A nurse is caring for a group of clients. Which of the following actions by the nurse demonstrates the use of critical thinking skills?
A. Administer
... [Show More] an influenza vaccine after asking a client about allergies.
B. Check a client's armband before dispensing daily thyroid medication to a client who has hyperthyroidism
C. Give a client who has type 1 diabetes mellitus her morning dose of insulin after checking her blood glucose level.
D. Intervene after reviewing arterial blood gas results for a client who is on mechanical ventilation.
D. Intervene after reviewing arterial blood gas results for a client who is on mechanical ventilation.
The nurse is using critical thinking when analyzing a client's critical issues and then planning to intervene with an appropriate action.
The rest are clinical judgement.
A nurse is following the steps of the nursing process when caring for a group of clients. Which of the following actions by the nurse demonstrates the evaluation step of the nursing process?
A. Draw a conclusion after noting a client has a 4+ pitting edema of the lower extremities and decreased urine output.
B. Check and document a client's pain level 30 minutes after administering pain medication.
C. Review the results of blood glucose drawn before a client ate breakfast.
D. Administer an antibiotic to a client who has an infected wound.
B. Check and document a client's pain level 30 min after administering pain medication.
The nurse is evaluating, which is the final step of the nursing process, to determine if the pain medication administered to the client is effective. Evaluation is the same as assessment; however, to determine the client's status and progress, evaluation is performed.
Choice C is assessing or gathering data, which is the first step of the nursing process
A nurse is implementing priority-based interventions for a group of clients. Which of the following clients should the nurse see first?
A. A client who is saturating dressings with serous drainage every 2 hours
B. A client who has a cast on a compound fracture and has SaO2 of 88%
C. A client who has emphysema and is coughing up thick, yellow secretions
D. A client who has a kidney stone and reports a pain of 8 on the numerical pain scale
B. A client who has a cast on a compound fracture and has SaO2 of 88%
When using the airway, breathing, circulation approach to client care, the nurse should determine that the finding of SaO2 of 88% indicates hypoxia and requires priority-based interventions.
A nurse is admitting a client who reports increased thirst and fatigue. Which of the following actions should the nurse include in the assessment step of the nursing process?
A. Take action to restore the client's health
B. Ask the client when the condition started
C. Reach a conclusion about the client's health status
D. Set goals for the client's recovery
B. Ask the client when the condition started.
Assessment is the first step of the nursing process, where the nurse gathers subjective and objective information about the client's condition.
A nurse is preparing a plan of care for a client who is experiencing pain after surgery. Which of the following components should the nurse identify as part of the planning step of the nursing process?
A. Organize client information
B. Compare client data with outcomes to draw a conclusion
C. Formulate client goals for prioritized problem
D. Supervise delegated client care to the assistive personnel
C. Formulate client goals for prioritized problem.
Formulating client goals for prioritized problems is a component of planning, which is the third step in the nursing process.
Lucy used the SBAR format while calling Dr. Higgins. Which of the following is the purpose of SBAR?
A. Provides a permanent client documentation record
B. Improves communication among health care workers
C. Tool used to evaluate a client's risk potential
B. Improves communication among health care workers
SBAR, which stands for Situation, Background, Assessment, and Recommendation, is used to decrease communication errors and improve client safety by standardizing how communication is exchanged between health care workers. SBAR is not a permanent part of the client record, nor is it an evaluation tool.
Lucy responds to Francine's aggressive request to cover for her during her break. Which of the following communication styles did Lucy use?
A. Passive
B. Shaming
C. Dismissive
A. Passive
Lucy used a passive communication style when responding to Francine. Passive or submissive communication is ineffective and inappropriate to use because the nurse avoids confrontation by permitting others to make decisions. Shaming and dismissive communication styles are ineffective forms of communication with negative consequences. The nurse did not respond when using these styles.
A nurse manager is conducting an in-service on ineffective communication patterns. Which of the following should she include when discussing components of passive communication? (Select all that apply.)
A. Puts others' needs and wants ahead of self
B. Avoids conflicts
C. Difficult time saying "no"
D. Uses "I" or "me" statements
E. Intimidating
A. Puts others' needs and wants ahead of self
B. Avoids conflicts
C. Difficult time saying "no"
Choice D is a component of assertive communication.
Choice E is a component of aggressive communication.
A nurse is reviewing professional communication skills with a newly licensed nurse. Which of the following is a form of effective communication?
A. Passive
B. Assertive
C. Passive-aggressive
B. Assertive
Assertive communication is the most effective communication technique that is used to convey information in an informative and professional manner.
A nurse manager is discussing formal and informal structures or processes with a newly licensed nurse. Which of the following statements made by the newly licensed nurse requires further teaching?
A. "Formal structures are generally highly planned."
B. "A written policy is a type of formal structure."
C. "Informal structures are visible."
C. "Informal structures are visible."
Informal structures or processes tend to be hidden and unplanned. Informal processes are not usually discussed or written.
Which of the following should be included in an interprofessional interdisciplinary team? (Select all that apply.)
A. Respiratory therapist
B. Provider
C. Nurses
D. Family members
E. Dietitian
A, B, C, E
Interprofessional relationships are a group of various disciplines who utilize their own individual professional theories to promote health care.
Which of the following should a nurse include in the verbal SBAR report to a provider? (Select all that apply.)
A. Introduction
B. Background
C. Assessment
D. Situation
E. Recommendation
B, C, D, E
Introduction is included in ISBAR
A charge nurse is reviewing organizational structure with a group of newly licensed nurses. Which of the following should she include in her discussion? (Select all that apply.)
A. Lines of authority
B. Organizational size
C. Formal structures
D. Informal structures
E. Interprofessional relationships
A, B, C, D
Choice E is incorrect because inter professional relationships are a component of collaborative relationships, not organized structure. [Show Less]