COMPREHENSIVE NUR 200: FUNDAMETALS OF NUURSING| COMPLETE QUESTIONS AND ANSWERS STUDY GUIDE SURE TO PASS GRADED A+

1. Reflection in action ANSWER Observing patient reaction to the action the nurse chose and deciding if the situation was fixed 2. responding (tanners) ANSWER taking action, ability to carry out nursing skills and effective communication, delegating, setting priorities 3. Reflection on action ANSWER Patient responses to the outcomes. Nursing reflection after the situation was solved 4. reflecting (tanners) ANSWER pt outcomes, evaluating data- complete actions then reassessment data is collected again used to determine if interventions were effective or any further actions needed, evaluating and correcting thinking. 5. Novice nurse ANSWER Uses analytic reasoning. Uses textbook in a systemic analysis of a situation 6. reflecting-in-action (reflect) ANSWER understanding of patients response to nursing actions while care is occurring. "real time" during pt care. determine pt statues and adjust care accordingly. 7. Expert nurse ANSWER Uses intuitive reasoning. Recognizes patterns immediately. Able to look at the big picture 8. reflecting-on-action (reflect) ANWER consideration of situation after the care occurs. contemplate a situation and decide what was and wasn't successful. critical for development of knowledge. 9. Assessment ANSWER Collecting and analyzing data from the patient, family members, health care team interrelated concepts of clinical judgment 10. Who does the initial assessment ANSWER RN 11. critical thinking ANSWER ability to think in a systematically and logical manner with openness to question and reflect on the reasoning process. ask "why, what am i missing" 12. Focused assessment ANSWER Used to gather information on a specific problem 13. critical thinking in nursing process ANSWER go hand in hand in making quality decisions about patient care. knowledge, standards, attitudes, experience 14. Complete assessment ANSWER A review and physical examination of all body systems, for stable patients only 15. clinical judgment ANSWER "Thinking Like A Nurse". integral to the Safety of pt. 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 improvise new ones as deemed appropriate by the patient's response. 16. Database ANSWER Completed health history and physical examination, large store or bank of info 17. clinical reasoning ANSWER is the thinking process by which a nurse reaches a clinical judgement. an iterative process of noticing, interpreting, and responding- reasoning in transition with a fine attunement to the patient and how the patient responds to the nurses action 18. Psychosocial history ANSWER Psychological and social factors 19. evidence-based practice ANSWER clinical decision making that integrates the best available research with clinical expertise and patient characteristics and preferences 20. 1st method of data collection ANSWER Interview patient, health history. Patient is your primary source 21. Tanner's Model ANSWER Noticing Interpreting Responding Reflecting 22. 2nd method of data collection ANSWER Physical examination (guided by subjective and objective) 23. noticing (tanners model) ANSWER identify s/s, gather complete and accurate data, assessing systematically and comprehensively, *predicting (and managing) potential complications, identifying assumptions 24. Concepts of clinical judgment ANSWERS 1. Safety 2. Healthcare quality 3. Leadership 4. Patient education 5. Evidence 6. Professionalism 7. Care coordination 25. objective data (noticing) ANSWER information that is seen, heard, felt, or smelled by an observer; signs 26. Analytic reasoning ANSWER Situation is unfamiliar 27. subjective data (noticing) ANSWER things a person tells you about that you cannot observe through your senses; symptoms 28. Intuitive reasoning ANSWER Able to recognize the situation immediately. Pattern based 29. factors that influence "Noticing" ANSWER -intrapersonal characteristics of the nurse -theoretical and experiential knowledge of the nurse -knowing the patient -context or environment of care 30. Narrative reasoning ANSWER Situation to patient experience with illness. 31. Interpreting (tanners) ANSWER comparing and contrast data, clustering related information, recognizing inconsistencies, checking accuracy, distinguishing relevant from irrelevant, determine importance of info, judge how much ambiguity is acceptable (ie b/p dt condition), determine legal ethical professional guidelines, (predicting and) *managing potential complications 32. Noticing ANSWER 1. Identify signs and symptoms 2. Complete and accurate date 3. Assessing systemically and comprehensively 4. Predicting and managing patient complications 5. Identifying assumptions 33. analytic reasoning (interpreting) ANSWER based on theoretical knowledge. nurse makes a hypothesis or best guess about the pt care situation and then tests. typically students and novice nurses 34. Interpreting ANSWER Understanding of the situation 35. intuitive reasoning (interpreting) ANSWER based on unstated but understood knowledge about the pt, the care giving context, and their previous experiences. typically expert nurse. 