(Davis Advantage for Understanding Medical-Surgical Nursing, 7e Linda Williams, Paula Hopper)
(Answer Manual)
Answers
CHAPTER 1 to collect appropriate data, identify a patient problem,
and determine the best possible plan of action. Clinical
CRITICAL THINKING, judgment is based on good critical thinking.
CLINICAL JUDGMENT, AND Cue
THE NURSING PROCESS Definition: Significant or relevant data. Not all data are
cues (relevant), but all cues are data.
AUDIO CASE STUDY Collaboration
Jane Practices Clinical Judgment Definition: Working together with the health team to
improve patient outcomes.
1. Identify and analyze cues; prioritize hypotheses; generate
solutions; take action; evaluate outcomes; repeat. Intervention
2. Jane was exhausted, failed a test, and was pulled in too Definition: Taking action to carry out a plan.
many directions. She was also crying in her car and had
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poor study habits and not enough sleep. Evaluation
3. Jane’s resources included a good friend, sick time from Definition: Comparing the outcomes you expected with
work, and wasted time between classes that she could actual outcomes. Did the plan work? Were expected
better utilize. Your resources will be different, but they outcomes met?
exist!
Vigilance
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4. Critical thinking—the why: Jane uses critical thinking
to determine why her current plan isn’t working. She Definition: The act of being attentive, alert, and watchful.
thinks honestly about her poor study habits, her time-
management problems, and the impact this is having on CRITICAL THINKING AND CLINICAL
her and her family. JUDGMENT
Clinical judgment—the do: Jane uses her thinking to Critical thinking and clinical judgment both follow a similar
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develop and carry out a plan that uses her resources and format. Both follow steps from collecting data to determin-
provides more productive study time and more quality ing problems and outcomes, developing and taking actions,
time with her kids. and evaluating outcomes. However, critical thinking helps
you think about the problem: What is it? Why is it happen-
VOCABULARY ing? And clinical judgment leads you to do something to
Sample sentences will vary for the Vocabulary problems. manage the problem.
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Nursing process CUE RECOGNITION
Definition: An organizing framework that links thinking
You will do many things for each individual, but the FIRST
with nursing actions. Steps include assessment/data
thing is listed below.
collection, nursing diagnosis, planning, implementation,
and evaluation. 1. Sit the patient upright.
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2. Call 911 while running across the street.
Critical thinking
3. Elevate the feet off the bed by placing a pillow under the
Definition: The use of those cognitive (knowledge) skills calves and allowing the feet to hang off the edge of the
or strategies that increase the probability of a desirable pillow.
outcome. Also involves reflection, problem-solving, and 4. Check blood glucose and have a glucose source ready.
related thinking skills. 5. Turn the patient to the side to prevent aspiration.
Clinical judgment
Definition: The observed outcome of critical thinking and
decision making. A process that uses nursing knowledge
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,2 Chapter 1 Answers
CRITICAL THINKING
This is just one possible way to complete a cognitive map.
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REVIEW QUESTIONS taking vital signs; data collection is the first step in the
nursing process. (2, 3, 4) are all steps in the nursing
The correct answers are in boldface.
process, for which the registered nurse is responsible;
1. (2) Critical thinking can lead to better outcomes for the the LPN/LVN may assist the registered nurse with
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patient. (1, 3, 4) may be true but are not the best answer. these. Nitroglycerin should not be administered without
2. (4) is correct. The nurse who can admit to not k nowing first knowing the patient’s blood pressure.
something is exhibiting intellectual humility. (1) shows 7. (2) indicates that the patient is concerned about freedom
expertise but not necessarily intellectual humility; from injury and harm. (1) relates to basic needs such as
(2) reporting an error shows intellectual integrity; air, oxygen, and water. (3) relates to feeling loved. (4) is
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(3) empathizing is positive but does is not evidence related to having positive self-esteem.
of humility. 8. (3, 1, 2, 4) is the correct order according to Maslow.
3. (3, 4, 5, 1, 2) is the correct order. 9. (5, 2, 1, 4, 6, 3) is the correct order.
4. (1) is the best definition. (2, 3, 4) do not define critical 10. (3) shows the patient is actually taking action. (1, 2, 4)
thinking but are examples of good thinking. are all positive but do not show intent to take action.
5. (4) is correct. Evaluation determines whether goals are 11. (4) is the nurse’s analysis of the situation. (1, 2) are
achieved and interventions effective. (2) is the role of the data; (3) is a recommendation.
