CUNY Lehman College NUR406/NUR 406 midterm exam, updated 100% 2025.

CUNY Lehman College NUR406/NUR 406 midterm exam, updated 100% 2025. Question 1 When delegating patient assignments to nursing assistants, the registered nurse must understand: Answer the interest level of the personnel for the task. the patient may prefer the nurse to perform the procedure the nurse is accountable for the outcome of the care the nurse supervisor must first approve of the assignment Question 2 Patient care goals must be: Answer realistic developed by th nurse only ordered by the physcian. All of the above Question 3 Which should the the intital action of the agency nurse who has been assigned to a patient that requires a non-urgent procedure with which the nurse is unfamiliar? Answer Tell the manager he or she had never done that procedure Ask the nurse who has the skill to do the procedure. Look up the facilities related policies and procedure Perform the procedure as he or she thinks it should be performed Question 4 Which of the following statements should the nurse write as an appropriate outcome for a patient newly diagnosed with diabetes mellitus? Answer The nurse will teach the patient foot care before discharge The patient's diabetes will be controlled The patient will do finger sticks for blood glucose before discharge The health team and patient will work to prevent complications of diabetes 2.5 pointsQuestion 5 Which one of the following actions by a nurse best demontrates critical thinking skills? Answer Completing assigned work on time Carrying out the physcian's prescription promptly Following standardized care plans on the unit Documenting relevant data in an organized way Question 6 You are caring for a newly admitted patient with a history of emphysema. The patient is SOB and dusky. His oxygen saturation level with oxygen is 90%. You administer his bronchodilating aerosol medication, which does not alleviate his complaints. He has no other medications ordered. What action would you take next? Answer Increase his oxygen Provide a quiet environment Call the physcian Begin chest physiotherapy Question 7 An 83 year old woman in a nursing home repeatedly puts on her call bell after her family visits in the evening. When the nurse responds the patient says that she just wants to check to make sure that the buzzer is working. What approach should the nurse take with this patient? Answer Visit with the patient after the family leaves Request that the patient have a roommate Remove the call bell from the patient's room Ignore her call lights after family visits Question 8You are interviewing a 70 year old patient at the cardiac clinic about her medications. She tells you that she takes a little yellow pill every morning for her heart. What can the nurse infer from this information? Answer The patient will be difficult to teach The patient understands the role of her medicine The patient is illiterate The patient is forgetful Question 9 Which of the following activities best supports the development and use of critical thinking when practicing at the bedside? Answer Relying on the expertise of others to make clinical decisions Becoming better at task functions Working independently of workers Exercising greater use of reflection to evaluate outcomes Question 10 Which of the following best describes why healthcare institutions implement policies and procedures for nurses practicing at the bedside? Answer To reduce the stress associated with remembering how to perform numerous procedures. To protect the nurse against being sued for unsafe practice patterns To help the nurse critically think To provide nurses with guidelines for conducting safe practice Question 11 Mr Jones is a 48 year old patient admitted with a fever of unknown origin, sudden onset of shortness of breath, progressive weakness, and rapid weight loss (15 pounds) over the last two weeks. Which of the following assessment activities should be made first when caring for this patient? Answer Perform a complete neurological assessmentWeigh the patient Auscultate the chest for abnormal heart sounds obtain oxygen saturation level Question 12 In an acute care hospital, which of the following situations should take the first priority for the nurse when caring for his or her patients? Answer A new mom experiencing postpartum depression A 28 year old male patient who refuses to take his medications A 90 year old patient with a sudden change in mental status A 36 year old patient who complains that her IV site is causing her pain. Question 13 The Nurse clusters the patients subjective and objective signs and symptoms mainly to: Answer a. Work with at risk diagnosis b. Identify the nursing diagnosis??????? c. Correlate the medical diagnosis d. Validate the subjective complaints Question 14 Critical thinking is best defined as: Answer a. Does not require creative thinking b. Involves assessment and diagnosis of the nursing process c. Is a process that is active, purposeful and organized d. Always involves independent thinking Question 15 The nurse enters the room of diabetic patient and finds the patient diaphoretic. What is the nurses priority action? Answer a. Document your findingsb. Provide for patient comfort c. Inform the healthcare provider d. Obtain a fingerstick stat Question 16 Which of the following phrases best describes the scope of practice for nurses Answer a. Developed by a nurse representative on a national level b. Developed by both