Nursing 111: Clinical Judgement – Flashcards

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What is to feel interest or concern?
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caring
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What is caring?
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to feel interest or concern
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What is an interpretation or conclusion about a patient's needs, concerns, or health problems, and/or the decision to take action (or not), use or modify standard approaches, or improve new ones as deemed appropriate by pt's response?
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clinical judgement
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What is clinical judgement?
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an interpretation or conclusion about a patient's needs, concerns, or health problems, and/or the decision to take action (or not), use or modify standard approaches, or improve new ones as deemed appropriate by pt's response
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What is the active, organized, cognitive process used to examine one's thinking?
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critical thinking
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What is critical thinking based on?
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-reason and reflection -knowledge -instinct derived from experience
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What are the levels of critical thinking?
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-basic -complex -commitment
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What happens at the basic level of critical thinking?
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-thinking is concrete -answers to complex problems are either right or wrong -accepts the opinions and values of experts not necessarily their own
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Which level of critical thinking is a nurse whose thinking is concrete, whose answers to complex problems are either right or wrong and accepts opinions and values of experts, not their own?
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Basic level
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What are characteristics of a complex level critical thinker?
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-begin to detach from authorities and become more independent -realize there are options -become more creative and innovative
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Which level of critical thinking is a nurse who becomes more independent, realizing there are options and becomes more creative and innovative?
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Complex level
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What are characteristics of a commitment level critical thinker?
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-anticipates and makes independent decisions and then assumes accountability -chooses the action or belief baseline on alternatives and stands by it
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Which level of critical thinking is a nurse who anticipates and makes independent decisions, then assumes accountability and chooses the action or belief baseline on alternatives and stands by it?
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commitment level
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What are obstacles to high level thinking?
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-habits and ruts -anxiety
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A nurse who has worked on the same floor for 20 years approaches her care with the same routine every shift. Which obstacle to high level thinking is this nurse experiencing?
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habits and ruts
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What is the thinking process by which the nurse reaches a clinical judgement?
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clinical reasoning
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What is clinical reasoning?
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reasoning in transition with a fine attunement to the patient and how the patient responds to the nurse's action
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What are the attributes of clinical judgement?
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-holistic view of patient situation -circular process -requires reasoning and interpretation of data
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What is needed before you can make a clinical judgement?
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-nursing knowledge -experience -ethical perspective -know the patient situation
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What are the steps in the clinical judgement process?
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-noticing -interpreting -responding -reflecting
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A nurse is looking for patterns in her patients that are consistent with previous experiences so she can use that information to guide her care. Which step in the clinical judgement process is she in?
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noticing
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A nurse is taking all of the information he gathered while assessing his patient and is trying to make sense of it. Which step in the clinical judgement process is he in?
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interpreting
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A nurse is implementing the actions and interventions for her patient, based on the pts needs. Which step in the clinical judgement process is she in?
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responding
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A nurse is thinking about whether or not her actions and interventions were appropriate or effective for her patient. Which step in the clinical judgement process is she in?
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reflecting
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A patient calls for her nurse to say she has a pain of 8. The nurse administers the prescribed pain medicine to the patient. After 30 min, the nurse comes back to reassess the patient's pain level. Which part of the clinical judgement process is the nurse in when she reassess the pain level?
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reflection-in-action
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A nurse just got home from her shift at work. She is thinking about her patient who coded that afternoon. She is replaying her patient care in her head to try to figure out if there was something more she could have done to prevent the code, or if she could have missed something. Which part of the clinical judgement process is this nurse in?
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reflection-on-action
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What is critical for development of knowledge and improvement in reasoning?
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reflecting
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What is an example of a patient interaction that does not require critical thinking?
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-vital signs are normal
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How does the environment you are in have an affect on clinical judgement?
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-more demanding environments such as critical care or emergency department can influence what a nurse notices -can add an increased burden on making clinical judgements -can interfere with competent clinical judgement
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What are the concepts related to clinical decision making?
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-Managing Care -Accountability -Collaboration -Communication -Oxygenation
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What are examples of managing care in relation to clinical decision making?
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-care coordination -cost-effective care -delegation
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How does managing care relate to clinical decision making?
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patient care is organized to include patient preferences, time constraints, resources, and expertise of other available disclipines
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What are the nursing implications of managing care in relation to clinical decision making?
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nursing care is achieved through the coordination of many factors that influence outcomes for the patient
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What falls under accountability in relation to clinical decision making?
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competence
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How does accountability relate to clinical decision making?
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standards o are set benchmarks for nursing performance expectations
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What are the nursing implications of accountability in relation to clinical decision making?
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nurses are responsible for the clinical decisions and judgements they make to support desired patient outcome
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What are examples of collaboration in relation to clinical decision making?
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-case management -interdisciplinary teams
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How does collaboration relate to clinical decision making?
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many disciplines contribute to the care of a patient
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What are the nursing implications of collaboration in relation to clinical decision making?
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nurses participate in a collaborative team approach when caring for patients
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What are examples of communication in relation to clinical decision making?
