra Bozan
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UNIT III: Person-Centered Care and the Nursing Process Chapter 10: Blended Competencies, Clinical Reasoning, and Processes of Person-Centered Care

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Alexandra Bozan
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Chapter 10: Blended Competencies, Clinical Reasoning, and Processes of Person-Centered Care

Chapter 10: Blended Competencies, Clinical Reasoning, and Processes of Person-Centered Care

Question 1 of 37

1

Fill the blank spaces to complete the text.

Read the following patient scenario and identify the step of the nursing process represented by each numbered nursing activity

Annie seeks the help of the nurse in the student health clinic because she suspects that her roommate, Angela, suffered date rape. She is concerned because Angela chose not to report the rape and does not seem to be coping well.

(1 - ) After talking with Annie, the nurse learns that although Angela blurted out that she had been raped when she first came home, since then she has refused verbalization about the rape ("I don't want to think or talk about it"), has stopped attending all college social activities (a marked change in behavior), and seems to be having nightmares.

After analyzing the data, the nurse believes that Angela might be experiencing (2 - ) rape-trauma syndrome: silent reaction. Fortunately, Angela trusts Annie and is willing to come to the student health center for help. A conversation with Angela confirms the nurse's suspicions and problem identification begins.

The nurse talks further with Angela (3 - and ) to develop some treatment goals and formulate outcomes. The nurse also begins to think about the types of nursing interventions mostly likely to yield the desired outcomes.

In the initial meeting with Angela (4 - ) the nurse encourages her expression of feelings and helps her to identify personal coping strategies and strengths.

The nurse and Angela decide to meet in 1 week (5 - ) to assess her progress toward achieving targeted outcomes. If she is not making progress, the plan of care might need to be modified.

Explanation

Question 2 of 37

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A female patient who is receiving chemotherapy for breast cancer tells the nurse, "The treatment for this cancer is worse than the disease itself. I'm not going to come for my therapy anymore". The nurse responds by using critical thinking skills to address this patient problem. Which action is the first step the nurse would take in this process?

Select one of the following:

  • The nurse judges whether the patient database is adequate to address the problem

  • The nurse considers whether or not to suggest a counseling session for the patient

  • The nurse reassesses the patient and decides how best to intervene in her care

  • The nurse identifies several options for intervening in the patient's care and critiques the merit of each option

Explanation

Question 3 of 37

1

The nursing process ensures that nurses are person centered rather than task centered. Rather than simply approaching a patient to take vital signs, the nurse thinks, "How is Mrs. Barcley today? Are our nursing actions helping her to achieve her goals? How can we better help her? This demonstrates which characteristics of the nursing process?

Select one of the following:

  • Systematic

  • Interpersonal

  • Dynamic

  • Universally applicable in nursing situations

Explanation

Question 4 of 37

1

An experienced nurse tells a beginning nurse not to bother studying too hard, since most clinical reasoning becomes "second nature" and "intuitive" once you start practicing. What thinking below should underlie the beginning nurse's response?

Select one of the following:

  • Intuitive problem solving comes with years of practice and observation, and novice nurses should base their care on scientific problem solving.

  • For nursing to remain a science, nurses must continue to be vigilant about stamping out intuitive reasoning

  • The emphasis on logical, scientific, evidence-based reasoning has held nursing back for years; it's time to champion intuitive, creative thinking!

  • It's simply a matter of preference; some nurses are logical, scientific thinkers, and some are intuitive, creative thinkers

Explanation

Question 5 of 37

1

The nurse uses blended competencies when caring for patients in a rehabilitation facility. Which examples of interventions involve cognitive skills?

Select one or more of the following:

  • The nurse uses critical thinking skills to plan care for a patient

  • The nurse correctly administers IV saline to a patient who is dehydrated

  • The nurse assists a patient to fill out an informed consent form

  • The nurse learns the correct dosages for patient pain medications

  • The nurse comforts a mother whose baby was born with Down syndrome

  • The nurse uses the proper procedure to catheterize a female patient

Explanation

Question 6 of 37

1

A nurse uses critical thinking skills to focus on the care plan of an elderly patient who has dementia and needs placement in a long-term care facility. Which statements describe characteristics of this type of critical thinking applied to clinical reasoning?