nurses and physicians on a national level c. Legal and ethical boundaries developed by physicians d. Legal and ethical boundaries of practice established by each state Question 17 The nurse has just received shift report for a patient who was admitted from the emergency department for complaints of abdominal pain, vomiting, and diarrhea and a medical diagnosis of possible appendicitis. Prior to entering the patient's room to conduct an assessment, the nurse considers the following possible patient problems that will guide the assessment: risk for deficient fluid volume, pain, risk for infection, risk for imbalanced electrolytes, anxiety. Which of the following critical thinking skills or habits of the mind did the nurse use when considering these possible patient problems? Answer analyzing predicting applying standards transforming knowledge Question 18 The nurse is preparing a patient for discharge home and assesses that the patient appears pale and uncharacteristically quiet. The nurse assesses the patient's vital signs and assesses that the heart rate is within normal limits but significantly higher than previously assessed. Given these assessment findings the nurse continues to assess for possible causes for the change in this patient's condition prior to discharging this patient. Which of the following critical thinking skills or habits of the mind is the nurse using? Answer reflection perserverance analyzingapplying standards Question 19 The nurse recognizes personally held attitudes about working with patients from different ethnic, cultural and social backgrounds when delivering and developing plans of care. Which of the following IOM competencies will this nurse's attitude support? Answer employing evidenced based practice patient-centered care employing informatics applying quality improvement Question 20 When considering the risks associated with handoffs (shift report) among providers and across transitions in care the nurse is addressing which of the following IOM competencies? Answer patient centered caring applying quality improvement utilizing informatics working in interdisciplinary teams Question 21 The nurse who communicates observations or concerns related to hazards and errors to patients, families and the health care team is addressing which of the following QSEN competencies? Answer use of informatics patient safety applying quality improvement patient centered care Question 22 A 55 year-old client is admitted with a medical diagnosis of possible pneumonia. Assessment findings reveal: BP 140/88, HR 90, RR 22 with mild intercostal retractions, temperature 100.0 (orally), PAO2 (pulse oximiter reading) 96% on room air, and diffuse scattered rhonchi and wheezes throughout all lung fields. Which of the following nursing diagnoses will the nurse useto initially develop and implement a plan of care? Think priority Answer ineffective airway clearance related to infection (pneumonia) risk for infection related to immunosuppression anxiety related to difficulty breathing ineffective gas exchange related to retained secretions Question 23 A 72 year old male patient attends the out-patient clinic and complains of bilateral lower leg pain upon walking more than one block. Past medical history includes: HTN, CAD, and angina. Assessment findings include: cool lower extremities, pedal pulses +1/3, and decreased hair on lower extremities. Which of the following nursing diagnoses will the nurse use to develop and implement a plan of care? Answer risk for ineffective coronary tissue perfusion decreased cardiac output risk for ineffective renal tissue perfusion ineffective peripheral tissue perfusion Question 24 The nurse explains to the patient that together they will plan the patient's care and set goals to achieve by discharge. The patient asks how this differs from what the physician does. The difference between the roles of nursing and medicine is best explained by the nurse as Answer medicine cures; nursing cares medicine focuses on diagnosis and treatment of the health problem: nursing focuses on diagnosis and treatment of the patient's response to the health problem there is little role difference between medicine and nursing nurses assist physicians to diagnose and treat patient with health care problems 2.5 points Question 25 When providing patient care using evidence-based practice, the nurse usesAnswer facility policy and procedures coupled with clinical expertise the application of the findings of a clinical research study clinical judgment based on experience observation of the evidence that patient outcomes have been met Question 26 The nurse has made the diagnosis of ineffective breathing pattern related to chest pain related to pneumonia. Assessment reveals: BP 139/88, HR 89, RR 29, Temperature 99.0 F, SAO2 97%. Following the administration of an analgesic, the nurse would Answer ask the patient to cough encourage use of the incentive spirometer lie the patient flat in bed continue to monitor the respiratory pattern Question 27 The following 2 questions will relate to an unfolding case study. Case study: 61 y/o patient with admitting Dx. of renal calculi, post cystoscopy with lithotripsy and stent placement Course of Events JR, a 61 year old white male was admitted to the hospital with a diagnosis of renal calculi for same day surgery for cystoscopy, lithotripsy and stent placement. Following the discharge from the PACU, JR arrived on the med/surg unit. The nursing admission