,
,
,
, KEY: Systems thinking, Quality improvement
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
11. A nurse is talking with a co-worker who is moving to a new state and needs to find new
employment there. What advice by the nurse is best?
a. Ask the hospitals there about standard nurse–client ratios.
b. Choose the hospital that has the newest technology.
c. Find a hospital that has achieved Magnet status.
d. Work in a facility affiliated with a medical or nursing school.
ANS: C
Client Magnet status is awarded by The Joint Commission (TJC) and certifies that nurses can
demonstrate how best current evidence guides their practice. New technology doesn’t
necessarily mean that the hospital is safe. Affiliation with a health profession school has
several advantages, but safety is most important.
DIF: Understanding
om
TOP: Integrated Process: Communication and Documentation
KEY: Evidence-based practice, Magnet status
MSC: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control
MULTIPLE RESPONSE
.c
1. A nurse manager wishes to ensure that the nurses on the unit are practicing at their highest
levels of competency. Which areas would the manager assess to determine if the nursing staff
ks
demonstrate competency according to the Institute of Medicine (IOM) report Health
Professions Education: A Bridge to Quality? (Select all that apply.)
a. Collaborating with an interprofessional team
b. Implementing evidence-based care
an
c. Providing family-focused care
d. Routinely using informatics in practice
e. Using quality improvement in client care
f. Formalizing systems thinking when implementing care
tb
ANS: A, B, D, E
The IOM report lists five broad core competencies that all health care providers should
practice. These include collaborating with the interprofessional team, implementing
es
evidence-based practice, providing patient-focused care, using informatics in client care, and
using quality improvement in client care. Systems thinking is required for quality
improvement but is not a specified part of the IOM report.
Bt
DIF: Remembering TOP: Integrated Process: Nursing Process: Assessment
KEY: Competencies, Institute of Medicine (IOM)
MSC: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control
2. A nurse is interested in making interprofessional work a high priority. Which actions by the
nurse best demonstrate this skill? (Select all that apply.)
a. Consults with other disciplines on client care.
b. Coordinates discharge planning for home safety.
c. Participates in comprehensive client rounding.
d. Routinely asks other disciplines about client progress.
Btestbanks.com
, e. Shows the nursing care plans to other disciplines.
f. Delegate tasks to unlicensed personnel appropriately.
ANS: A, B, C, D, F
Collaborating with the interprofessional team involves planning, implementing, and
evaluating client care as a team with all other involved disciplines included. Simply showing
other caregivers the nursing care plan is not actively involving them or collaborating with
them.
DIF: Applying TOP: Integrated Process: Communication and Documentation
KEY: Teamwork and collaboration, Interprofessional team
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
3. The nurse utilizing evidence-based practice (EBP) considers which factors when planning
care? (Select all that apply.)
a. Cost-saving measures
b. Nurse’s expertise
om
c. Client preferences
d. Research findings
e. Values of the client
f. Plan-do-study-act model
ANS: B, C, D, E
.c
EBP consists of utilizing current evidence, the client’s values and preferences, and the nurse’s
expertise when planning care. It does not include cost-saving measures. The PDSA model is a
systematic model for quality improvement, but is not a specific component of EBP.
ks
DIF: Remembering TOP: Integrated Process: Nursing Process: Planning
KEY: Evidence-based practice (EBP)
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
an
4. A nurse manager wants to improve hand-off communication among the staff. What actions by
the manager would best help achieve this goal? (Select all that apply.)
a. Attend hand-off rounds to coach and mentor.
tb
b. Create a template of suggested topics to include in report.
c. Encourage staff to ask questions during hand-off.
d. Give raises based on compliance with reporting.
es
e. Provide education on the SBAR method of communication
ANS: A, B, C, E
The SBAR method of communication has been identified as an excellent method of
Bt
communication between health care professionals. It is a formalized structure consisting of
Situation, Background, Assessment, and Recommendation/Request. Using a formalized
mechanism for communication helps ensure successful hand-off and fewer client errors. When
establishing this new format for report, the most helpful actions by the manager would be to
provide initial education on the process, develop a template with suggested topics under each
heading, attend rounds to coach and mentor, and encourage staff to ask questions to clarify
information. Basing raises on compliance would not be the most helpful method because
raises are often determined only once a year and are based on multiple criteria.
