Module 36 Clinical Decision Making

Module 36   Clinical Decision Making

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

The Concept of Clinical Decision Making

 

1) A nurse has just received a shift report and is preparing to care for clients assigned on a medical-surgical unit. Which client should the nurse plan to assess first?

1. A) The client who needs assistance with activities of daily living
2. B) The client who needs help ambulating to the bathroom
3. C) The client with a pain rating of 3/10
4. D) The client experiencing shortness of breath

Answer:  D

Explanation:  A) The nurse begins by assessing the client who is at the greatest risk, who in this case is the client having trouble breathing. The risk for the client with mild pain is not as severe as the client with dyspnea. The nurse can delegate the ambulation of a client to a nursing assistive individual. The nurse can also delegate assisting a client who needs help with a bath.

1. B) The nurse begins by assessing the client who is at the greatest risk, who in this case is the client having trouble breathing. The risk for the client with mild pain is not as severe as the client with dyspnea. The nurse can delegate the ambulation of a client to a nursing assistive individual. The nurse can also delegate assisting a client who needs help with a bath.
2. C) The nurse begins by assessing the client who is at the greatest risk, who in this case is the client having trouble breathing. The risk for the client with mild pain is not as severe as the client with dyspnea. The nurse can delegate the ambulation of a client to a nursing assistive individual. The nurse can also delegate assisting a client who needs help with a bath.
3. D) The nurse begins by assessing the client who is at the greatest risk, who in this case is the client having trouble breathing. The risk for the client with mild pain is not as severe as the client with dyspnea. The nurse can delegate the ambulation of a client to a nursing assistive individual. The nurse can also delegate assisting a client who needs help with a bath.

Page Ref: 2323

Cognitive Level:  Analyzing

Client Need:  Physiological Integrity

Nursing Process:  Assessment

Learning Outcome:  1. Discuss how clinical decision making impacts quality client outcomes.

 

2) A client with congestive heart failure is having difficulty breathing. Before leaving the room the nurse ensures the client has an over-bed table to lean on when awake if needed to ease breathing. Which technique did the nurse use to make this decision?

1. A) Delegating a task
2. B) Priority-setting
3. C) Conflict resolution
4. D) Critical thinking

Answer:  D

Explanation:  A) After assessing the client, the nurse sets goals for and with the client. To arrive at the goal, the nurse uses critical thinking to make the decision to provide the client with optimum ability to breathe. Delegating involves giving the task to another team member. There is no conflict in this decision. Conflict resolution usually involves a compromise that affects two sides that are in disagreement. Priority-setting involves deciding which task to perform first.

1. B) After assessing the client, the nurse sets goals for and with the client. To arrive at the goal, the nurse uses critical thinking to make the decision to provide the client with optimum ability to breathe. Delegating involves giving the task to another team member. There is no conflict in this decision. Conflict resolution usually involves a compromise that affects two sides that are in disagreement. Priority-setting involves deciding which task to perform first.
2. C) After assessing the client, the nurse sets goals for and with the client. To arrive at the goal, the nurse uses critical thinking to make the decision to provide the client with optimum ability to breathe. Delegating involves giving the task to another team member. There is no conflict in this decision. Conflict resolution usually involves a compromise that affects two sides that are in disagreement. Priority-setting involves deciding which task to perform first.
3. D) After assessing the client, the nurse sets goals for and with the client. To arrive at the goal, the nurse uses critical thinking to make the decision to provide the client with optimum ability to breathe. Delegating involves giving the task to another team member. There is no conflict in this decision. Conflict resolution usually involves a compromise that affects two sides that are in disagreement. Priority-setting involves deciding which task to perform first.

Page Ref: 2316

Cognitive Level:  Analyzing

Client Need:  Physiological Integrity

Nursing Process:  Planning

Learning Outcome:  2. Apply behaviors to improve critical thinking skills when providing nursing care.

 

3) A postoperative client prescribed pain medication every 4 to 6 hours is requesting medication every 6 hours. At 4 hours the client’s pain level is 8 on a rating scale of 1 to 10. The nurse decides to give the pain medication now. What does this nurse’s action exemplify?

1. A) Meeting a client goal
2. B) Time management skills
3. C) Prioritizing the client’s care
4. D) A response to a change in the client’s condition

Answer:  D

Explanation:  A) Each client has a plan of care, but, it is the nurse who constantly evaluates the client for changes that the nurse responds to, if needed. Prioritizing involves choosing tasks in order of importance. Time management is completing the assigned tasks in the given time frame by organizing and using efficiency. The goal has not been met if the client is experiencing pain.

1. B) Each client has a plan of care, but, it is the nurse who constantly evaluates the client for changes that the nurse responds to, if needed. Prioritizing involves choosing tasks in order of importance. Time management is completing the assigned tasks in the given time frame by organizing and using efficiency. The goal has not been met if the client is experiencing pain.
2. C) Each client has a plan of care, but, it is the nurse who constantly evaluates the client for changes that the nurse responds to, if needed. Prioritizing involves choosing tasks in order of importance. Time management is completing the assigned tasks in the given time frame by organizing and using efficiency. The goal has not been met if the client is experiencing pain.
3. D) Each client has a plan of care, but, it is the nurse who constantly evaluates the client for changes that the nurse responds to, if needed. Prioritizing involves choosing tasks in order of importance. Time management is completing the assigned tasks in the given time frame by organizing and using efficiency. The goal has not been met if the client is experiencing pain.