Select one or more of the following:

  • It functions independently of nursing standards, ethics, and state practice acts

  • It is based on the principles of the nursing process, problem solving, and the scientific methods

  • It is driven by patient, family and community needs as well as nurses needs to give competent, efficient care

  • It is not designed to compensate for problems created by human nature, such as medication errors

  • It is constantly re-evaluating, self-correcting, and striving for improvement

  • It focuses on the big picture rather than identifying the key problems, issues, and risks involved with patient care

Explanation

Question 7 of 37

1

A nurse is caring for a patient who has complications related to type 2 diabetes mellitus. The nurse researches new procedures to care for foot ulcers when developing a plan of care for this patient. Which QSEN competency does this action represent?

Select one of the following:

  • Patient-centered care

  • Evidence-based practice

  • Quality improvement

  • Informatics

Explanation

Question 8 of 37

1

A nurse working in a long-term care facility bases patient care on five caring processes: knowing, being with, doing for, enabling and maintaining belief. This approach to patient care best describes the theory of which theorists?

Select one of the following:

  • Travelbe

  • Watson

  • Benner

  • Swanson

Explanation

Question 9 of 37

1

A nurse is assessing a 15-year old female patient who is diagnosed with anorexia. Following the assessment, the nurse recommends that the patient meet with a nutritionist. This action best exemplified the use of:

Select one of the following:

  • clinical judgement

  • clinical reasoning

  • critical thinking

  • blended competencies

Explanation

Question 10 of 37

1

The nurse practices using critical thinking indicators (CTIs) when caring for patients in the hospital setting. The best description of CTIs is:

Select one of the following:

  • Evidence-based descriptions of behaviors that demonstrates the knowledge that promotes critical thinking in clinical practice

  • Evidence-based descriptions of behaviors that demonstrates the knowledge and skills that promote critical thinking in clinical practice

  • Evidence-based descriptions of behaviors that demonstrates the knowledge, characteristics, and skills that promote critical thinking in clinical practice

  • Evidence-based descriptions of behaviors that demonstrate the knowledge, characteristics, standards, and skills that promote critical thinking in clinical practice

Explanation

Question 11 of 37

1

Fill the blank spaces to complete the text.

Characteristics of the Nursing Process:

1. : Each nursing activity is part of an ordered sequence. Each one depends on the accuracy of the the preceding activity and influences the one that follows.

2. : There is great interaction and overlapping among the 5 steps. In some situations, all 5 stages occur almost simultaneously

3. : Ensures nurses are person centered rather than task centered.

4. : Offers a means for nurses and patients to work together to identify specific outcomes related to health promotion, disease and illness prevention, health restoration, and coping with altered functioning

5. in : Nurses can practice nursing with well or ill people, young or old, in any type of practice setting

Explanation

Question 12 of 37

1

The nurse has measured from the tip of the client nose to his earlobe and then down to the xiphoid process before inserting a nasogastric (NG) tube and attaching it to low suction. Which of the following components of the nursing process has the nurse demonstrated?

Select one of the following:

  • Diagnosing; implementing

  • Implementing; evaluation

  • Assessing: diagnosing

  • Planning; implementing

Explanation

Question 13 of 37

1

The nurse is responsible for establishing a caring relationship with the client. The nurse could evaluate her priority for caring by asking which self-reflecting questions?

Select one or more of the following:

  • How do I decide what the client needs and prioritize my time

  • How does the client need to change in order for me to know him better

  • Do I provide care that is individualized, or do I provide care as planned

  • When the client's family comes, do I take time to talk to them

  • What do I know about the client beyond his physical condition

Explanation

Question 14 of 37

1

According to Schuster (2008), what is the fourth step in developing a concept map?

