Flashcards in Clinical Decision Making Deck (24)
The nurse decides to take vital signs and draw morning blood work before the patient's family comes to visit. Which type of decision does the nurse's action reflect?
A. Scheduling decision
B. Value decision
C. Time-management decision
D. Priority decision
A. Scheduling decision - Nurses make four types of decisions. A scheduling decision is made when the nurse decides take vital signs and draw blood before visiting hours. Value decisions are those regarding patient confidentiality. Time-management decisions are those made to help the nurse manage time better. A priority decision is deciding what needs to be completed first and what can be delegated to a nursing assistant.
The nurse with 15 years of obstetric experience is caring for a patient in labor who is reporting extreme pain. The nurse knows that the patient is likely getting very close to delivery but asks the provider to come and evaluate the patient. Which decision-making process is reflected in this situation?
A. The scientific method
C. Trial and error
D. The nursing process
B. Intuition - The nurse is relying on intuition from the 15 years of previous experience. Intuition is relying on subconscious clues and previous experience to find patterns in patient behavior. Trial and error is the process of trying different options to see what works and what does not, such as trying different positions to find one that is comfortable for the patient. The scientific process is a formal, investigative approach to problem solving, which is not the process used by this nurse. The nursing process uses five defined steps (assessment, diagnosis, planning, implementation, and evaluation) to solve a problem.
Which clinical situation best exemplifies the nurse who is choosing between alternatives when making a clinical decision?
A. The nurse changes the patient's position numerous times until the patient appears in less pain.
B. The nurse has a "gut reaction" to the patient's pain and calls the patient's physician.
C. The nurse determines that the patient's nursing diagnosis is Pain, Acute.
D. The nurse administers an intravenous (IV) narcotic instead of an oral narcotic.
D. The nurse administers an intravenous (IV) narcotic instead of an oral narcotic. - The nurse who administers an IV narcotic instead of an oral narcotic is choosing between alternatives. The nurse who helps the patient change position numerous times is using trial and error. The nurse acting on a "gut reaction" is using intuition. The nurse determining the nursing diagnosis is utilizing the nursing process. (NANDA-I ©2014)
The nurse auscultates a patient's breath sounds after the patient receives an albuterol nebulizer treatment secondary to wheezing. The nurse finds that the patient is still wheezing despite the therapy. Which aspect of Tanner's clinical judgment model is the nurse displaying?
C. Noticing - According to Tanner's clinical judgment model, the nurse is displaying noticing by recognizing the presence or absence of expected significant cues from the patient's response to an illness or medical condition. Interpreting involves using logical reasoning to determine appropriate action after noticing a clinical finding. Responding occurs when the nurse acts based on what is found and interpreted. When the nurse reviews the clinical action, the nurse is reflecting.
The nurse is looking at ways to help infants in the healthcare process. Which intervention is appropriate for this age group?
A. Encourage the use of play therapy and toys in the treatment rooms.
B. Place cots for parents to stay over in all patient rooms.
C. Provide simple options when appropriate.
D. Allow for hands-on exploration of all equipment.
B. Place cots for parents to stay over in all patient rooms. - Infants are not able to be involved in decision making but must be comforted and made to feel secure throughout the entire healthcare process. Placing cots in patient rooms to allow parents to sleep over helps infants feel more comfortable. Infants are not able to participate in play therapy, choose between options, or explore all equipment with their hands.
The nurse educator is reviewing Tanner's clinical decision-making model and asks the students about the purpose of reflecting. Which response by a student is correct?
A. "To gain understanding about a situation"
B. "To sense what is happening in a situation"
C. "To learn from actions in order to make adjustments to future practice"
D. "To analyze a situation to choose an action"
C. "To learn from actions in order to make adjustments to future practice" - According to Tanner's model, reflecting helps the nurse learn from actions to make adjustments. Interpreting involves using logical reasoning to gain understanding about a situation and determine appropriate actions. Noticing requires a sense of what is happening in the patient situation. Responding is analyzing a situation to choose the best course of action.
The nurse manager is looking at models of clinical judgment to use as an employee assessment tool. The nurse manager wishes to use a model that can evaluate clinical competence in the workplace. Which is best suited for the job?
A. Tanner's clinical judgment model
B. Guided reflection
C. Lasater's clinical judgment rubric
D. Benner's skill acquisition model
D. Benner's skill acquisition model - Benner's skill acquisition model looks at clinical competence at five different levels and would be best suited for an employee evaluation tool. Tanner's clinical judgment model looks at the different cognitive skills needed in effective nursing practice. Lasater's clinical judgment rubric builds off Tanner's model to evaluate learners in a simulated environment. Guided reflection helps the nurse reflect on a given situation and is not suited as an employee evaluation tool.
The nurse is caring for a toddler who appears frightened by the nurse. To make the child more at ease, the nurse gives the toddler a disposable tape measure to play with. Which critical thinking concept is the nurse displaying?
