Quiz 36: Clinical Judgment

Concepts For Nursing Practice

Nursing
9
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True/False
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Questions

Q1
Free

A student nurse is studying clinical judgment theories and is working with Tanners Model of Clinical Judgment. The student nurse can generalize the process as

Multiple Choice
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A) a reflective process where the nurse notices, interprets, responds, and reflects in action.
B) one conceptual mechanism for critiquing ideas and establishing goal-oriented care.
C) researching best practice literature to create care pathways for certain populations.
D) assessing, diagnosing, implementing, and evaluating the nursing care plans.
Answer:
A) a reflective process where the nurse notices, interprets, responds, and reflects in action.

Explanation:
Looking across theories and definitions of clinical judgment, they all have in common the ability to reflect on data and choose actions. Reflection also considers evaluating the result of the actions to determine whether they were effective. Although critiquing ideas and establishing goal-oriented care could be considered part of a generalized statement of critical thinking, this is not broad enough without the reflection and evaluation. Clinical judgment would most likely be used to create care paths derived from the evidence; however, this is not the cornerstone of the Tanner Model. Clinical judgment is used when engaging in the nursing process, but this is too narrow in focus to capture the essence of critical thinking definitions and theories. Critical thinking is not synonymous with the nursing process.
Q2
Free

The nurse is implementing a plan of care for a patient newly diagnosed with type 2 diabetes mellitus. The plan includes educating the patient about diet choices. The patient states that they enjoy exercising and understand the need to diet; however, they cant see living without chocolate on a daily basis. Using the principles of responding in the Model of Clinical Judgment, how would the nurse proceed with the teaching?

Multiple Choice
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A) The nurse explains to the patient that chocolate has a high glycemic index. The nurse then focuses on foods that have low glycemic indexes and provides a list for the patient to choose from.
B) The nurse explains that the patient may eat whatever they would like as long as the patients glucose reading and A1c remain stable.
C) The nurse derives a new nursing diagnosis of Knowledge Deficit and readjusts the plan of care to include additional sessions with the registered dietician.
D) The nurse examines the patients daily glucose log and incorporates the snack into the time of day that has the lowest readings. The nurse then follows up and evaluates the response in 1 week.
Answer:
D) The nurse examines the patients daily glucose log and incorporates the snack into the time of day that has the lowest readings. The nurse then follows up and evaluates the response in 1 week.

Explanation:
Responding entails adjusting the plan of care to the particular patient issue through one or more nursing interventions. In this case, the nurse is working with the patients wishes, knowing that the patient will most likely cheat. The patient will be allowed to cheat. The plan will be evaluated to be sure the snack does not elevate the glucose excessively and be readjusted if warranted. While it is true that most chocolate has a high glycemic index, providing a list of foods that do not include the one thing the patient enjoys will most likely lead to nonadherence to the diet. Advising the patient that they can have whatever they want to eat may lead to further dietary indiscretions and cause side effects such as obesity or high glucose readings. Knowledge Deficit is an inaccurate diagnosis for this patient as evidenced by the patient stating they understand the need to exercise and the need to diet.
Q3
Free

A new graduate nurse (GN) is working with an experienced nurse to chart assessment findings. The GN notes that the physical therapist wrote on the chart that the patient is lazy and did not want to participate in assigned therapies this AM. The experienced nurse asks the GN what may be going on here. What is the best explanation for this statement?

Multiple Choice
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A) Data on the chart can sometimes be documented in a biased manner.
B) Data on the chart changes as the patients condition changes.
C) Data on the chart is usually accurate and can be verified from the patient.
D) Reading the chart is not a wise use of time as this can be time consuming and tedious.
Answer:
A) Data on the chart can sometimes be documented in a biased manner.

Explanation:
It is important that the nurse records only what is assessed, without adding judgments or interpretations to the record. Data do indeed change (and need to be charted) as the patients condition changes, but this would not be the best answer to this question. Assessment data may at times be difficult to obtain, but that would not occur often enough to warrant a warning about the difficulty in charting it. Also, obtaining data is clearly a different activity from charting it. Charting can be time consuming and tedious, but this is not the most complete answer to this question.
Q4

A home care nurse receives a physician order for a medication that the patient does not want to take because the patient has a history of side effects from this medication. The nurse carefully listens to the patient, considers it in light of the patients condition, questions its appropriateness, and examines alternative treatments. This nurse would most likely

Multiple Choice
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A) call the physician, explain rationale, and suggest a different medication.
B) consult an experienced nurse on whether there are other similar treatments.
C) hold the drug until the physician returns to the unit and can be questioned.
D) question other staff as to the physicians acceptance of nursing input.
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Q5

A patient has been admitted for a skin graft following third degree burns to the bilateral calves. The plan of care involves 3 days inpatient and 6 months outpatient treatment, to include home care and dressing changes. When should the nurse initiate the educational plan?

Multiple Choice
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A) After the operation and the patient is awake
B) On admission, along with the initial assessment
C) The day before the patient is to be discharged
D) When narcotics are no longer needed routinely
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Q6

A nurse has designed an individualized nursing care plan for a patient, but the patient is not meeting goals. Further assessment reveals that the patient is not following through on many items. Which action by the nurse would be best for determining the cause of the problem?

Multiple Choice
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A) Assess whether the actions were too hard for the patient.
B) Determine whether the patient agrees with the care plan.
C) Question the patients reasons for not following through.
D) Reevaluate data to ensure the diagnoses are sound.
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Q7

A GN appears to be second-guessing herself and is constantly calling on the other nurses to double-check their plan of care or rehearse what they will say to the doctor before she call on the patients behalf. This seems to be annoying some of the nurses coworkers. The nurse managers best response to this situation is to

Multiple Choice
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A) explain to coworkers that this is a characteristic of critical thinking and is important for the GN to improve reasoning skills.
B) agree with the staff and have someone follow and work more closely with a preceptor.
C) have a talk with the nurse and suggest asking fewer questions.
D) tell the staff that all new nurses go through this phase, and ignore their behavior.
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Q8

A nurse has committed a serious medication error and has reported their error to the hospitals adverse medication error hotline as well as to the unit manager. The manager is a firm believer in developing critical thinking skills. From this standpoint, what action by the manager would best nurture this ability in the nurse who made the error?

Multiple Choice
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A) Have the nurse present an in-service related to the cause of the error.
B) Instruct the nurse to write a paper on how to avoid this type of error.
C) Let the nurse work with more experienced nurses when giving medications.
D) Send the nurse to refresher courses on medication administration.
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Q9

A nursing instructor assigns their clinical group the task of writing a journal depicting the students clinical day. What is the most likely rationale for this assignment?

Multiple Choice
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A) Journaling allows reflection, an important critical thinking skill.
B) Journaling gives you time to review what happened in your clinical.
C) Journaling is a way to organize your thoughts about your experiences.
D) Journaling teaches open-mindedness, a critical thinking disposition.
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