Select one of the following:

  • Analyze and categorize data

  • Identify goals, outcomes, and intervention

  • Develop a basic skeleton diagram

  • Label and analyze nursing diagnosis relationships

Explanation

Question 15 of 37

1

Which step of the nursing process is the nurse performing when analyzing client data to identify client strengths and health problems that independent nursing interventions can prevent or resolve?

Select one of the following:

  • Implementing

  • Evaluating

  • Diagnosing

  • Assessing

Explanation

Question 16 of 37

1

According to Schuster (2008), what is the second step in developing a concept map?

Select one of the following:

  • Analyze and categorize data

  • Label and analyze nursing diagnoses relationships

  • Develop a basic skeleton diagram

  • Identify goals, outcomes, and interventions

Explanation

Question 17 of 37

1

The nursing process is based upon the process of problem solving. What type of problem solving is the nurse is using if she attempts to obtain a blood pressure on the client's right arm, the left arm, the left leg, and finally the right leg, where a blood pressure is finally obtained?

Select one of the following:

  • Critical thinking

  • Scientific problem solving

  • Trial and error problem solving

  • Intuitive thinking

Explanation

Question 18 of 37

1

A client who has been admitted to the hospital for the treatment of a gastrointestinal bleed requires a transfusion of packed red blood cells. Which of the following aspect's of the nurse's execution of this order demonstrates technical skill?

Select one of the following:

  • ensuring that informed consent has been obtained and properly filed in the client's chartu

  • understanding the Rh system that underlies the client's blood type

  • starting a new, large-gauge intravenous site on the client, and priming the infusion tubing

  • explaining the process that will be involved in preparing and administering the transfusion

Explanation

Question 19 of 37

1

A nursing instructor is describing the nursing process to a class. Which of the following would the instructor include as a characteristic of the nursing process?

Select one of the following:

  • it can be used in hospital settings

  • it is a framework for providing care

  • it is independent of other disciplines

  • it involves general care for all clients

Explanation

Question 20 of 37

1

Two nurses have disagreed about the role of intuition in nursing practice, with one characterizing it as "hocus pocus" and the other nurse advocating it as a superior problem-solving strategy. Which of the following statements best conveys the role of intuition in nurse's problem solving?

Select one of the following:

  • intuition can be a clinically useful adjunct to logical problem solving

  • in experienced nurses, intuition can be a valid replacement for scientific problem solving

  • intuition is an unreliable mode of thinking that should be avoided

  • intuition is reliable when those nurses implementing it have a special gifting

Explanation

Question 21 of 37

1

The nurse is caring for a newly admitted client. How can a nurse arrive at a more complete database for this client?

Select one of the following:

  • through clustering of data

  • analyses of lab values

  • review of the chart

  • consult with several sources

Explanation

Question 22 of 37

1

The nurse is making morning rounds after receiving reports on clients. The nurse takes the opportunity to greet the clients and do an initial observation. The nurse is actually accomplishing which step of the nursing process?

Select one of the following:

  • Planning

  • implimentation

  • assessing

  • evaluation

Explanation

Question 23 of 37

1

Which of the following activities is the clearest example of the evaluating step in the nursing process?

Select one of the following:

  • Taking the client's blood pressure on both arms in the beginning of the shift

  • Giving the patient a PRN (as needed) dose of captopril (an antihypertensive) in light of this blood pressure reading

  • Recognizing that the client's blood pressure of 172/101 is an abnormal finding

  • Checking the client's blood pressure 30 minutes after administering the captopril

Explanation

Question 24 of 37

1

The nurse caring for a client formulates client outcomes based on the understanding that the outcomes should be which of the following?

Select one of the following:

  • general in scope

  • measurable

  • not bound to time

  • abstract in nature

Explanation

Question 25 of 37

1

The nurse assesses a client's blood pressure, which was 160/90. 2 hours following the administration of hydrochlorothyazide, the nurse reassesses the blood pressure at 140/78. What action has the nurse implemented?

Select one of the following:

  • planning

  • appraising

  • evaluation

  • implementation

Explanation

Question 26 of 37

1

A hospice nurse is meeting with the parents of a terminally ill child. The nurse listens to the concerns and fears that the parents are verbalizing as they prepare to allow the child to die peacefully at home. What Critical Thinking Indicator characterizes the behavior of the nurse?