A. Creativity - The nurse is using creativity, or finding a solution by using a method that is unconventional. In this case, the nurse is "thinking outside the box" to let the toddler play and put the child at ease. Concreteness is a concept of therapeutic communication, which is when the nurse is specific rather than general. Confidence is an attitude that nurses convey by acting on information and experience they know are correct. Nurses exhibit independence by looking at facts and not being easily
The nurse is planning to transfer a 76-year-old patient to a long-term care facility. The patient wants to live close to family; however, the facility that would best meet the patient's needs is a few miles farther away. Which action should the nurse implement?
A. Tell the patient that being near family is not always a good idea.
B. List other facilities so that the patient can make a better decision.
C. Discuss the advantages of the facility that is a bit farther away.
D. Tell the patient that the facility that is closer to family is not accepting admissions.
C. Discuss the advantages of the facility that is a bit farther away. - Nurses help patients make decisions by providing information or making referrals to resources. In this situation, the patient wants to be placed in a facility near family, but the best facility for the patient is farther away. The nurse needs to help the patient through the decision-making process by providing additional information about the facility that is more suited to the patient's needs. The nurse should not make up information so that the patient agrees to the facility that is farther away. Listing other facilities might confuse the issue. Telling the patient that being near family is not always a good idea is a judgment and does not take the patient's needs into
A pregnant patient presents with rising blood pressure and protein in her urine. After testing, the provider diagnoses the patient with preeclampsia and informs her that they are taking her to the operating room to deliver the baby through cesarean delivery immediately. Which decision-making model is displayed?
A. Paternalism - This is an example of paternalism, where the provider has the education and experience to make the best decision for the mom and baby. The consumerism model is a hands-off approach to healthcare where the provider provides the scientific information and allows the patient to make the best decision. Mutualism is a process of shared decision making between both the patient and the provider. There is no maternalism model of decision making.
Which action by the nurse indicates support for a preschooler's decision-making ability?
A. Inviting the child to the interdisciplinary meeting
B. Asking if the child would like to have the scheduled snack before or after going for an x-ray
C. Showing the child the materials that will be used to stitch up the wound in the child's knee
D. Soothing the child by rocking the child until calm
B. Asking if the child would like to have the scheduled snack before or after going for an x-ray - Preschoolers are able to make some decisions related to preference when information is provided to them in a way that makes sense to them. Asking preschoolers if they would like a scheduled snack before or after a procedure is an example of assisting a preschool child in decision making. Because adolescents are capable of participating in making decisions on their own behalf, it would be appropriate to invite an adolescent patient to come to an interdisciplinary meeting. School-age children benefit from direct explanations and would likely be interested in seeing and handling materials that will be used in their own care. Although infants cannot make decisions, they need to feel secure during care; soothing and rocking the infant patient is appropriate.
The nurse is caring for a patient with a history of diabetes mellitus. The nurse notices an upward trend to the patient's daily fasting serum blood glucose and notifies the patient's healthcare provider. Which level best describes this nurse according to Benner's skill acquisition model?
B. Advanced beginner
D. Proficient - The nurse is proficient according to Benner's skill acquisition model. In this level of the model, nurses develop their own rules for actions by analyzing significant cues and are able to see the "big picture." The novice level includes those without any nursing experience who act only by rules, not cognition. The advanced beginner is typically a new graduate who begins to recognize significant cues using cognition but is unable to piece all clinical cues into a whole picture. The competent nurse, according to Benner, has 2–3 years of nursing experience. However, the competent nurse is still unable to see the "big picture."
The nurse is caring for a teenager who requires surgery to repair a broken femur after a motor vehicle crash. Which statement about patient consent is correct?
A. The parents must provide consent.
B. The teenager must sign the consent form.
C. The parents must provide consent, and the teen must sign an assent form.
D. The teenager must sign the consent form, and the parents must also provide assent.
A. The parents must provide consent. - Even though teenagers should be involved in healthcare decisions whenever possible, the parents must provide consent. Whenever possible, the teenager should also assent to the procedure, although no formal form is required. Unless the teenager was given autonomous and legal decision-making power, the teen does not sign the consent form.
The nurse is caring for a neonate who requires nasogastric (NG) tube feedings due to prematurity. The NG tube frequently slips out of position, and the nurse tries different approaches to prevent this from happening. Which critical thinking skill is the nurse demonstrating?
A. Inquiry - When using inquiry, objective information is examined in order to clarify and find solutions to problems. Inquiry uses questions to find alternative approaches or solutions. Nurses use intellect to identify salient cues and group them into meaningful patterns. Clinical reasoning is the careful evaluation of information to improve patient care. Reflection is looking back at a situation to determine what worked, what did not work, or what could have been done better.
The nurse is caring for a patient who is having back discomfort. The nurse helps the patient change position several times until comfortable. Which process is defined by this action?