DIF: Applying TOP: Integrated Process: Communication and Documentation
KEY: Teamwork and collaboration, Communication
Btestbanks.com
,MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
om
.c
ks
an
tb
es
Bt
Btestbanks.com
,Chapter 02: Clinical Judgment and Systems Thinking
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A nurse asks the charge nurse to explain the difference between critical thinking and clinical
judgment. What statement by the charge nurse is best?
a. “Clinical judgment is often clouded by erroneous hypotheses.”
b. “Clinical judgment is the observable outcome of critical thinking.”
c. “Critical thinking requires synthesizing interactions within a situation.”
d. “Critical thinking is the highest level of nursing judgment.”
ANS: B
Clinical judgment is the observable outcome of critical thinking and decision making. It can
be, but most often is not, clouded by erroneous hypotheses. Recognizing, understanding, and
synthesizing interactions and interdependencies in a set of components designed for a specific
om
purpose is systems thinking. Critical thinking is not the highest level of nursing judgment.
DIF: Understanding TOP: Integrated Process: Teaching/Learning
KEY: Clinical judgment
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
.c
2. The nurse understands which information regarding patient-centered care?
a. A competency recognizing the client as the source of control of his or her care
ks
b. A project addressing challenges in implementing patient-centered care
c. Purposeful, informed, and outcome-focused care of clients or families
d. The ability to use best evidence and practice when making care-related decisions
an
ANS: A
Patient-centered care is a QSEN competency that recognizes the patient or caregiver as the
source of control and full partner in providing compassionate and coordinated care based on
respect for the patient’s preferences, values, and needs. QSEN is a project addressing the
challenge of preparing future nurses with the knowledge, skills, and attitudes (KSAs)
tb
necessary to continuously improve the quality and safety of the health care systems in which
they work. Critical thinking is the application of purposeful, informed, and outcome-focused
care. The ability to use best evidence and practice when making care-related decisions is
es
evidence-based practice.
DIF: Understanding TOP: Integrated Process: Teaching/Learning
KEY: Patient-centered care
Bt
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
3. A nurse wishes to participate in an activity that will influence health outcomes. What action
by the nurse best meets this objective?
a. Creating a transportation system for health care appointments
b. Lobbying with a national organization for health care policy
c. Organizing a food pantry in an impoverished community
d. Running for election to the county public health board
ANS: B
Btestbanks.com
, All options are good choices for an altruistic nurse wishing to influence health outcomes;
however, being involved in policy creation and health care reform is an activity specifically
recognized to improve health outcomes. This action will also affect a wider population than
the more local options.
DIF: Applying TOP: Integrated Process: Communication and Documentation
KEY: Health outcomes
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
4. What factor best predicts a nurse’s willingness to employ critical thinking?
a. Caring
b. Knowledge
c. Presence
d. Skills
ANS: A
All attributes are important in nursing, however; the nurse’s willingness to think critically is
om
predicted by caring behaviors, self-reflection, and insight.
DIF: Remembering TOP: Integrated Process: Nursing Process: Assessment
KEY: Critical thinking
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
.c
5. To demonstrate clinical reasoning skills, what action does the nurse take?
a. Collaborating with co-workers to buddy up for lunch breaks
b. Delegating frequent vital signs on a new postoperative patient
ks
c. Documenting a complete history and physical on an admission
d. Requesting the provider order medication for a client with high potassium
ANS: D
an
The components of clinical reasoning include assessing, analyzing, planning, implementing,
and evaluating. This nurse shows the ability to analyze by interpreting the meaning of the lab
value, to plan by anticipating the consequences of the lab value, and to implement by taking
action.
tb
DIF: Analyzing TOP: Integrated Process: Nursing Process: Implementation
KEY: Clinical judgment
es
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
6. The new nurse asks the preceptor how context affects clinical judgment. What response by the
preceptor is best?
a. “Context considers the whole of the patient’s story and circumstances.”
Bt
b. “It shouldn’t, only nursing knowledge would affect clinical judgment.”
c. “Outside influences such as environment in which you provide care, influence
your decisions.”
d. “The context of the situation provides an extra layer of complexity to consider.”
ANS: C
The context of a situation considers and supports clinical judgment. The factors within this
layer—such as environment, time pressure, availability or content of electronic health records,
resources, and individual nursing knowledge—have a direct impact on clinical judgment. The
other two options are too vague to provide appropriate information.