Page Ref: 2354

Cognitive Level:  Analyzing

Client Need:  Physiological Integrity

Nursing Process:  Evaluation

Learning Outcome:  5. Recognize the importance of critical thinking when making decisions for clinical judgment.

 

4) The nurse is assigned two clients. One client needs postoperative teaching in preparation for discharge and the other client with pneumonia has a PaCO2 of 85. Why does the nurse decide to see the client with pneumonia first?

1. A) The nurse can delegate postoperative teaching to unlicensed assistive personnel (UAP).
2. B) The client with pneumonia needs more care than the client needing postoperative teaching.
3. C) The client with pneumonia may be experiencing respiratory distress.
4. D) The room of the client with pneumonia is closer than that of the client needing postoperative teaching.

Answer:  C

Explanation:  A) The client with a PaCO2 of 85 could be in serious trouble. The nurse would decide to assess that client first in order to prevent dire consequences for the client. The client with pneumonia probably needs more care than the client preparing for discharge, but the reason for the decision is based on a potentially critical need by the client with pneumonia. The nurse cannot delegate discharge teaching to a UAP; even if delegation were permitted, the nurse would see the client with a high PaCO2 as being the greater priority. Placement of the client’s room can be a decision that is made when considering time management issues; however, the physiological needs of the clients are the first consideration of the nurse.

1. B) The client with a PaCO2of 85 could be in serious trouble. The nurse would decide to assess that client first in order to prevent dire consequences for the client. The client with pneumonia probably needs more care than the client preparing for discharge, but the reason for the decision is based on a potentially critical need by the client with pneumonia. The nurse cannot delegate discharge teaching to a UAP; even if delegation were permitted, the nurse would see the client with a high PaCO2as being the greater priority. Placement of the client’s room can be a decision that is made when considering time management issues; however, the physiological needs of the clients are the first consideration of the nurse.
2. C) The client with a PaCO2of 85 could be in serious trouble. The nurse would decide to assess that client first in order to prevent dire consequences for the client. The client with pneumonia probably needs more care than the client preparing for discharge, but the reason for the decision is based on a potentially critical need by the client with pneumonia. The nurse cannot delegate discharge teaching to a UAP; even if delegation were permitted, the nurse would see the client with a high PaCO2as being the greater priority. Placement of the client’s room can be a decision that is made when considering time management issues; however, the physiological needs of the clients are the first consideration of the nurse.
3. D) The client with a PaCO2of 85 could be in serious trouble. The nurse would decide to assess that client first in order to prevent dire consequences for the client. The client with pneumonia probably needs more care than the client preparing for discharge, but the reason for the decision is based on a potentially critical need by the client with pneumonia. The nurse cannot delegate discharge teaching to a UAP; even if delegation were permitted, the nurse would see the client with a high PaCO2as being the greater priority. Placement of the client’s room can be a decision that is made when considering time management issues; however, the physiological needs of the clients are the first consideration of the nurse.

Page Ref: 2319

Cognitive Level:  Analyzing

Client Need:  Physiological Integrity

Nursing Process:  Assessment

Learning Outcome:  4. Evaluate client care situations using problem solving.

 

5) A client seen in an urgent care clinic is complaining of abdominal pain and believes that the food eaten the previous evening was tainted. What should the nurse do after the client states that the food was tainted?

1. A) Ask the client open-ended questions to further assess the situation.
2. B) Tell the client the physician does not need to assess the client.
3. C) Call an ambulance before assessing the client any further.
4. D) Advise the client to take an antacid.

Answer:  A

Explanation:  A) The nurse must recognize that the client has not given the nurse enough information. The client could, indeed, have eaten bad food or may be experiencing appendicitis. The nurse asks more questions followed by a physical examination. Short-cut decisions here could be harmful for this client. The nurse would not give advice about taking a medication. The nurse does not have enough information to make the decision to call an ambulance. Because the nurse does not have enough information, telling the client that a physician does not need to assess the client is inappropriate.

1. B) The nurse must recognize that the client has not given the nurse enough information. The client could, indeed, have eaten bad food or may be experiencing appendicitis. The nurse asks more questions followed by a physical examination. Short-cut decisions here could be harmful for this client. The nurse would not give advice about taking a medication. The nurse does not have enough information to make the decision to call an ambulance. Because the nurse does not have enough information, telling the client that a physician does not need to assess the client is inappropriate.
2. C) The nurse must recognize that the client has not given the nurse enough information. The client could, indeed, have eaten bad food or may be experiencing appendicitis. The nurse asks more questions followed by a physical examination. Short-cut decisions here could be harmful for this client. The nurse would not give advice about taking a medication. The nurse does not have enough information to make the decision to call an ambulance. Because the nurse does not have enough information, telling the client that a physician does not need to assess the client is inappropriate.
3. D) The nurse must recognize that the client has not given the nurse enough information. The client could, indeed, have eaten bad food or may be experiencing appendicitis. The nurse asks more questions followed by a physical examination. Short-cut decisions here could be harmful for this client. The nurse would not give advice about taking a medication. The nurse does not have enough information to make the decision to call an ambulance. Because the nurse does not have enough information, telling the client that a physician does not need to assess the client is inappropriate.

Page Ref: 2364

Cognitive Level:  Applying

Client Need:  Physiological Integrity

Nursing Process:  Assessment

Learning Outcome:  5. Recognize the importance of critical thinking when making decisions for clinical judgment.