Clincal Judgement/Communication RNSG 1125 End of
Chapter Quizzes, Taylor Ch. 13-18 Questions With
Complete Solutions
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?
A. The nurse judges whether the patient database is adequate to
address the problem.
B. The nurse considers whether or not to suggest a counseling
session for the patient.
C. The nurse reassesses the patient and decides how best to
intervene in her care.
D. The nurse identifies several options for intervening in the
patient's care and critiques the merit of each option. Correct
Answer c. The first step when thinking critically about a
situation is to identify the purpose or goal of your thinking.
Reassessing the patient helps to discipline thinking by directing
all thoughts toward the goal. Once the problem is addressed, it is
important for the nurse to judge the adequacy of the knowledge,
identify potential problems, use helpful resources, and critique
the decision.
A new nurse who is being oriented to the subacute care unit is
expected to follow existing standards when providing patient
care. Which nursing actions are examples of these standards?
Select all that apply.
A. Monitoring patient status every hour
,B. Using intuition to troubleshoot patient problems
C. Turning a patient on bed rest every 2 hours
D. Becoming a nurse mentor to a student nurse
E. Administering pain medication ordered by the physician
F. Becoming involved in community nursing events Correct
Answer a, c, e. Standards are the levels of performance
accepted and expected by the nursing staff or other health care
team members. They are established by authority, custom, or
consent. Standards would include monitoring patient status
every hour, turning a patient on bed rest every 2 hours, and
administering pain medication ordered by the physician. Using
intuition to troubleshoot patient problems, becoming a nurse
mentor to a student nurse, and becoming involved in community
nursing events are not patient care standards.
A new RN is being oriented to a nursing unit that is currently
understaffed and is told that the UAPs have been trained to
obtain the initial nursing assessment. What is the best response
of the new RN?
A. Allow the UAPs to do the admission assessment and report
the findings to the RN.
B. Do his or her own admission assessments but don't interfere
with the practice if other professional RNs seem comfortable
with the practice.
C. Tell the charge nurse that he or she chooses not to delegate
the admission assessment until further clarification is received
from administration.
D. Contact his or her labor representative to report this practice
to the state board of nursing. Correct Answer c. The nurse
should not delegate this nursing admission assessment because
,only nurses can perform this intervention. The nurse should seek
clarification for this policy from the nursing administration.
A nurse assesses a patient and formulates the following nursing
diagnosis: Risk for Impaired Skin Integrity related to prescribed
bed rest as evidenced by reddened areas of skin on the heels and
back. Which phrase represents the etiology of this diagnostic
statement?
A. Risk for Impaired Skin Integrity
B. Related to prescribed bed rest
C. As evidenced by
D. As evidenced by reddened areas of skin on the heels and back
Correct Answer b. "Related to prescribed bed rest" is the
etiology of the statement. The etiology identifies the
contributing or causative factors of the problem. "Risk for
Impaired Skin Integrity" is the problem, and "as evidenced by
reddened areas of skin on the heels and back" are the defining
characteristics of the problem.
A nurse develops a detailed care plan for a 16-year-old patient
who is a new single mother of a premature infant. The plan
includes collaborative care measures and home health care
visits. When presented with the plan, the patient states, "We will
be fine on our own. I don't need any more care." What would be
the nurse's best response?
A. "You know your personal situation better than I do, so I will
respect your wishes."
B. "If you don't accept these services, your baby's health will
suffer."
C. "Let's take a look at the plan again and see if we can adjust it
to fit your needs."
, D. "I'm going to assign your case to a social worker who can
explain the services better." Correct Answer c. When a patient
does not follow the care plan despite your best efforts, it is time
to reassess strategy. The first objective is to identify why the
patient is not following the therapy. If the nurse determines,
however, that the care plan is adequate, the nurse must identify
and remedy the factors contributing to the patient's
noncompliance.
A nurse is about to perform pin site care for a patient who has a
halo traction device installed. What is the FIRST nursing action
that should be taken prior to performing this care?
A. Administer pain medication.
B. Reassess the patient.
C. Prepare the equipment.
D. Explain the procedure to the patient. Correct Answer b.
Before implementing any nursing action, the nurse should
reassess the patient to determine whether the action is still
needed. Then the nurse may collect the equipment, explain the
procedure, and, if necessary, administer pain medications.
A nurse is assessing a patient who is diagnosed with anorexia.
Following the assessment, the nurse recommends that the patient
meet with a nutritionist. This action best exemplifies the use of:
A. Clinical judgment
B. Clinical reasoning
C. Critical thinking
D. Blended competencies Correct Answer a. Although all the
options refer to the skills used by nurses in practice, the best
choice is clinical judgment as it refers to the result or outcome of
critical thinking or clinical reasoning—in this case, the
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