Btestbanks.com
, DIF: Understanding TOP: Integrated Process: Teaching/Learning
KEY: Clinical judgment
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
7. Once the nurse has considered all possible collaborative and client problems, what action does
the nurse take next?
a. Act on the observed cues.
b. Determine desired outcomes.
c. Generate solutions.
d. Prioritize the hypotheses.
ANS: D
Analyzing cues lead to a list of potential hypotheses. The nurse prioritizes them, determines
the desired outcomes, generates solutions, and acts. This is part of the six-step clinical
judgment model.
om
DIF: Understanding TOP: Integrated Process: Nursing Process: Diagnosis
KEY: Clinical judgment
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
8. A nurse working in a medical home would do which of the following as part of the job?
a. Advocate with insurance companies.
.c
b. Coordinate interprofessional care.
c. Hold monthly team meetings.
d. Provide out-of-network specialty referrals.
ks
ANS: B
The medical home concept came into being to decrease the fragmentation of care. On a daily
basis, this nurse would expect to coordinate with the interprofessional care team. Advocating
an
with insurance companies would not be a daily function. Monthly team meetings may or may
not be needed. Out of network referrals would not be needed as the interprofessional team
strives to provide comprehensive care.
tb
DIF: Remembering
TOP: Integrated Process: Nursing Process: Implementation KEY: Medical home
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
es
9. A nurse is confused on why systems thinking is important since working on the unit involves
caring for a few specific clients. What explanation by the nurse manager is best?
a. “It’s a good way to conduct root-cause analysis.”
Bt
b. “It is important for quality improvement and safety.”
c. “Systems thinking helps you see the bigger picture.”
d. “You may enter management 1 day and need to know this.”
ANS: B
A systems thinking approach to care reinforces the nurse’s role in safety and quality
improvement while expanding clinical judgment to include the patient’s place within the
greater health care system in the context of care decisions. Root-cause analyses would be a
small portion of systems thinking. It does give the nurse a big-picture view, but this answer is
vague. The nurse may or may not ever join management.
Btestbanks.com
,
,
, KEY: Systems thinking, Quality improvement
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
11. A nurse is talking with a co-worker who is moving to a new state and needs to find new
employment there. What advice by the nurse is best?
a. Ask the hospitals there about standard nurse–client ratios.
b. Choose the hospital that has the newest technology.
c. Find a hospital that has achieved Magnet status.
d. Work in a facility affiliated with a medical or nursing school.
ANS: C
Client Magnet status is awarded by The Joint Commission (TJC) and certifies that nurses can
demonstrate how best current evidence guides their practice. New technology doesn’t
necessarily mean that the hospital is safe. Affiliation with a health profession school has
several advantages, but safety is most important.
DIF: Understanding
om
TOP: Integrated Process: Communication and Documentation
KEY: Evidence-based practice, Magnet status
MSC: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control
MULTIPLE RESPONSE
.c
1. A nurse manager wishes to ensure that the nurses on the unit are practicing at their highest
levels of competency. Which areas would the manager assess to determine if the nursing staff
ks
demonstrate competency according to the Institute of Medicine (IOM) report Health
Professions Education: A Bridge to Quality? (Select all that apply.)
a. Collaborating with an interprofessional team
b. Implementing evidence-based care
an
c. Providing family-focused care
d. Routinely using informatics in practice
e. Using quality improvement in client care
f. Formalizing systems thinking when implementing care
tb
ANS: A, B, D, E
The IOM report lists five broad core competencies that all health care providers should
practice. These include collaborating with the interprofessional team, implementing
es
evidence-based practice, providing patient-focused care, using informatics in client care, and
using quality improvement in client care. Systems thinking is required for quality
improvement but is not a specified part of the IOM report.
Bt
DIF: Remembering TOP: Integrated Process: Nursing Process: Assessment
KEY: Competencies, Institute of Medicine (IOM)
MSC: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control
2. A nurse is interested in making interprofessional work a high priority. Which actions by the
nurse best demonstrate this skill? (Select all that apply.)
a. Consults with other disciplines on client care.
b. Coordinates discharge planning for home safety.
c. Participates in comprehensive client rounding.
d. Routinely asks other disciplines about client progress.