36. Responding ANSWER Based on what you interpreted the nurse will determine appropriate actions 37. narrative reasoning (interpreting) ANSWER way of making sense of a situation through telling and interpreting stories. nurse hears pt stories of past medical experiences, helps nurse understand specific pt experiences, setting the stage for individualized care 38. Head to toe assessment ANSWER Systemic approach so you dont miss something nursing process Assessment Diagnosis Planning Implementation Evaluation 39. Objective data ANSWER What you can observe or measure. Also known as signs 40. assessment (nursing process) ANSWER 1- collection of info from primary source (pt) and secondary (family, friends, health professionals, medical record). 2- interpretation and validation of data to ensure a complete data base subjective and objective 41. Subjective data ANSWER Can not be measured. What the patient is feeling. Also known as symptoms 42. Cue and Inference (assessment) ANSWER Cue is information that you obtain through use of senses. Inference is your judgment or interpretation of these cues. 43. Clinical judgment ANSWER Interpretation or conclusion about a patients needs, concerns or health problems, and/or the decision to take action ( or not) use or modify standard approaches, or improvise as one deems appropriate to the patients response 44. diagnosis (nursing process) ANSWER clinical judgment concerning a human response to health conditions/ life process, or vulnerability. Educated judgment about health concern. use NANDA. used to make care plan 45. Reasoning ANSWER Leads to clinical judgment 46. Types of Nursing Diagnoses (diagnosis) ANSWER Actual Risk Possible Wellness Syndrome 47. Case management ANSWER Planning and the coordination of care, patient advocate for providing quality care, cost effective outcomes for the patient 48. 3 part nursing diagnosis (diagnosis) ANSWER P:problem; ex impaired physical mobility E: etiology/ related factor; ex incisional pain S: symptom or defining characteristics; ex evidence by restricted turning and positioning 49. Analysis and database ANSWER Lead to the identification of nursing diagnosis 50. planning (nursing process) ANSWER collaborates with pt, family, and the rest of the health care team to determine the urgency of the identified problems and prioritizes patients needs. 51. Data clustering ANSWER Defining characteristics Helps to identify patterns that assist with the identification of nursing diagnosis 52. Care plan (planning) ANSWER Assessment, nursing diagnosis, interventions, evaluation care plan for each diagnosis. patients involved with planning. increase communication between staff. goals and expected outcomes need to be S.M.A.R.T specific, measurable, attainable, realistic, timed. 53. Attributes of clinical judgment ANSWER 1. Holistic view 2. Process orientation 3. Reasoning and interpretation 54. goal (planning) ANSWER broad statement that describes a desired change in a pt conditions, perception, or behavior. ex "pt will understand postoperative risks" 55. Expected outcome (planning) ANSWER is the measurable change (pt behavior, physical state, or perception) that must be achieved to reach a goal. sometimes several expected outcome need to be met for a single goal. "measure how many out of 3 questions the pt answers correct for infection identification" 56. Cue ANSWER A piece or pieces of data that often indicate that an actual or potential problem has occured or will occur 57. Biographic data ANSWER Facts or events in a persons life 58. interventions (care plan) ANSWER independent- a nurse initiates, dependent- require and order, collaborative- require the combined knowledge, skill, and expertise of multiple providers. Includes; actions, frequency, quantity, method, and person to perform them 59. Direct thinking ANSWER Purposeful and outcome- oriented 60. implementation (nursing process) ANSWER putting plan into action. reassessing, review and revise care plan, 61. Problem- oriented thinking ANSWER Focuses on a particular problem to find a solution 62. Standing order ANSWER preprinted document containing orders for routine therapies, monitoring guidelines, and or diagnostic procedures for specific patients with identical problems.