assessment revealed an engaging man, alert and oriented x3 with complaints of left flank pain 7/10 and intravenous (IV) D51/5 NS infusing at 80 milliliters per hour (ml/hr) to the left hand. Physical exam was unremarkable with the exception of left costrovetebral (CVA) tenderness and the use of oxygen (O2) 2 liters/minute (l/m) via nasal cannula. Significant past medical history included history of renal calculi one year ago, hypertension (HTN), and sleep apnea. When discussing his actual and anticipated needs the patient verbalized that he sleeps with a bipap machine for his sleep apnea and wished pain medication. When discussing his acceptable pain threshold he stated “0”. JR stated that the doctors had never obtained a sample of his “stone” and he doesn’t know what type they are. He states that he is satisfied with his home life and that he and his wife have a very good relationship. JR is a retired diamond cutter and heis very proud of the level of professionalism he incorporated into his work and he expects the same level of professionalism from the health care providers. JR has no known allergies. Medications taken at home are Inderal 10 milligrams (mg) twice per day. Vital Signs: 132/88, 86, 20, 98.0po, 94% on room air. Question: Use critical thinking processes and your knowledge of QSEN nursing competencies to analyze the case study and: 1)Identify 2 priority patient problems or nursing diagnoses including likely etiologies and signs and symptoms (defining characteristics) and 2) Identify any Risks to Patient Safety for each patient problem. Question 28 The case study unfolds: JR is maintaining an saturated oxygen concentration (SAO2) of 92-94% as ordered receiving oxygen 2-4 l/nasally. The bipap machine is at the bedside to be used at bedtime. When JR falls asleep in the chair his SAO2 drops to 85% and when he is woken up the level returns to within normal limits (WNL). Pulse oximeter alarms are set to alarm when the level drops below 90%. The respiratory therapist and pulmonary physician attended and it was discussed with JR that we would make frequent rounds (q15-30 minutes) and are comfortable that his room is near the nurses station. JR’s vital signs remain stable with temperature (T) max 99.0po. JR verbalized the need to measure and strain urine to capture any sand or stone for analysis and to measure output. JR also was able to verbalize the manifestations of urinary tract infection. Additionally, JR verbalized approval of the bipap machine used in the hospital and demonstrated use. When his sleep apnea was discussed he shared that he is on a weight reduction regimen which he hopes will positively impact his breathing status. JR was able to verbalize a low calorie, high fiber diet which he has been on at home. His BMI is currently 30 and JR states that he has lost 10 pounds in the last 3 months by following a low calorie and high fiber diet. Unfortunately, JR continues to experience pain in the left flank area upon micturation and there is a plan to incorporate new pain management measures into the therapeutic regimen which does not cause JR to become sleepy. JR was able to verbalize the indications and instructions for his discharge medications of ampicillin and inderal as well as his next physician appointment. Question: • Define the IOM competency of Patient-Centered Caring.• Discuss how the plan of care for JR met or did not meet the requirements of this competency and make recommendations. This plan of care met the expectation for the patient. His plan was re assessed and changes were made taking patient safety into consideration • Identify specific "knowledge, attitudes, or skills" of the competency when critiquing this plan of care. Provide patient-centered care- patient was involved in his plan of care. His decisions were respected. His plan was communicated by the interdisciplinary team. Work in interdisciplinary teams- Team work together and collaborated well. Employ evidence-based practice: incorporate new pain management measures into the therapeutic regimen which does not cause JR to become sleepy Apply quality improvement: patient was kept close to the nurses’ station • Identify any risks to JR's safety. Question 29 Listed 3 CT processes that the nurse used in the 2 min video Question 30 You will need your graded Critical Thinking Inventory to complete this question. Now that you are halfway through this course, please reflect on your initial CT inventory and: 1) List each CT process (at least 4) that you identified as "would like to improve" and discuss an example of how you used these skills in a real life situation to facilitate the diagnostic reasoning process. If you are not working as a nurse, please use a non-clnical situaion. "Thinking habits" transfer to all aspects of life. (10 points) 2) Identify ONE specific (measureable) goal that you would like to achieve by the end of the semester regarding your "thinking habits". This should include a plan and description of how (just like a recipe) you will accomplish this (10 points) Midterm1. The focus of nursing is to diagnose and treat human responses to health problems 2. Which of the following statements are correct regarding the ANA standard: diagnosis → diagnoses should contain relevant causes to determine expected outcomes, are problems that nurses identify, validates the diagnoses or problems with the patient, family, and other health care workers. 