Btestbanks.com
, e. Shows the nursing care plans to other disciplines.
f. Delegate tasks to unlicensed personnel appropriately.
ANS: A, B, C, D, F
Collaborating with the interprofessional team involves planning, implementing, and
evaluating client care as a team with all other involved disciplines included. Simply showing
other caregivers the nursing care plan is not actively involving them or collaborating with
them.
DIF: Applying TOP: Integrated Process: Communication and Documentation
KEY: Teamwork and collaboration, Interprofessional team
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
3. The nurse utilizing evidence-based practice (EBP) considers which factors when planning
care? (Select all that apply.)
a. Cost-saving measures
b. Nurse’s expertise
om
c. Client preferences
d. Research findings
e. Values of the client
f. Plan-do-study-act model
ANS: B, C, D, E
.c
EBP consists of utilizing current evidence, the client’s values and preferences, and the nurse’s
expertise when planning care. It does not include cost-saving measures. The PDSA model is a
systematic model for quality improvement, but is not a specific component of EBP.
ks
DIF: Remembering TOP: Integrated Process: Nursing Process: Planning
KEY: Evidence-based practice (EBP)
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
an
4. A nurse manager wants to improve hand-off communication among the staff. What actions by
the manager would best help achieve this goal? (Select all that apply.)
a. Attend hand-off rounds to coach and mentor.
tb
b. Create a template of suggested topics to include in report.
c. Encourage staff to ask questions during hand-off.
d. Give raises based on compliance with reporting.
es
e. Provide education on the SBAR method of communication
ANS: A, B, C, E
The SBAR method of communication has been identified as an excellent method of
Bt
communication between health care professionals. It is a formalized structure consisting of
Situation, Background, Assessment, and Recommendation/Request. Using a formalized
mechanism for communication helps ensure successful hand-off and fewer client errors. When
establishing this new format for report, the most helpful actions by the manager would be to
provide initial education on the process, develop a template with suggested topics under each
heading, attend rounds to coach and mentor, and encourage staff to ask questions to clarify
information. Basing raises on compliance would not be the most helpful method because
raises are often determined only once a year and are based on multiple criteria.
DIF: Applying TOP: Integrated Process: Communication and Documentation
KEY: Teamwork and collaboration, Communication
Btestbanks.com
,MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
om
.c
ks
an
tb
es
Bt
Btestbanks.com
,Chapter 02: Clinical Judgment and Systems Thinking
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A nurse asks the charge nurse to explain the difference between critical thinking and clinical
judgment. What statement by the charge nurse is best?
a. “Clinical judgment is often clouded by erroneous hypotheses.”
b. “Clinical judgment is the observable outcome of critical thinking.”
c. “Critical thinking requires synthesizing interactions within a situation.”
d. “Critical thinking is the highest level of nursing judgment.”
ANS: B
Clinical judgment is the observable outcome of critical thinking and decision making. It can
be, but most often is not, clouded by erroneous hypotheses. Recognizing, understanding, and
synthesizing interactions and interdependencies in a set of components designed for a specific
om
purpose is systems thinking. Critical thinking is not the highest level of nursing judgment.
DIF: Understanding TOP: Integrated Process: Teaching/Learning
KEY: Clinical judgment
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
.c
2. The nurse understands which information regarding patient-centered care?
a. A competency recognizing the client as the source of control of his or her care
ks
b. A project addressing challenges in implementing patient-centered care
c. Purposeful, informed, and outcome-focused care of clients or families
d. The ability to use best evidence and practice when making care-related decisions
an
ANS: A
Patient-centered care is a QSEN competency that recognizes the patient or caregiver as the
source of control and full partner in providing compassionate and coordinated care based on
respect for the patient’s preferences, values, and needs. QSEN is a project addressing the
challenge of preparing future nurses with the knowledge, skills, and attitudes (KSAs)
tb
necessary to continuously improve the quality and safety of the health care systems in which
they work. Critical thinking is the application of purposeful, informed, and outcome-focused
care. The ability to use best evidence and practice when making care-related decisions is
es
evidence-based practice.
