NURS 3730 Midterm Exam Questions
with Correct Answers
trajectory of health challenges - ANSWER-Allows us to anticipate assessment
findings and care needs (knowing what to look for when)
Important for care planning
Important for discharge planning
If a patient is not following their trajectory, it makes us ask 'why?"
life expectancy, survival rate, recovery time, genetics, age factor, co-morbidities, etc.
Evidence for switching to CJM revealed the 2 most common nursing errors are: -
ANSWER-•failure to notice
•failure to respond/act
CJM steps - ANSWER-Recognize cues
Analyze cues
Prioritize hypothesis
Generate solutions
Take Action
Evaluate outcomes
Clinical judgement - ANSWER-•The OBSERVED outcome of critical thinking and
decision making.
•Decisions nurses make or fail to make are directly measured and VISIBLE as
patient outcomes
•Iterative (continuous) thinking process that requires nursing knowledge (content +
context) to observe and assess patients, identify and prioritize concerns, generate
evidence-based solutions, put solutions into action and evaluate patient response.
Clinical reasoning - ANSWER-•Thinking and considering a patient situation in
relation to the context and concerns.
•Cognitive processes used for analyzing knowledge relative to a clinical situation or
specific patient.
Critical thinking - ANSWER-•A skill set that involves clinical reasoning and clinical
judgement
•Requires practice and is never 'finished'
•Iterative process - a loop that goes back and forth not one-directional
1. Assess and analyze cues - ANSWER-your patient assessment
What info is relevant?
Prioritize- what needs to be done now and what can wait
2. Analyze cues - ANSWER-is what your assessment findings mean?
Consider the cues in context to the patient.
Think of history and situation
,Ex. How old are they? What are their chronic conditions?
3. Prioritizing hypothesis (priority concern) - ANSWER-What is your priority
problem/diagnosis?
•What are all the possible things that could be occurring based on your cue analysis?
-These are your 'hypothesis'
•Consider the urgency and risk for the client of each possibility / hypothesis.
•Determine which hypothesis are most likely and most serious, and why. What
evidence do you have? This becomes your priority focus (to rule out or in)
What is more or less likely for the patient?
4. Generate solutions - ANSWER-what do you need to do in relation to the problem?
5. Take action - ANSWER-intervene to prevent or promote a health outcome
Decide which nursing actions will address the highest priorities of care
6. Evaluate outcomes - ANSWER-did your action/intervention work? How will you
know?
•Determine what client assessment findings indicate improvement, decline, or no
change in the client's condition.
Time is essential!
How to communicate priority concerns/hypothesis? - ANSWER-3 parts:
identification of problem or potential problem/risk + related factors/etiology + signs &
symptoms/characteristics
priority concerns/hypothesis statement example - ANSWER-For example:
Your patient is admitted with pneumonia, on your assessment you notice a O2
saturation of 85% they are confused, no longer oriented and feel sleepy.
You might say:
I am concerned that my patient is hypoxic related to pneumonia as evidenced by low
O2 sats, new onset confusion and stating 'let me sleep -I am so tired'
Priority hypothesis statement - ANSWER-(1) ________ (problem) related to (2)
_____ (etiology)
as evidenced by (3) ________ and
_________(risk/factors/symptoms/characteristics).
Nurses Need To Prioritize In Acute Care - ANSWER-•ANTICIPATE= Serious
problems that could lead to deterioration
•NOTICE & RECOGNIZE= Signs that indicate early deterioration
•PRIORITIZE= Application of life extending interventions first
Anticipate reactive tools - ANSWER-Incidental findings in your assessment that are
not normal or are abnormal in relation to one another.
Anticipate proactive tools - ANSWER-Evidence you seek out based on your critical
thinking to confirm or dispel your concerns
Some patients are at higher risk of deteriorating (ex. recent trauma, limited
resources/family, etc)
, Index of Suspicion
Sick or Unstable - ANSWER-•If they are not currently unstable, they could be soon
•Think: Stabilize and control
•Vascular access (sometimes several)
•Frequent monitoring
•Often NPO
•Higher impact medications, more unscheduled or STAT medications
•You'll wake these patients up for their vital signs and lab work
•Foley catheter, measure I&O
•Still address comfort and kindness, but some things less emphasized
•Collaborate with a team
Not sick or stable - ANSWER-Unlikely to deteriorate rapidly
•Should be able to self-manage if needed
•Think: Rehabilitation and discharge goals
•Mobilization
•Toilets on own, no I&O
•Scheduled medications, many home meds on the MAR
•Encourage oral hydration
•Nutrition and uninterrupted mealtimes
•Sleep hygiene
•Facilitating family support
•Health and discharge teaching
•"Fluff and Puff"
•Can often manage on your own
Screening tests - ANSWER-look for suspected disease/problem (example BGM, or
urine analysis
Diagnostic tests - ANSWER-disease specific, confirms the problem (example
troponins, biopsy), can also rule out differentials
Monitoring - ANSWER-determines progress of disease or treatments, helps with
medication changes, planning of interventions and care, opportunity to act earlier,
helps for prognosis
Venous blood sample - ANSWER-most common source for blood lab values
arterial blood sample - ANSWER-for blood gases
capillary blood sample - ANSWER-BGM, heel prick in infants
serum blood sample - ANSWER-venous draw then blood is allowed to clot in the
tube and settles to the bottom leaving the serum on the top - centrifuge
plasma blood sample - ANSWER-Blood is mixed with an anticoagulant then
centrifuged
Hematocrit (Hct) - ANSWER-Also known as packed cell volume (PCV)
with Correct Answers
trajectory of health challenges - ANSWER-Allows us to anticipate assessment
findings and care needs (knowing what to look for when)
Important for care planning
Important for discharge planning
If a patient is not following their trajectory, it makes us ask 'why?"
life expectancy, survival rate, recovery time, genetics, age factor, co-morbidities, etc.