A. The nursing process
C. Trial and error
D. Clinical decision making
C. Trial and error - Trial and error is the process of trying different options to see what works and what does not, such as trying different positions to find one that is comfortable for the patient. Intuition is relying on subconscious clues and previous experience to find patterns in patient behavior. The nursing process uses five defined steps (assessment, diagnosis, planning, implementation, and evaluation) to solve a problem. Clinical decision making uses the nurse's skills, experience, and knowledge to make a decision.
The nurse forgets to provide the patient with discharge papers. When speaking with a coworker, the nurse states, "I should have remembered to bring the papers into the patient's room, but I got distracted with another task." Which guided reflection task is the nurse demonstrating?
A. Interpreting - The nurse is interpreting the situation after thinking about the background information needed to understand the situation and making pertinent observations (observing) about what happened. Responding describes the nursing response to the situation. Reflecting describes an understanding of the "take-away" lesson from the experience or situation.
The nurse working in the intensive care unit (ICU) has decided to attend a professional critical care conference. Which critical thinking attitude is exemplified by the nurse's actions?
D. Awareness of self-limits
D. Awareness of self-limits - The nurse is demonstrating awareness of self-limits by seeking new knowledge or skills. Nurses exhibit independence when they think on their own. Confidence is exemplified by self-assurance. Integrity is displayed when the nurse chooses the right option, even if it is not the popular option.
The nurse is caring for a patient who was admitted with abdominal pain. The patient's complete blood count (CBC) is normal, but the nurse is still concerned about the patient having a gastrointestinal bleed and monitors the patient closely. Which cognitive skill is the nurse displaying?
B. Intuition - Intuition is the use of nursing knowledge and experience for understanding without the conscious use of reasoning. Inquiry uses questions to find alternative approaches or solutions. Nurses use intellect to identify salient cues and group them into meaningful patterns. Clinical reasoning is the careful evaluation of information to improve patient care. Reflection is looking back at a situation to determine what worked, what did not work, or what could have been done better.
The nurse is caring for a young woman who is receiving antibiotics for a urinary tract infection. The patient returns to the clinic complaining of continued burning urination 4 days after starting the medication. The nurse looks at the patient's chart and notices that a urine culture was never performed. Which feature of Tanner's clinical judgment model is displayed here?
C. Reflecting - According to Tanner's clinical judgment model, this is an example of reflecting because the nurse is reviewing the previous clinical actions. Noticing is the recognition of the presence or absence of expected significant cues from the patient's response to an illness or medical condition. Interpreting involves using logical reasoning to determine appropriate action after noticing a clinical finding. Responding occurs when the nurse acts based on what is found and interpreted.
The nurse is working on the oncology floor of the hospital and notes that many of the patients request internet access so that they can communicate with loved ones more easily. Using this information, the nurse obtains a grant to purchase several laptops for the patients to share. Which type of reasoning did the nurse use to develop this protocol?
A. Clinical reasoning
B. Inductive reasoning
C. Careful reasoning
D. Deductive reasoning
B. Inductive reasoning - Inductive reasoning uses a "bottom-up" approach that helps the nurse develop a theory or change in practice. In this example, the nurse observed a way to help some patients cope better with their diagnosis, then developed a protocol or practice to address their needs. The nurse may also be demonstrating clinical or careful reasoning, but these are not the best and most inclusive answers. Deductive reasoning uses a "top-down" approach and looks at a specific rule to see if examples apply to the rule.
The nurse decides to suction and perform tracheostomy care on a patient before sending the patient to a scheduled procedure. Which process does the nurse's action define?
A. Clinical decision making
C. Trial and error
D. Choosing among alternatives
A. Clinical decision making - Here, the nurse is relying on clinical judgment to perform respiratory care for the patient before sending the patient off the floor. This is to ensure that the patient does not need to be suctioned or cleaned up while at the procedure. The nurse is not relying on intuition to make the decision, using trial and error, or choosing among alternatives.
The nurse is sitting with a laboring patient who is requesting intermittent fetal monitoring. The nurse is explaining the risks, benefits, and evidence to support the different types of monitoring. Which type of decision making is the nurse demonstrating?
C. Mutualism - This is an example of mutualism, which is a process of shared decision making between both the patient and the provider. Paternalism is where the provider has the education and experience to make the best decision for the mom and baby. The consumerism model is a hands-off approach to healthcare where the provider provides the scientific information and allows the patient to make the best decision. There is no maternalism model of decision making.
The nurse educator is teaching student nurses about nursing judgment. Which statement by a student indicates effective learning?
A. "Students must be skilled at using clinical judgment while in nursing school."
B. "Both clinical decision making and critical thinking are important parts of nursing judgment."
C. "Clinical decision making is scarcely used in nursing judgment."
D. "Intuition is an important part of nursing judgment in the new nurse."
B. "Both clinical decision making and critical thinking are important parts of nursing judgment." - Nursing judgment combines both critical thinking and clinical decision making when making decisions about patient care. Student nurses are not expected to have excellent clinical judgment because it is honed and improved over time. Clinical nursing judgment is frequently used by nurses. As new nurses become more experienced, they will increasingly be able to use their intuition to help in decision making.