DIF: Understanding TOP: Integrated Process: Teaching/Learning
KEY: Patient-centered care
Bt
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
3. A nurse wishes to participate in an activity that will influence health outcomes. What action
by the nurse best meets this objective?
a. Creating a transportation system for health care appointments
b. Lobbying with a national organization for health care policy
c. Organizing a food pantry in an impoverished community
d. Running for election to the county public health board
ANS: B
Btestbanks.com
, All options are good choices for an altruistic nurse wishing to influence health outcomes;
however, being involved in policy creation and health care reform is an activity specifically
recognized to improve health outcomes. This action will also affect a wider population than
the more local options.
DIF: Applying TOP: Integrated Process: Communication and Documentation
KEY: Health outcomes
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
4. What factor best predicts a nurse’s willingness to employ critical thinking?
a. Caring
b. Knowledge
c. Presence
d. Skills
ANS: A
All attributes are important in nursing, however; the nurse’s willingness to think critically is
om
predicted by caring behaviors, self-reflection, and insight.
DIF: Remembering TOP: Integrated Process: Nursing Process: Assessment
KEY: Critical thinking
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
.c
5. To demonstrate clinical reasoning skills, what action does the nurse take?
a. Collaborating with co-workers to buddy up for lunch breaks
b. Delegating frequent vital signs on a new postoperative patient
ks
c. Documenting a complete history and physical on an admission
d. Requesting the provider order medication for a client with high potassium
ANS: D
an
The components of clinical reasoning include assessing, analyzing, planning, implementing,
and evaluating. This nurse shows the ability to analyze by interpreting the meaning of the lab
value, to plan by anticipating the consequences of the lab value, and to implement by taking
action.
tb
DIF: Analyzing TOP: Integrated Process: Nursing Process: Implementation
KEY: Clinical judgment
es
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
6. The new nurse asks the preceptor how context affects clinical judgment. What response by the
preceptor is best?
a. “Context considers the whole of the patient’s story and circumstances.”
Bt
b. “It shouldn’t, only nursing knowledge would affect clinical judgment.”
c. “Outside influences such as environment in which you provide care, influence
your decisions.”
d. “The context of the situation provides an extra layer of complexity to consider.”
ANS: C
The context of a situation considers and supports clinical judgment. The factors within this
layer—such as environment, time pressure, availability or content of electronic health records,
resources, and individual nursing knowledge—have a direct impact on clinical judgment. The
other two options are too vague to provide appropriate information.
Btestbanks.com
, DIF: Understanding TOP: Integrated Process: Teaching/Learning
KEY: Clinical judgment
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
7. Once the nurse has considered all possible collaborative and client problems, what action does
the nurse take next?
a. Act on the observed cues.
b. Determine desired outcomes.
c. Generate solutions.
d. Prioritize the hypotheses.
ANS: D
Analyzing cues lead to a list of potential hypotheses. The nurse prioritizes them, determines
the desired outcomes, generates solutions, and acts. This is part of the six-step clinical
judgment model.
om
DIF: Understanding TOP: Integrated Process: Nursing Process: Diagnosis
KEY: Clinical judgment
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
8. A nurse working in a medical home would do which of the following as part of the job?
a. Advocate with insurance companies.
.c
b. Coordinate interprofessional care.
c. Hold monthly team meetings.
d. Provide out-of-network specialty referrals.
ks
ANS: B
The medical home concept came into being to decrease the fragmentation of care. On a daily
basis, this nurse would expect to coordinate with the interprofessional care team. Advocating
an
with insurance companies would not be a daily function. Monthly team meetings may or may
not be needed. Out of network referrals would not be needed as the interprofessional team
strives to provide comprehensive care.
tb
DIF: Remembering
TOP: Integrated Process: Nursing Process: Implementation KEY: Medical home
MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care
es
9. A nurse is confused on why systems thinking is important since working on the unit involves
caring for a few specific clients. What explanation by the nurse manager is best?
a. “It’s a good way to conduct root-cause analysis.”
Bt
b. “It is important for quality improvement and safety.”
c. “Systems thinking helps you see the bigger picture.”
d. “You may enter management 1 day and need to know this.”
ANS: B
A systems thinking approach to care reinforces the nurse’s role in safety and quality
improvement while expanding clinical judgment to include the patient’s place within the
greater health care system in the context of care decisions. Root-cause analyses would be a
small portion of systems thinking. It does give the nurse a big-picture view, but this answer is
vague. The nurse may or may not ever join management.
Btestbanks.com