Evidence for switching to CJM revealed the 2 most common nursing errors are: -
ANSWER-•failure to notice
•failure to respond/act
CJM steps - ANSWER-Recognize cues
Analyze cues
Prioritize hypothesis
Generate solutions
Take Action
Evaluate outcomes
Clinical judgement - ANSWER-•The OBSERVED outcome of critical thinking and
decision making.
•Decisions nurses make or fail to make are directly measured and VISIBLE as
patient outcomes
•Iterative (continuous) thinking process that requires nursing knowledge (content +
context) to observe and assess patients, identify and prioritize concerns, generate
evidence-based solutions, put solutions into action and evaluate patient response.
Clinical reasoning - ANSWER-•Thinking and considering a patient situation in
relation to the context and concerns.
•Cognitive processes used for analyzing knowledge relative to a clinical situation or
specific patient.
Critical thinking - ANSWER-•A skill set that involves clinical reasoning and clinical
judgement
•Requires practice and is never 'finished'
•Iterative process - a loop that goes back and forth not one-directional
1. Assess and analyze cues - ANSWER-your patient assessment
What info is relevant?
Prioritize- what needs to be done now and what can wait
2. Analyze cues - ANSWER-is what your assessment findings mean?
Consider the cues in context to the patient.
Think of history and situation
,Ex. How old are they? What are their chronic conditions?
3. Prioritizing hypothesis (priority concern) - ANSWER-What is your priority
problem/diagnosis?
•What are all the possible things that could be occurring based on your cue analysis?
-These are your 'hypothesis'
•Consider the urgency and risk for the client of each possibility / hypothesis.
•Determine which hypothesis are most likely and most serious, and why. What
evidence do you have? This becomes your priority focus (to rule out or in)
What is more or less likely for the patient?
4. Generate solutions - ANSWER-what do you need to do in relation to the problem?
5. Take action - ANSWER-intervene to prevent or promote a health outcome
Decide which nursing actions will address the highest priorities of care
6. Evaluate outcomes - ANSWER-did your action/intervention work? How will you
know?
•Determine what client assessment findings indicate improvement, decline, or no
change in the client's condition.
Time is essential!
How to communicate priority concerns/hypothesis? - ANSWER-3 parts:
identification of problem or potential problem/risk + related factors/etiology + signs &
symptoms/characteristics
priority concerns/hypothesis statement example - ANSWER-For example:
Your patient is admitted with pneumonia, on your assessment you notice a O2
saturation of 85% they are confused, no longer oriented and feel sleepy.
You might say:
I am concerned that my patient is hypoxic related to pneumonia as evidenced by low
O2 sats, new onset confusion and stating 'let me sleep -I am so tired'
Priority hypothesis statement - ANSWER-(1) ________ (problem) related to (2)
_____ (etiology)
as evidenced by (3) ________ and
_________(risk/factors/symptoms/characteristics).
Nurses Need To Prioritize In Acute Care - ANSWER-•ANTICIPATE= Serious
problems that could lead to deterioration
•NOTICE & RECOGNIZE= Signs that indicate early deterioration
•PRIORITIZE= Application of life extending interventions first
Anticipate reactive tools - ANSWER-Incidental findings in your assessment that are
not normal or are abnormal in relation to one another.
Anticipate proactive tools - ANSWER-Evidence you seek out based on your critical
thinking to confirm or dispel your concerns
Some patients are at higher risk of deteriorating (ex. recent trauma, limited
resources/family, etc)
, Index of Suspicion
Sick or Unstable - ANSWER-•If they are not currently unstable, they could be soon
•Think: Stabilize and control
•Vascular access (sometimes several)
•Frequent monitoring
•Often NPO
•Higher impact medications, more unscheduled or STAT medications
•You'll wake these patients up for their vital signs and lab work
•Foley catheter, measure I&O
•Still address comfort and kindness, but some things less emphasized
•Collaborate with a team
Not sick or stable - ANSWER-Unlikely to deteriorate rapidly
•Should be able to self-manage if needed
•Think: Rehabilitation and discharge goals
•Mobilization
•Toilets on own, no I&O
•Scheduled medications, many home meds on the MAR
•Encourage oral hydration
•Nutrition and uninterrupted mealtimes
•Sleep hygiene
•Facilitating family support
•Health and discharge teaching
•"Fluff and Puff"
•Can often manage on your own
Screening tests - ANSWER-look for suspected disease/problem (example BGM, or
urine analysis
Diagnostic tests - ANSWER-disease specific, confirms the problem (example
troponins, biopsy), can also rule out differentials
Monitoring - ANSWER-determines progress of disease or treatments, helps with
medication changes, planning of interventions and care, opportunity to act earlier,
helps for prognosis
Venous blood sample - ANSWER-most common source for blood lab values
arterial blood sample - ANSWER-for blood gases
capillary blood sample - ANSWER-BGM, heel prick in infants
serum blood sample - ANSWER-venous draw then blood is allowed to clot in the
tube and settles to the bottom leaving the serum on the top - centrifuge
plasma blood sample - ANSWER-Blood is mixed with an anticoagulant then
centrifuged
Hematocrit (Hct) - ANSWER-Also known as packed cell volume (PCV)