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-documentation -reporting
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How does communication relate to clinical decision making?
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priorities of patient care need to be communicated to achieve continuity of care
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What are the nursing implications of communication in relation to clinical decision making?
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-Nurses use the patient's plan of care to communicate priority needs of the patient
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How does oxygenation relate to clinical decision making?
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nurses use clinical decision making following assessment of airway patency to identify: a) additional assessment data essential to determine care needs b) priority interventions necessary to promote effective respiration and gas exchange
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What are the nursing implications of oxygenation in relation to clinical decision making?
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-knowledge of oxygenation, patient history, and facility protocols is necessary when making decisions about the nursing care of patients with alterations in oxygenation -examples include prioritizing assessment data to gather relative to oxygenation, and anticipating appropriate physician orders, such as supplemental oxygen, encouragement of oral fluids and IV antibiotics
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In any clinical circumstances, patient outcome improves when the nurse uses _____________.
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critical thinking
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What is the ability to learn and understand knowledge; the capacity for thinking and reasoning intelligently?
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Intellect
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What are common attitudes of the critical thinker?
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-independence -fair-mindedness -aware of self-limits -integrity -perseverance -confidence
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A nurse who does her own thinking, objectively and honestly is exhibiting which of the common attitudes of a the critical thinker?
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independence
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A nurse who is open to new ideas and ways of doing things is exhibiting which of the common attitudes of a the critical thinker?
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fair-mindedness
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A nurse who looks for the facts and is not easily swayed by opinions is exhibiting which of the common attitudes of a the critical thinker?
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independence
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A nurse who has neutral judgments without bias is exhibiting which of the common attitudes of a the critical thinker?
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fair-mindedness
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A nurse who considers opposing views to understand all aspects before making decisions is exhibiting which of the common attitudes of a the critical thinker?
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fair-mindedness
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A nurse who knows her limits of intellect and experience is exhibiting which of the common attitudes of a the critical thinker?
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aware of self-limits
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A nurse who seeks new knowledge or skills in current evidence is exhibiting which of the common attitudes of a the critical thinker?
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aware of self-limits
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A nurse who expresses a willingness to self-reflect on her own beliefs and ideas is exhibiting which of the common attitudes of a the critical thinker??
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aware of self-limits
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A nurse who challenges their own ideas and methods of doing nursing care is exhibiting which of the common attitudes of a the critical thinker?
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integrity
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A nurse who evaluates inconsistencies within their own nursing practice is exhibiting which of the common attitudes of a the critical thinker?
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integrity
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A nurse who chooses the right thing to do over the popular thing to do is exhibiting which of the common attitudes of a the critical thinker?
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integrity
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A nurse who has a stick-with-it motivation to find the best solution for quality patient outcomes is exhibiting which of the common attitudes of a the critical thinker?
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perseverance
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A nurse who is patient with processes is exhibiting which of the common attitudes of a the critical thinker?
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perseverance
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A nurse who knows that he knows what he knows is exhibiting which of the common attitudes of a the critical thinker?
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confidence
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A nurse who trusts the skills and abilities of intellect, creativity, inquiry, reasoning, reflection, and intuition is exhibiting which of the common attitudes of a the critical thinker?
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confidence
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What are the skills and abilities necessary to develop critical thinking?
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-intellect -creativity -inquiry -reasoning -reflection -intuition
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What is the leading, most noticeable, or most important information about a patient's health status?
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salient cue
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What is a salient cue?
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the leading, most noticeable, or most important information about a patient's health status
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What can cluster to form a pattern that can be translated into a priority problem for a patient?
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salient cue
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What can a salient cue do?
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-can indicate a negative or positive change in a patient's health status or pattern -varies from the norms of the patient population -can indicate a developmental delay
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What is finding unique solutions to unique problems when traditional interventions are not effective?
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creativity
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What is creativity?
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finding unique solutions to unique problems when traditional interventions are not effective
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What is a search for knowledge or facts?
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inquiry
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What is inquiry?
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a search for knowledge or facts
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Helping a patient newly diagnosed with diabetes learn what foods are appropriate is an example of which skill or ability of critical thinking?
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creativity
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Finding alternatives for an IV tubing label when not traditional label is available is an example of which skill or ability of critical thinking?
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creativity
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Using tape and tongue blades to make a toy house for a young child is an example of which skill or ability of critical thinking?
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creativity
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A nurse who examines objective information to gain clarification and find solutions to problems exhibits which skill or ability of critical thinking?
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inquiry
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A nurse who asks "Why do we always need to apply the dressing this way?" is exhibiting which skill or ability of critical thinking?
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inquiry
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A nurse who asks "Is there something else we can try?" is exhibiting which skill or ability of critical thinking?
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inquiry
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What are the two forms of logical reasoning?
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-deductive reasoning -inductive reasoning
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What is deductive reasoning?
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-starting with the conclusion and analyzing it for valid significant cues -top down approach
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The nurse concludes a newly admitted patient with pneumonia would have the typical symptoms of pneumonia. This is an example of which form of logical reasoning?
