PNC TEST 2 Complete Questions And Answers | 100% Correct Answers | 2024 Updated Study Quiz

A female pt 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? - ANS-The nurse reassess the pt and decides how best to intervene in her care. The nursing process ensures that nurses are person centered rather than task centered. Rather than simply approaching a pt to take VS, the nurse thinks, "How is Mrs. Barclay today? Are our nursing actions helping her achieve her goals? How can we better help her?" This demonstrates which characteristic of the nursing process? - ANS-Interpersonal An experienced nurse tells a beginning nurse not to bother studying too hard, since most clinical reasoning becomes "second nature" and "intuitive" once you start practicing. What thinking below should underlie the beginning nurse's response? - ANS-Intuitive problem solving comes from years of practice and observation, and novice nurses should base their care on scientific problem solving. The nurse uses blended competencies when caring for patients in a rehab facility. Which examples of interventions involve cognitive skills? Select all that apply. - ANS--the nurse uses critical thinking skills to plan care for a patient -the nurse learns t he correct dosages for patient pain meds A nurse uses critical thinking skills to focus on the care plan of an elderly patient who has dementia and needs placement in a long-term care facility. Which statements describe characteristics of this type of critical thinking applied to clinical reasoning? Select all that apply. - ANS--it is based on the principles of the nursing process, problem solving, and the scientific method -it is driven by patient, family, and community needs as well as nurses' needs to give competent, efficient care. -it is constantly re-evaluating, self-correcting and striving for improvement A nurse is caring for a patient who has complications r/t type 2 diabetes Mellitus. The nurse researches new procedures to care for foot ulcers when developing plan of care for this patient. Which QSEN competency does this action represent? - ANS-Quality improvement 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: - ANS-Clinical judgement A nurse working in a LTC facility bases patient care in five caring processes: knowing, being with, doing for, enabling, and maintaining belief. This approach to pt care best describes whose theory? - ANS-Swanson's The nurse practices using critical thinking indicators (CTIs) when caring for patients in the hospital setting. The best description of CTIs is: - ANS-Evidence-based descriptions of behaviors that demonstrate the knowledge, characteristics, and skills that promote critical thinking in clinical practice The nurse practitioner is performing a short assessment of a newborn who is displaying signs of jaundice. The nurse observes the infant's skin color and orders a test for bilirubin levels to report to the primary care provider. What type of assessment has this nurse performed? - ANS-Quick priority The nurse is admitting a 35 y/o pregnant woman to the hospital for treatment of preeclampsia. The patient asks the nurse: "why are you doing a history and physical exam when the doctor just did one?" Which statements best explain the primary reasons a nursing assessment is performed? Select all that apply. - ANS--"the nursing assessment will allow us to plan and deliver individualized, holistic nursing care that draws your strengths." -"we need to check your health status and see what kind of nursing care you may need." -"we need to see if you require a referral to a physician or other healthcare professional." A nurse noted that a shift report states that a patient has no special skin care needs. The nurse is surprised to observe reddened areas over bony prominences during the pt bath. Which nursing action is appropriate? - ANS-Perform and document a focused assessment of skin integrity A student nurse attempts to perform a nursing history for the first time. The student nurse asks the instructor how anyone ever learns all the questions the nurse must ask to get good baseline data. What would be the instructor's best reply? - ANS-"You make the basic questions a part of you and then learn to modify them for each unique question, asking yourself how much you need to know to plan good care." The nurse collects objective and subjective data when conducting pt assessments. Which patient situations are examples of subjective data? Select all that apply. - ANS--a pt tells the nurse that she is feeling nauseated -a pt tells the nurse that she is nervous about her test results -a pt complains that the skin in her arms are tingling -a pt rates his pain 7/10 When a nurse enters the pt's room to begin a nursing hosiery, the pt's wife is there. After introducing herself to the pt and his wife, what should the nurse do? - ANS-Ask the pt if he would like his wife to stay A nurse is performing an initial comprehensive assessment of a pt admitted to a LTC facility from home. The nurse begins the assessment by asking the pt, "how would you describe your health status and well being?" The nurse also asks the pt, "what would you do to keep yourself healthy?" Which model for organizing data is this nurse following? - ANS-Gordon's functional health patterns The nurse is surprised to detect an elevated temperature (102°F) in a patient scheduled for surgery. The patient has been afebrile and shows no other signs of being febrile. What is the first thing the nurse should do? - ANS-validate the finding A student nurse tells the instructor that a patient is fine and has "no complaints." What would be the instructor's best response? - ANS-"You made an inference that she is fine because she has no complaints. How did you validate this?" An RN is writing a diagnosis for a pt who is in traction because of multiple fractures from a motor vehicle accident. Which nursing actions are related to this step in the nursing process? Select all that apply. - ANS--the nurse analyzes data collected in the nursing assessment -the nurse points out the pt's strengths -the nurse identifies community resources to help his family cope A nurse is caring for a patient who presents with non labored respiration's, productive cough, and fever. What would be appropriate nursing diagnoses for this pt? Select all that apply. - ANS--impaired gas exchange he -ineffective airway clearance -risk for septic shock After assessing a pt who is recovering from a stroke in a rehab facility, a nurse interprets and analyzes patient data. Which of the four basic conclusions has the nurse reached when identifying the need to collect more data to confirm a diagnosis of situational low definition-esteem? - ANS-Possible problem A nurse assesses a pt and formulates the following nursing diagnosis:Risk for impaired skin integrity r/t preserved bed rest as evidenced by reddened areas of skin on the heels and back. Which phrase represents the etiology of this diagnostic statement? - ANS-Related to prescribed bed rest A nurse is counseling a pt's who refused to look at or care for a new colostomy. The pt tells the nurse, "I don't care what I look like anymore, I don't even feel like waging my hair, let alone changing my bag." The nursing diagnoses altered health maintenance. This is an example of what kind of problem? - ANS-Nursing problem The nurse records a pt's BP as 148/100. What is the priority action of the nurse when determining the significance of this reading? - ANS-Compare this reading to standards When the initial nursing assessment revealed that a patient had not had a bowel movement for 2 days, the student nurse wrote the diagnostic label "constipation." Which of the following comments is the nurse most likely to hear from the instructor? - ANS-"Was this diagnosis derived from a cluster of significant data or a single cue? A nurse makes a clinical judgement that an African American man in a stressful job is more vulnerable to developing hypertension than a white man in the same similar situation. The nurse has formulated what type of nursing diagnosis? - ANS-Risk A nurse is writing nursing diagnoses for pts in a psychiatrist's office. Which nursing diagnoses are correctly written as two part nursing diagnoses? - ANS--ineffective coping related to inability to maintain marriage -defensive coping related to loss of job and economic security -altered though processes related to panic state -decisions conflict related to placement of prentice in a LTC facility. A nurse is planning care for a patient who was admitted to the hospital for treatment of a drug overdose. Which nursing actions are related to the outcome id