Test 1

Question 1

Tanners four domains of clinical judgement

Answer 1

1. Noticing
2. interpreting
3. responding
4. reflecting

Question 2

Noticing

Answer 2

background of nurse, nurse relationship with pt, context of care. step one. know expectations of pt and medical staff before step 2.

Question 3

Interpreting

Answer 3

2. includes reasoning, patterns, analytic, intuitive and narrative-use data plus theoretical knowledge plus experience to make sense. interpret all data before next step

Question 4

responding

Answer 4

3. actions/ outcomes/ reflection in action

Question 5

reflecting

Answer 5

4. challenges one to use critical thinking to examine presented information, question validity, and draw conclusions based on the resulting ideas. reflection can lead to greater self awareness.

Question 6

hypothetico-deductive

Answer 6

a reasoning pattern might be triggered, through which interpretive or diagnostic hypotheses are generated. Additional assessment is performed to help rule out hypotheses until the nurse reaches an interpretation that supports most of the data collected and suggests an appropriate response

Question 7

to arrive at conclusions in clinical judgement process need

Answer 7

reflection in action AND reflection on action
IN- how is client responding,do i need to change what I’m doing
ON-final outcome, how did my actions influence outcome, what might i have done differently and in what part of process could my thinking have been more clear

Question 8

preoperative nurse responsibilities

Answer 8

consents signed (and witness)
Hx and P in chart and signed
Dx and radiologic test in chart
prophylactic antibiotic is give if ordered

Question 9

time out

Answer 9

correct pt (2 ID)
correct procedure (orders and consent same)
Correct site (marked and initialed)
Correct client position, correct diagnostic radiology tests, prophylactics given? RN and Surgen verbal verify visual of site, safety precautions, RN docs time out

Question 10

Circulating RN pre op room

Answer 10

ID pt, confirm orders, consent, verify site marked, verify client position, equipment availability and test result availability, communicate all drug related issues and antibiotic admin prior to surgery.

Question 11

core measure

Answer 11

evidence based, scientifically researched standard of care which has been shown to result in improved clinical outcomes. reduces morbidity, mortality complications and readmissions

Question 12

heart failure measures

Answer 12

complete discharge instructions
Left ventricular systolic function assessment
ace inhibitor or ARB for LVS dysfunction
smoking cessation counseling

Question 13

heart failure discharge instructions

Answer 13

activity level, diet/fluid
med reconciliation, follow up with dr
worsening sxs, weight monitoring

Question 14

acute MI measures arrival

Answer 14

ASA (75-325mg) on arrival or before
EKG timing (with in 10 mins)
Thrombolysis (within 30 mins)
Percutaneous Coronary Intervention within 90

Question 15

acute MI measures discharge

Answer 15

beta blocker prescribed
ace inhibitor/ carb prescribed for left ventricular systolic dysfunction
ASA prescribed and adult smoking cessation counseling

Question 16

pneumonia prevention

Answer 16

antibiotic timing within 6 hrs of arrival, blood culture before antibiotic
influenza and pneumonia vaccine- given, refused or contraindicated, smoking cessation

Question 17

surgical infection prevention

Answer 17

antibiotic 1 hour prior to surgery
antibiotic DC’d w/in 24 after end of surgery
appropriate hair removal (no razors)
urinary cath removal on pod1 or2

Question 18

Surgical venous thromboembolism prophylaxis

Answer 18

pharmacologic and mechanical phrophylaxis ordered and administered within 24 hrs end of surgery. if pt takes beta blockers daily, need to take day prior to, day of, pod1and2

Question 19

Donning PPE

Answer 19

hand hygiene, gown, mask, eyes, gloves

Question 20

removing ppe

Answer 20

gloves, mask, gown, eyes, hand hygiene

Question 21

use avoidance when

Answer 21

time is needed to collect additional data before decision is made. prolongs resolution which can worsen prob

Question 22

competitive conflict strategy

Answer 22

use when making an unpopular decision that needs to be implemented. hostility from losing side. result is goal oriented and quick

