Nursing Process and Clinical Judgment Quiz

Quality and Safety Education for Nurses (QSEN)

• QSEN is a framework for educating nurses in quality and safety.
• Topics include Evidence-Based Practice, Quality Improvement, Safety, Informatics, Patient-Centered Care, and Teamwork & Collaboration.
• Mnemonic: Every Quick Squirrel Investigate Potential Trees.

Patient-Centered Care

• Patient-centered care prioritizes the patient as the central figure in their care.
• It involves respecting patient preferences, values, and needs, and coordinating care accordingly.
• Patients are active participants in decisions about their health.

Nursing Process (ADPIE)

• Assessment: Gathering patient information.
• Diagnosis: Identifying patient problems.
• Planning: Setting care goals and actions.
• Implementation: Performing planned nursing actions.
• Evaluation: Determining if goals were met.

Clinical Judgement

• Clinical judgment is a complex cognitive process.
• Model: Red Apples Provide Great Tasting Energy. Concepts to remember: Recognize Cues, Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take action, and Evaluate Outcomes.
• Key Concepts: Every Kite Soars Really Quickly.

Critical Thinking Attitudes

• Critical thinking involves attributes like confidence, independent thought, fairness, responsibility, risk assessment, and discipline.
• Also includes perseverance, creativity, curiosity, integrity, and humility.

Critical Thinking and Clinical Judgement Skills

• Interpretation
• Analysis
• Inference
• Evaluation
• Explanation
• Self-Regulation

Standards of Professional Performance

• Ethical conduct, advocating for patients, respecting others, effective communication, collaboration, effective leadership, professional learning, scholarly inquiry, quality of care, professional evaluation, resource management, environmental health.

Cultural Competency Model

• Cultural awareness: Recognizing one's own biases.
• Cultural knowledge: Learning about other cultures.
• Cultural skills: Communicating effectively with diverse populations.
• Cultural encounters: Directly engaging with diverse groups.
• Cultural desire: The motivation to be culturally competent.

Health Disparities

• Health disparities highlight differences in health outcomes among population groups based on factors like race, ethnicity, socioeconomic status, gender, or geography.

Health Literacy

• Health literacy is the ability to process and understand health information to make informed decisions.

Linguistic Competence

• Linguistic competence means effectively communicating with patients of different language backgrounds.
• It includes using interpreters and translation services, and being mindful of non-verbal cues.

Interview Techniques

• Observing verbal and nonverbal cues.
• Open-ended questions: encourage detailed responses.
• Leading questions: influence responses.
• Back channeling: show active listening.
• Direct closed-ended questions: precise answers.
• Probing: asking for more detail.
• 4Cs for open-ended questions: What do you CALL your problems? Cause, concerns, cope.
• Interview skills: Courtesy, comfort, connection, and confirmation.

Modes of Transmission

• Contact transmission:
  • Direct: Person-to-person (fecal-oral).
  • Indirect: Object-to-person.
• Droplet: Organisms ≥5 mcg.
• Airborne: Organisms <5 mcg.
• Vehicles: Contaminated items (needles, water, blood, food).
• Vector-borne: Organisms carried by animals/insects.

Isolation Precautions

• Contact: Private room/cohort, gown, gloves.
• Droplet: Private room/cohort, surgical mask.
• Airborne: Private negative-pressure room, N95 respirator.
• Protective: Private positive-airflow room, mask, gown, gloves.

Standard Precautions

• Treating all body fluids as potentially infectious.
• Hand hygiene, Personal Protective Equipment (PPE).

Donning and Doffing PPE

• Donning: Putting on PPE (gown, mask, goggles, gloves).
• Doffing: Removing PPE (gloves, gown, goggles, mask).

Temperature Assessment

• Oral: Posterior sublingual pockets.
• Rectal: Used when other routes aren't possible. ≈0.7 – 1 degree F higher)
• Tympanic: Infrared emissions.
• Temporal artery: Infrared emission across forehead/behind ear. ≈1 degree F higher than oral.
• Axillary: Used when other routes aren't possible. ≈1 degree F lower than oral.

Variables Affecting Temperature

• Normal variations: Exercise, menstrual cycle, circadian rhythm, age, environment.
• Abnormal variations: Fever, hyperthermia, heatstroke, heat exhaustion, hypothermia.

Skin Color Changes

• General pigmentation.
• Localized bruising, vascularity.
• Pallor (white): Reduced oxyhemoglobin.
• Erythema (red): Increased oxyhemoglobin.
• Cyanosis (blue): Increased deoxyhemoglobin.
• Jaundice (yellow): Increased bilirubin.

ABCDE of Skin Lesions

• Asymmetry
• Border
• Color
• Diameter
• Evolution

Skin Lesions (Types)

• Macule
• Papule
• Nodule
• Tumor
• Wheal
• Vesicle
• Pustule
• Ulcer
• Atrophy

Skin Turgor

• Measuring skin hydration. Normal = 1-2 seconds for skin to return to normal.