Select one of the following:

  • flexible

  • empathetic

  • creative

  • self-disciplined

Explanation

Question 27 of 37

1

Once the nurse has administered pain medication, it is the nurse's responsibility to determine it's effects and other results. When accomplishing this follow up with this client, the nurse is utilizing which step of the nursing process?

Select one of the following:

  • evaluation

  • planning

  • assessing

  • implementation

Explanation

Question 28 of 37

1

The nurse employs interpersonal personal skills of communication when caring for and interacting with clients. Which of the following is the best example of establishing a therapeutic nurse-client relationship.

Select one of the following:

  • approach the client as part of your job, and complete nursing care quickly to promote comfort

  • recognize how your approach affects client care, and describe why you have to do things the nursing way

  • respect for the client, and engage in open communication in getting to know the client

  • introduce yourself and accomplish nursing care activities efficiently to allow the client to rest

Explanation

Question 29 of 37

1

The nurse who demonstrates accountability and for responsibilities for client in their care is responsive to client needs. The client's hospital stay is often limited to a few days, and nurse-client assignments change. There is not much time to get to know the client. What are way to develop responsible caring?

Select one or more of the following:

  • Developing my strengths and weakneses in client care

  • Reporting to the oncoming shift to ensure continuity of care

  • Being attentive and responsive to the client's needs

  • Ensuring that the nurse is comfortable before communicating with the health care team

  • Demonstrating concern for the client regardless of what happens to the unit

Explanation

Question 30 of 37

1

In which of the following situations would the nurse be most justified in implementing trial-and-error problem solving?

Select one of the following:

  • The nurse is attempting to determine whether a post-stroke client has a swallowing deficit

  • the nurse is attempting to determine the range of motion of a client's hip joint following hip surgery

  • the nurse is attempting to landmark an obese client's apical pulse

  • the nurse is attempting to determine which PRN (as needed) analgesic to offer a client who is in pain

Explanation

Question 31 of 37

1

A client complains of weakness following his administration of insulin. The nurse decides to assess the client's blood sugar and prepare a snack in case the blood sugar is low. What action has the nurse implemented?

Select one of the following:

  • Caring

  • Clinical reasoning

  • assessment

  • reflection

Explanation

Question 32 of 37

1

The nursing student is working with an experienced nurse in ICU. As the nursing student enters the room of the client diagnosed with a cerebral hemorrhage, the experienced nurse immediately says "This patient is getting worse" This is an example of the experienced nurse using

Select one of the following:

  • acute observation ability

  • intuitive problem identification

  • illogical thinking

  • an assumption to guide practice

Explanation

Question 33 of 37

1

Which of the following steps in the nursing process is the careful taking of a history and a nursing examination?

Select one of the following:

  • planning

  • nursing diagnosis

  • assessment

  • evaluation

Explanation

Question 34 of 37

1

Which phase of the nursing process enables the nurse to compare the actual outcomes with the expected outcomes?

Select one of the following:

  • planning

  • implementation

  • assessment

  • evaluation

Explanation

Question 35 of 37

1

What components are located at the center of a concept map?

Select one of the following:

  • Nursing interventions and client responses

  • Client's current and past medical history

  • Short-term and long-term goals

  • Nursing diagnoses and assessment data

Explanation

Question 36 of 37

1

The committed nurse takes the opportunity to interact with the client while providing care. This is an opportunity to enrich both the client and the nurse. Select the nursing behavior that describes how to give care that makes a difference.

Select one of the following:

  • Providing care based on best practices, correct procedures and policies.

  • Accomplishing all tasks for the day required by the client and family

  • Recognizing the significance of completing the plan of care and reaching outcomes

  • Being conscious how one's responses may influence the well being of others

Explanation

Question 37 of 37

1

Care models:

: the helping role of the nurse
: caring process
: carative factors

Drag and drop to complete the text.

    Benner
    Swanson
    Watson

Explanation

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