3. Critical thinking is includes active, purposeful, organized, cognitive thinking and reflection 4. In an acute care hospital setting, which of the following situations should take priority for the nurse? Sudden change in mental status 5. Patient care goals must be: realistic, based on current patient data 6. A potential (risk) nursing diagnosis is defined as: problem that is likely to develop if the nurse does not intervene 7. The nurse explains to the client together they will plan the clients care and set goals to achieve by discharge. The patient asks how this differs from what the physician does. The nurse explains the difference between the nursing and medicine roles can be best be described as: medicine focuses on diagnoses and treatment of the health problem and nursing focuses on the diagnosis and treatment of the patients response to the problem 8. A nurse is preparing a patient for discharge. The nurse notices that the patiet is uncharacteristically quiet and pale. After taking the patients vital signs, the nurse notes that they are within normal limits, but they are higher than usual for the patient. Given the assessment findings, the nurse continues to assess for possible causes of the changes prior to discharging the patient, which of the following CT skills or habits of the mind is the nurse using: SELECT ALL THAT APPLY: Reflection and analyzing 9. Critical thinkin nurses avoid diagnostic errors by all of the following except: drawing conclusions based on unsubstantiated patient data 10. A 55- year old married man visists his primary care provider because of fatigue and a weight gain of 7 lbs of the past month. He has a history of an anterior wall MI 1 year ago. He works 60 hours a week and smokes 2 packs of cigarettes a day. His strengths might include: he is married 11. A patient is admitted to the hospital complaining of having diarrhea 10 times a day for the past 3 days. She states that the stool id jelly-like , with mucous, and blood streaks. Her medical admitting diagnosis is c-dif. Her heart rate is elevated and her medical plan of care includes IV fluids. A priority nursing diagnosis for this patient might be: F/E imbalance 12. A patient was admitted to the medical-surgical unit for repair of an inguinal hernia. On the day of the surgery, the nurse notes a physician order for a regular diet as tolerated. The nurse intercepts the patients breakfast tray before the patient can eat. What critical thinking skills or habits of the mind is the nurse using? Applying standards 13. Why is diagnostic reasoning important to patient safety? Nurses have responsibility to develop plans of care that promote positive patient outcomes 14. When applying the DNT model, making inferences in patient care: B 15. Ms g is admitted to the ER with a diagnosis of HF she was discharged from the hospital 10 days ago and comes in today stating “ I cant catch my breath and my legs are as big as tree trunks” after further questioning, you learn ms g is strictly following fluid restriction. However she is not taking her medication regularly. Which of the following patientstatements indicate that ms g has a knowledge deficit? AC,D… I didn’t take the little white pill bc it made me go to the bathroom, I thought if I stuck to my fluid restriction, I wouldnt have any problems, I don’t know why I cant walk 2 blocks I used to walk a milke. 16. A nursing care plan: enhances continuity of care, organizes information for communication with other nurses and health care workers, coordinates resources for patient care 17. Diagnostic reasoning standards that promote quality thinking include all of the following except: steadfastness 18. a nurse is adminteresting medication to a patient, when the patient asks for a bedpan. The nurse places the patient on a bedpan before leaving the room. The nurse tells the CAN that she put the pt on the bedpan and asks the CAN to check in a few minutes. Which of the quality and safety education askes the QSEN competencies does the nurses actions best exhibit? work in interdisciplinary teams 19. SP is admitted to the othropedic ward. She has fallen at home and has sustained a frature to the right hip. She is 75 years old widow with three children living nearby. Her father died of cancer at 62, mother from HF 79. Her height is 5’3 and weight is 188 lbs she has a 50-pack-year smoking denies alcohol use. She has RA and has upper GI bleed, VS: 128/60, 98, 14, 99, 90%, . Priority nursing diagnosis : ineffective gas exchange 20. In the assment hased of the nursing process: the medical diagnosis is important but is not the primary focus 21. 55 y/o male unresolved pneumonia, misses a few courses of antibiotics. When planning mr Redford care the nurse should: include him in the process and ask him how he prefers to learn 22. Mr, redfords VS: Bp 145/88, pulse 110, rr 25, temp 100.2, oxygen 90%. He is restless and says I feel a bit short of breath: ineffective gas exchange 23. While examining k, the school nurse notices that the child is speaking hesistantly and softly, giving brief answers to questions and avoiding eye contact. The nurse wonders if the child is shy, withdrawn, anxious, or perhaps having difficulty with her self-concept the nurse continutes to father data to confirm or disconfirm these possibilities. Which skill? information seeking 24. Which CT. habit of mind describes the nurses examination of the patient assessment data and determining a priority diagnoses? Discrimination 25. M had a coronary artery bypass graft three days