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deductive reasoning
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A nurse is familiar with typical symptoms of pneumonia, and observes her patient has these symptoms. She concludes that her patient has a strong probability of pneumonia. This is an example of which form of logical reasoning?
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inductive reasoning
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What is inductive reasoning?
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-put significant cues together to reach a conclusion -bottom up approach
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What is the action of making sense of occurrences, situations, or decisions by carefully considering the totality of the experience?
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reflection
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What is the use of nursing knowledge, experience, and expertise for understanding without the conscious use of reasoning?
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intuition
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What is the purpose of noticing in the nursing process?
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to establish a database about the patient's response to health concerns or illness and the ability to manage health care needs
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What is the purpose of patient problem identification in the nursing process?
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-To identify patient strengths and health problems that can be prevented or resolved by collaborative and nursing interventions -to develop a list of nursing and collaborative problems
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What is the purpose of interpreting in the nursing process?
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to develop an individualized plan of care that specifies patient goals/desired outcomes, and related priority nursing interventions
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What is the purpose of implementation/responding in the nursing process?
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-to assist the patient to meet desired goals/desired outcomes -promote wellness -prevent illness and disease -restore health -facilitate coping with altered functions
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What is the purpose of reflection in the nursing process?
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to determine whether to continue, modify, or terminate the plan of care
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-obtaining health history -review pt records -speak with family members and significant support persons -speak with appropriate health professionals These are examples of which phase of the nursing process?
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noticing
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-compare data against standards -cluster or group data -identify pts strengths, risks, and problems -documenting priority problem These are examples of which phase of the nursing process?
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Problem identification
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-setting priorities and goals/outcomes in collaboration with patient -write goals/desired outcomes -select nursing interventions -consult other health professionals These are examples of which phase of the nursing process?
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Interpreting
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-reassess the patient to update the database to keep it current -communicate what nursing actions were implemented -perform priority nursing interventions These are examples of which phase of the nursing process?
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Responding
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-judge whether goals/outcomes have been achieved -relate nursing actions to patient outcomes -make decisions about problem status -review and modify plan of care
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-refletion
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What are the types of nursing problems?
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-actual problems -risk problems -wellness problems -health promotion problems
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Which type of nursing problem is a current, right now problem?
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actual problem
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Which type of nursing problem is a potential/probable problem?
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risk probolem
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Which type of nursing problem address the enhancement of an individual, family or community?
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wellness problem
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Which type of nursing problems involve motivating the patient to have a healthier lifestyle?
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health promotion
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What must happen for patient goals to be effective?
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the patient/family must agree upon the goals to be acheived
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What acronym helps us write patient goals?
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SMART -Single specific action -Measurable -Attainable -Relevant -Time limited
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What are the guidelines of writing a patient goal?
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-write in terms of the patient responses -must be realistic -ensure compatible with other therapies -derived from only one problem -urse observable, measurable terms -make sure pt considers the goal to be important
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What are the types of nursing interventions?
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-independent -dependent -collaborative
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Which type of nursing intervention is the nurse licensed to initiate?
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independent
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What is an independent nursing intervention?
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-nurse is licensed to initiate
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Which type of nursing intervention is carried out under physician's orders, supervision?
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dependent
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What is a dependent nursing intervention?
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-carried out under physician's orders, supervisions
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Which type of nursing intervention reflects overlapping responsibilities of the healthcare team?
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-collaborative
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What is collaborative nursing interventions?
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-reflet overlapping responsibilities of healthcare team
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What do nursing interventions focus on?
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-assessments to observe for changes in pt's status -prevention to avoid complications -reduction of risk factors -treatment through teaching and providing physical care -improvement of health through health promotion and achieving higher levels of wellness
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Who mandates the use of a plan of care?
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The Joint Commission
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What determines the format of the plan of care?
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the facility
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Why are concept maps ideal for creating a plan of care?
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the show a more holistic view of patient
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What is the difference between effectiveness and efficiency?
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effectiveness- doing the right thing efficiency- doing things right
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What is the key to prioritization?
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assessment, you can't prioritise what you don't know
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What are the levels of priorities?
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-low -medium -high
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Problems that can be delegated are which level of priority?
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low
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Problems that cannot be delegated and will have unhealthy physical or emotional consequences if not addressed are which level of priority?
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medium
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Problems that are life threatening are which level of priority?
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high
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What is a way to illustrate how much time can safely lapse before doing interventions without compromising patient outcomes?
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urgency factor
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What are the levels of urgency?
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-nonacute -acute -critical -imminent death
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What is the process of identifying priorities for implementing care in emergency situations?
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triage
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What are the categories patients can be placed into when triaged?
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-emergent- life threatening issues -urgent- serious conditions where delay would not result in life-threatening situation -nonurgent-pt can ambulate, is stable
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Where can a nurse find what can be delegated and to whom it can be delegated?
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-The PA State Code -Nurse Practice Act
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