Question 23

collaborative conflict strategy

Answer 23

when time available compromise, creative solution acceptable to everyone, integrates ideas from all

Question 24

harmonizing conflict strategy

Answer 24

used in pt service- if safe do it patient’s way instead of nurses, puts relationship before conflict, allows relationship to remain positive

Question 25

compromising conflict

Answer 25

each party giving up something they want, best for issues of mild to moderate importance and when both parties are equal and there is no simple solution

Question 26

core measure

Answer 26

evidence based, scientifically researched standard of care which has been shown to result in improved clinical outcomes- protocols- if this then do x, y, z. TJC mandates organizations to track to monitor quality care

Question 27

group process

Answer 27

2 or more persons in face-to-face interaction. aware in a group, aware of others and of positive collaboration . example surgical team function as a single unit- trust cooperation, understanding and consideration of other team members

Question 28

Background

Answer 28

What is the background or circumstances leading up to the situation? State pertinent background information related to the situation that may include • Admitting diagnosis and date of admission • List of current medications, allergies, IV fluids • Most recent vital signs • Date and time of any laboratory testing and results of previous tests for comparison. Synopsis of treatment to date • Code status (Lewis 15)

Question 29

Assessment

Answer 29

State what you think the problem is: Changes from prior assessments Patient condition unstable or worsening

Question 30

Situation

Answer 30

I am Jackie, I just assessed pt so and so in room number_ I am concerned about_ov

Question 31

Recommendation

Answer 31

What should we do to correct the problem? What is your recommendation or request? State your request. Specific treatments Tests needed Patient needs to be seen now (Lewis 15)

Question 32

documented benefits of collaboration

Answer 32

shorter length of stays, increased job retention and less job turnover, increased job satisfaction and increase in problem solving skills

Question 33

8 national pt safety goals

Answer 33

improve effectiveness of communication improve safety of using meds improve accuracy of pt ID reduce risk of harm from falls accurate and complete reconciliation of meds across continuum of care prevent health care related pressure ulcers organizations ID safety risks to pt (suicide, O2 at home)

Question 34

Universal Protocol (UP)

Answer 34

preprocedure verification, mark site, perform time out, conduct time out before invasive or surgical, confirm correct pt, procedure, and site

Question 35

shock

Answer 35

``` not circulating enough blood low bp, fast irregular heart beat weak rapid absent pulse restlessness, confusion, anxiety cool clay skin, rapid shallow breaths, chest pain nausea, lightheaded ```

Question 36

clinical decision process steps

Answer 36

ID, analyze, logical inferences, list all poss actions, evaluate options, select options

Question 37

critical thinking concepts/behaviors

Answer 37

truth seeking, analyticity, self confidence, maturity, open mindedness, systematically, inquisitiveness

Question 38

how to manage caring for a group of patients

Answer 38

ID dx for each, find most urgent, how to cluster care, consider help resources (assistants, family), delegate

Question 39

clinical reasoning is and supports clinical decision process with (3 things)

Answer 39

rule based/ analytical to reach judgment 1. guidance (assessment, data collection) 2. Selection (discard irrelevant data) 3. providing correct decision

Question 40

commitment level of critical thinking

Answer 40

anticipate when to make choices without assistance and accept accountability

Question 41

interpretist

Answer 41

uses context of care and what the nurse brings (knowledge of standards or care) and understanding individual client situation-recognize one restricted approach not for all- does not use info from chart

Question 42

contact precautions

Answer 42

incontinance of stool, drainage of body fluids, skin infection/ rash. wear gloves. wear gown if lots of interaction

Question 43

droplet precautions

Answer 43

respiratory viruses, rsv, influenza, bordetella, first 24 hours of strep a. facemark. also gown and googles if spraying. pt wear mask out of room

Question 44

airborn precautions

Answer 44

TB, measles, chicken pox. own special room, disposable n95 respirator

Question 45

holistic

Answer 45

influenced by complex factors surrounding pt circumstances

Question 46

process orientation

Answer 46

uses experimental knowledge