ago. The nurses notes decreased breath sounds in the lower lung fields and his oxygen saturation is 92% on 2 L nasal cannula. The nurse believes the patient may be developing atelectasis. This suspicion is based on which CT skills and habits of the mind? Logical reasoning, applying standards, transforming knowledge 26. The telemetry unit charge nurse takes report on a recently extubated patient coming from the cardiac care unit. Based on the results of the patients last four 4 abgs and the patients vital signs which are within normal limits but tranding towards the abnormal range, the charge nurse is concerned that the patient will need to be re-intubated. Which of the following critical thinking skills or habits of the mind is the charge nurse using? Analyzing ,predicting ,contextual perspective, intuition, confidence 27. A patient is scheduled for discharge. While the nurse is doing follow up discharge teaching he learns that the patient lost her apartment while she was in the hospital. Thenurse informas the physician, who says that the patient must be discharged because she was exceeded her length of stay for her condition. The nurse contacts the nursing supervisor and the social worker. Togethery they speak with the physician and the patient remains in the hospital while arrangements are made to send the patient to a rehab center. Which is an example of QSEN the nurse demonstrated? Collaboration and teamwork 28. Classification systems (taxonomies): identify and categorize ideas on the basis of their similiarities 29. Components of the NANDA-1 diagnosis include all of the following except: uncertainty 30. Which of the following situations take priority? The CNA says “ come quickly mr Ds dressing is all wet with blood and its trickling down under it. 31. A purpose of outcomes statements is to? Evaluate changes in patient health status 32. Nursing interventions: are any action nurses make based on clinical judgement 33. A healthcare organization that promotes charting that only focuses on noting significant findings or changes in patients condition utilizes? Promotes charting by CBE 34. A professional code of ethics is a set of written statements: that reflect the values, goals, and professional expectations of nursing 35. Ms albert comes to the clinic and states she doesn’t feel well. Ms albert weighs 250 lbs. the nurse sends ms albert to the waiting area outside. Then says to the secretary “this patient is greedy with poor self-control” this is an example of the nurse : judging the patient 36. An interdisciplinary team meets to discuss a patients impending discharge. The patient was newly diagnosed with type2 diabetes. The team includes the DR. charge nurse primary nurse social worker and nursing attendant. The primary nurse says she taught the patient self-injection of insulin and the patient performed a successful return demonstration. The CNA tells the team “the patient was talking to her family and said she is afraid to stick herself, and doesn’t know what she is going to do when she gets homes. The CNA’s statement is an example of: relevant patient information 37. A successful interdisciplinary team: values the contributions of all the team members 38. What is the purpose of nursing assessment? Get a picture of the patient and how he can be helped 39. The patients vital signs (BP, RR, TEMP) are types of: objective 40. The patient says she is not feeling well today. This is an example of: subjective 41. The PT met with Ms M who had a right hip repair surgery the previous day. After metting the therapists documents.” The patient agrees to the following goal:will be able to walk to the nurses stations with minimal assistance within 2 days”…….. a mutually determined short-term therapy goal 42. Which of the following theories is best described as the patients ability to perform their own care to maintain life, helath, and well being and nurse provide patients enough help to address care deficits: Orem’s self care model 43. The main purpose of nursing documentation is: to effectively communicate patients response to treatments 44. A 65 year old patient was admitted to the intesntive care unit for a couple of days. A RN is assigned to care for the patient after a pleural biopsy. The nurse determines that the patient is experiencing a serious complication from the pleural biopsy when the patients exhibits which of the following manifestations? Sudden dyspnea45. A 79 y/o woman is on a med-surg unit with medical diagnosis of pneumonia. Assessment findings include BP 140/88 HR 90 RR 26 temp 100 orally pulse ox 92%, the patient is coughing up copious thick secretions. A priority nursing diagnosis might be: ineffective airway clearance related to copious secretions secondary to infection 46. An alderly woman in the nursing home repead, the patient says the she just wants to check to make sure the buzzer is working: visit the patient after the family leaves and frequently thereafter 47. 