Skin Integrity

• Skin's health and ability to protect.

Hair Assessment

• Expected: Symmetrical distribution.
• Assess for cleanliness and uniformity.
• Alopecia (hair loss).
• Pediculosis Capitis: Head lice.

Nail Assessment

• Shape, contour, consistency, color, capillary refill (2-3 seconds is brisk).

Factors Influencing Hygiene

• Social practices.
• Personal preferences.
• Body image.
• Socioeconomic status.
• Health beliefs/motivation.
• Cultural variables.
• Developmental stage.
• Physical condition.

Bathing Procedures

• Collect supplies.
• Explain procedure.
• Apply gloves.
• Maintain safety and warmth.
• Promote independence.

Diabetic Foot Care

• Don't soak feet, clip nails with physician's order.
• Cut nails straight across, file edges.
• Avoid heat unless prescribed.

Avoiding Abbreviations

• Avoid abbreviations that can be easily mistaken.

Eye Assessment

• Visual Acuity (Snellen chart, handheld).
• Myopia (nearsightedness), Presbyopia (age-related near vision).
• Extraocular Movements (Inspect for nystagmus).
• Visual Fields (Confrontation test).
• External ocular structures: General, eyebrows, eyelids, eyeballs, conjunctiva, sclera, lacrimal apparatus.
• External anterior eyeball: Cornea, lens, iris, pupils (PERRLA).
• Pupillary light reflex (direct & consensual), Accommodation

Mouth, Head, and Neck Assessment

• Mouth: Teeth, gums, tongue, mucous membranes.
• Head: Normocephalic.
• Neck: Supple ROM, no masses, or lymphadenopathy.

Oral Hygiene

• Brushing, flossing, and rinsing are important.
• Interventions for unconscious clients include suction and care to avoid accidental insertion of fingers into the mouth.

Denture Care

• Encourage denture cleaning, removal nightly.
• Store dentures covered in water and protected.

Eye Irrigation

• Positioning, sterile saline, direction of irrigation.

Ear Irrigation

• Assess for infection.
• Positioning, warm water/solution, gentle irrigation.

Artificial Eye Care

• Hygiene, gentle handling/washing.

Heart Auscultation Techniques

• Begin at apex/base.
• Diaphragm (high frequency), bell (low frequency)
• Positions.
• Eliminate external noise.

Heart Sounds

• S1 (Lub): AV valve closure, loudest at apex.
• S2 (Dub): Semilunar valve closure, loudest at base.
• S3: Early rapid filling (ventricular resistance).
• S4: Pre-systole (ventricular resistance).

Heart Auscultation Locations

• Aortic, Pulmonic, Tricuspid, Mitral.

Pulse Characteristics

• Rate: Tachycardia, Bradycardia.
• Rhythm: Regular, Irregular.
• Strength: Bounding, Strong, Normal, Thread, Absent.
• Equality: Bilateral.

Blood Pressure

• Systolic/Diastolic pressures.
• Method: Brachial pulse, cuff placement, inflation, auscultation and note sounds.
• Causes of false readings (high and low).

Peripheral Vascular Insufficiency (PVI)

• Inadequate blood flow to extremities.
• Causes: Arterial (atherosclerosis, blood clots, spasms) or Venous (valve damage, DVT, varicose veins).
• Symptoms differ for arterial vs. venous insufficiency.

Peripheral Artery Disease (PAD)

• Oxygen Deficit.
• Symptoms: Leg pain (claudication), weak/absent pulses, cold/pale skin, non-healing wounds. Peripheral arterial issues: pain with activity, pallor, hair loss, coolness.

Peripheral Venous Insufficiency

• Venous issues: redness, warmth, edema, pain, brownish skin, pitting, bleeding sores- skin is warm, pitting edema. Risk factors: immobility.

Lung & Thorax Assessment

• Inspection, Palpation, Percussion, Auscultation

Lung/Thorax Inspection

• General body posture, shape, and respiratory rate.
• Observe Skin color, use accessory muscles.
• Observe respirations.
• Shape, configuration, and placement of trachea.

Lung/Thorax Palpation

Assess for tenderness, skin temperature, moisture, and tactile fremitus.

Lung/Thorax Percussion

• Assessing for resonance/hyperresonance/dullness/flatness.

Lung/Thorax Auscultation

• Listening for normal vesicular breath sounds, absence of adventitious sounds.
• Auscultation steps and locations, expected findings are listed

Adventitious Lung Sounds

• Crackles (fine & course), wheezes, and stridor.

Chronic Bronchitis and Emphysema (Expected findings)

• Subjective, objective findings, and auscultation.

Test your knowledge on the nursing process and the critical thinking involved in clinical judgment. This quiz covers essential concepts such as patient-centered care, goal setting, and cultural competency in healthcare. Perfect for nursing students and professionals looking to reinforce their understanding.