Leadership, Prioritization and Delegation
Nurs 450 Exam 1 Questions and
Answers
What is Clinical Judgement? ✅"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"
Characteristics of Clinical Judgement ✅1) Nursing Process is Framework (ADPIE)
2) Influenced by knowledge and attitudes of 'judger'
3) NOT task oriented (ex: choose main priority)
4) Compare Assessments to known normals, patient baseline, pattern recognition
McCarthy (2003) study: Situated Clinical Reasoning ✅Failure to Recognize Acute
Confusion in Elderly was attributed to
1) Attitudes and knowledge about normal aging
2) Lack of awareness of significance of confusion
3) Inadequate knowledge of patient states
Role of Reflection (Tanner 2006) Study ✅Focuses on
1) Reflection - in - Action
2) Reflection- on - action
Reflection - in - action ✅adjusting to patient responses
Reflection - on - action ✅-what you learn from a clinical experience
-development of clinical judgment
Failure to Rescue ✅Clinicians inability to save a hospitalized patients life when he
experiences a complication (a condition not present on admission)
Successful Rescue: Surveillance ✅Ongoing interpretation and synthesis, Recognize
emerging complications
MONITOR
Successful Rescue: Rescue ✅Mobilize resources
- SBAR
- Anticipate what is needed
- Rapid Response Team
, SAVE
Examples of complications ✅Pneumonia
Shock
Cardiac Arrest
GI Bleed
DVT/PE
Respiratory Failure
Seizures
Acute Renal Failure
Indicators of Emerging Complications ✅1) Change in LOC
2) Pain
3) Dyspnea
4) Change in vitals or labs
5) Urine Output (could indicate that organs arent perfusing properly)
Prioriziation ✅Essential aspect of clinical judgement
Frameworks of Priorizitation ✅- ABCs
- Maslows hierarchy of needs
- Assess before Intervening
- Systemic before local ("life before limb")
- Acute before Chronic
- Actual before Potential
- Unexpected before Expected
Maslow's Hierarchy of Needs ✅Self Actualization
Esteem
Love/belonging
Safety
Physiological needs
The nurse receives report on a group of patients. Which of the following patients should
the nurse assess first?
A. A diabetic patient being treated for a COPD exacerbation with a blood glucose of 290
mg/dL
B. A patient who is post-op day one after a total hip replacement with a pain rating of "8"
C. A patient recently diagnosed with stage 4 lung cancer who is crying
D. A patient who is post-op day 2 after a tracheostomy with an SpO2 of 88% ✅D.
The nurse receives laboratory results on 4 patients. Which result should the nurse
address first?
A. A patient being treated for heart failure with a potassium of 2.6 mEq/L
Nurs 450 Exam 1 Questions and
Answers
What is Clinical Judgement? ✅"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"
Characteristics of Clinical Judgement ✅1) Nursing Process is Framework (ADPIE)
2) Influenced by knowledge and attitudes of 'judger'
3) NOT task oriented (ex: choose main priority)
4) Compare Assessments to known normals, patient baseline, pattern recognition
McCarthy (2003) study: Situated Clinical Reasoning ✅Failure to Recognize Acute
Confusion in Elderly was attributed to
1) Attitudes and knowledge about normal aging
2) Lack of awareness of significance of confusion
3) Inadequate knowledge of patient states
Role of Reflection (Tanner 2006) Study ✅Focuses on
1) Reflection - in - Action
2) Reflection- on - action
Reflection - in - action ✅adjusting to patient responses
Reflection - on - action ✅-what you learn from a clinical experience
-development of clinical judgment
Failure to Rescue ✅Clinicians inability to save a hospitalized patients life when he
experiences a complication (a condition not present on admission)
Successful Rescue: Surveillance ✅Ongoing interpretation and synthesis, Recognize
emerging complications
MONITOR
Successful Rescue: Rescue ✅Mobilize resources
- SBAR
- Anticipate what is needed
- Rapid Response Team
, SAVE
Examples of complications ✅Pneumonia
Shock
Cardiac Arrest
GI Bleed
DVT/PE
Respiratory Failure
Seizures
Acute Renal Failure
Indicators of Emerging Complications ✅1) Change in LOC
2) Pain
3) Dyspnea
4) Change in vitals or labs
5) Urine Output (could indicate that organs arent perfusing properly)
Prioriziation ✅Essential aspect of clinical judgement
Frameworks of Priorizitation ✅- ABCs
- Maslows hierarchy of needs
- Assess before Intervening
- Systemic before local ("life before limb")
- Acute before Chronic
- Actual before Potential
- Unexpected before Expected
Maslow's Hierarchy of Needs ✅Self Actualization
Esteem
Love/belonging
Safety
Physiological needs
The nurse receives report on a group of patients. Which of the following patients should
the nurse assess first?
A. A diabetic patient being treated for a COPD exacerbation with a blood glucose of 290
mg/dL
B. A patient who is post-op day one after a total hip replacement with a pain rating of "8"
C. A patient recently diagnosed with stage 4 lung cancer who is crying
D. A patient who is post-op day 2 after a tracheostomy with an SpO2 of 88% ✅D.
The nurse receives laboratory results on 4 patients. Which result should the nurse
address first?
A. A patient being treated for heart failure with a potassium of 2.6 mEq/L