48 year old patient admitted with a fever of unknown origin, sudden onset of SOB → OXYGEN SATUARTION priority 48. the nurse clusters the patients subjective and objective signs and symptoms mainly to: identify a nursing diagnosis 49. the nurse recognisez personally held attitudes about working with patients with different ethnic, culture, and social backgrounds when delivering plans of care. Which of the following IOM compentencies does the nurses attitude support? Patient centered care 50. when providing patient care using evidence based practice the nurse uses: the findings of clinical practice research Describe a critical thinking SKILL for Fatou video (Not habit of the mind) 6 signs and symptoms for deficient fluid volume (For Blackman video) Name defining characteristics for decreased cardiac output (Mr. Gomez scenario) 90 year old mental status change is the priority Know skills and habits of the mind for matching. Had to match examples, not definitions. Examples too specific to remember Patient suspected to be in shock, nurse should do what next immediately? I put elevate feet, others said call provider (Choose at your discretion) Know common signs of complication from IV therapy (Swelling, ulceration, infection,etc) Patient with DVT: Diagnosis Altered tissue perfusion related to venous congestion Interventions are everything but spiritually appropriate A 65 year old patient was admitted to the intensive care unit for a couple of days. A RN is assigned to care for the patient after a pleural biopsy. The nurse determines that the patient is experiencing a serious complication from the pleural biopsy when the patients exhibits which of the following manifestations? Sudden dyspnea Nurse scope of practice does not include implementing intake and outTell other staff members that it is inappropriate to talk about patient. 1) Ineffective airway clearance, 2) ineffective breathing pattern, 3)constipation, 4)grieving Patient with SOB, weight loss 15lbs. Check pulse oximetry, not auscultate the heart. Old lady using call bell; visit after family leaves Patient about to be discharged has elevated vital signs. Nurse stops discharge, looks for possible causes. What critical thinking used? ANALYZING Appreciate risks of handoffs between members of interdisciplinary Teamwork and collaboration Nurses do not treat health problems Mr Jones is a 48 year old patient admitted with a fever of unknown origin, sudden onset of shortness of breath, progressive weakness, and rapid weight loss (15 pounds) over the last two weeks. Which of the following assessment activities should be made first when caring for this patient? Check pulse oximetry The nurse clusters the patients subjective and objective signs and symptoms mainly to: identify a nursing diagnosis Patient newly diagnosed with DM. What is an appropriate outcome? Patient demonstrates glucose testing by discharge (SMART) Which of the following activities best supports the development and use of critical thinking when practicing at the bedside? Reflection (Evaluation) The nurse has just received shift report for a patient who was admitted from the emergency department for complaints of abdominal pain, vomiting, and diarrhea and a medical diagnosis of possible appendicitis. Prior to entering the patient's room to conduct an assessment, the nurse considers the following possible patient problems that will guide the assessment: risk for deficient fluid volume, pain, risk for infection, risk for imbalanced electrolytes, anxiety. Which of the following critical thinking skills or habits of the mind did the nurse use when considering these possible patient problems? Prediction The nurse is preparing a patient for discharge home and assesses that the patient appears pale and uncharacteristically quiet. The nurse assesses the patient's vital signs and assesses that theheart rate is within normal limits but significantly higher than previously assessed. Given these assessment findings the nurse continues to assess for possible causes for the change in this patient's condition prior to discharging this patient. Which of the following critical thinking skills or habits of the mind is the nurse using? Analyze When considering the risks associated with handoffs (shift report) among providers and across transitions in care the nurse is addressing which of the following IOM competencies? Teamwork and collaboration A 55 year-old client is admitted with a medical diagnosis of possible pneumonia. Assessment findings reveal: BP 140/88, HR 90, RR 22 with mild intercostal retractions, temperature 100.0 (orally), PAO2 (pulse oximiter reading) 96% on room air, and diffuse scattered rhonchi and wheezes throughout all lung fields. Which of the following nursing diagnoses will the nurse use to initially develop and implement a plan of care? Ineffective airway clearance The nurse who communicates observations or concerns related to hazards and errors to patients, families and the health care team is addressing which of the following QSEN competencies? Safety When considering the risks associated with handoffs (shift report) among providers and across transitions in care the nurse is addressing which of the following competencies? Teamwork and collaboration A 72 year old male patient attends the out-patient clinic and complains of bilateral lower leg pain upon walking more than one block. Past medical history includes: HTN, CAD, and angina. Assessment findings ilude: cool lower extremities, pedal pulses +1/3, and decreased hair on lower extremities. Which of the following nursing diagnoses will the nurse use to develop and implement a plan of care? Impaired peripheral perfusion The nurse explains to the patient that together they will plan the patient's care and set goals to achieve by discharge. The patient asks how this differs from what the physician does. The difference between the roles of nursing and medicine is best explained by the nurse as Know difference between nursing and medical nursing