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

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 - [blank_start]assessing[blank_end]) 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 - [blank_start]diagnosing[blank_end]) 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 - [blank_start]outcome[blank_end] [blank_start]identification[blank_end] and [blank_start]planning[blank_end]) 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 - [blank_start]implementing[blank_end]) 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 - [blank_start]evaluating[blank_end]) to assess her progress toward achieving targeted outcomes. If she is not making progress, the plan of care might need to be modified.

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?

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?

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?

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

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?

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?

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?

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:

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

Characteristics of the Nursing Process: 1. [blank_start]Systematic[blank_end]: 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. [blank_start]Dynamic[blank_end]: There is great interaction and overlapping among the 5 steps. In some situations, all 5 stages occur almost simultaneously 3. [blank_start]Interpersonal[blank_end]: Ensures nurses are person centered rather than task centered. 4. [blank_start]Outcome[blank_end] [blank_start]oriented[blank_end]: 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. [blank_start]Universally[blank_end] [blank_start]Applicable[blank_end] in [blank_start]Nursing[blank_end] [blank_start]Situations[blank_end]: Nurses can practice nursing with well or ill people, young or old, in any type of practice setting

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?

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?

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

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?

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

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?

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?

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?

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?

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

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?

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

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

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?

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?

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?

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.

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?

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

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?

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

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

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

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

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.

Care models: [blank_start]Benner[blank_end]: the helping role of the nurse [blank_start]Swanson[blank_end]: caring process [blank_start]Watson[blank_end]: carative factors