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physician. (1, 3) encompass data collection and imple- 12. (1, 2, 3, 4) should be present. Since the data provides
mentation, which are earlier steps in the nursing process. only hip replacement as the patient’s problem, (5) the
6. (1) is correct. The licensed practical nurse/licensed voca- dietitian is not necessary.
tional nurse (LPN/LVN) can collect data, which includes
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, Answers
CHAPTER 2 EVIDENCE-BASED PRACTICE
EVIDENCE-BASED PRACTICE 1. proof
2. context
3. quality
AUDIO CASE STUDY 4. care
Marie and Evidence-Based Practice 5. randomized
6. outcomes
1. Thirdhand smoke is the dangerous toxins of smoke that 7. gold
linger on hair, clothing, furniture, and other surfaces in 8. nursing
an area after a cigarette is put out. Marie learned that 9. patient’s
exposure to these toxins can be neurotoxic to children 10. information
and can trigger asthma attacks in sensitive people.
2. Evidence-based practice is considered the gold standard CLINICAL JUDGMENT
of health care.
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3. Step 1: Ask the burning question. Step 2: Search and 1. By questioning the existing way of doing things to
collect the most relevant and best evidence available. ensure that the patient receives the best care possible
Step 3: Think critically. Appraise the evidence for 2. A thorough search of the literature, with the assistance of
validity, relevance to the situation, and applicability. the medical librarian, in the area of their burning ques-
Step 4: Measure the outcomes before and after instituting tion regarding music reducing preoperative anxiety.
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the change. Step 5: Make it happen. Step 6: Evaluate the 3. Cumulative Index to Nursing and Allied Health
practice decision or change. Literature (CINAHL) Database, Joanna Briggs Institute
4. Combination therapy with a nicotine patch and nicotine evidence-based resources, Cochrane Reviews, Medline/
lozenges worked best, although bupropion (Zyban) or PubMed
varenicline (Chantix) and nicotine lozenges worked well, 4. Measure patient outcomes before instituting the
too. A Cochrane Review found that advice and support evidence-based change in practice so comparisons can
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from nursing staff can increase patients’ success in quit- be made after implementation to determine if the inter-
ting smoking, especially in a hospital setting. vention worked
5. Evaluate the results to determine whether the change
VOCABULARY made a significant difference and if it was valuable in
terms of cost and time
Sample sentences will vary for the Vocabulary problems.
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1. Evidence-based practice: A systematic process that uses REVIEW QUESTIONS
current evidence in making decisions about patient care. The correct answers are in boldface.
2. Evidence-informed practice: Consideration of patient
factors along with the use of evidence for shared decision 1. (3) is correct. Providing an explanation of why some-
making between the health-care provider and the patient. thing is done promotes the understanding for why it is
3. Randomized controlled trials: True experimental studies important to be done and therefore will more likely be
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in which as many factors as possible that could falsely done. (1, 2, 4) only communicate the need to perform a
change the results are controlled. task. They do not provide rationale for the task to pro-
4. Research: Scientific study, investigation, or experimenta- mote understanding of the importance of the task.
tion to establish facts and analyze their significance. 2. (3) is correct. Evidence-based nursing care that has been
5. Systematic review: A review of relevant research using evaluated as appropriate for an agency provides the best
guidelines. and safest patient care. (1) Opinions may not be based on
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, 2 Chapter 2 Answers
evidence. (2) Specific evidence-based nursing interven- 6. (1, 3, 4, 5, 6) are all independent nursing interventions
tions will not be found in orientation policies that famil- because no health-care provider’s order is required.
iarize the orientee with the organization. (4) A nursing (2) is a dependent function because it requires a health-
program’s content has not been evaluated by the health- care provider’s order.
care agency for its feasibility for the agency’s patients, 7. (4, 6) represent Level I research. (1, 2, 3, 5) are not
which is a step in the evidence-based practice process. systematic reviews or more than three randomized
3. (2) is correct. Joanna Briggs Institute evidence-based controlled trials of good quality with similar results.
resource is dedicated to identifying valid nursing 8. (1, 3, 5, 6) are correct because the evidence-based prac-
evidence. (1, 3, 4) do not reflect the highest levels of tice process involves “ASKMME”: ask, search, think,
evidence, so they are not considered the best sources of measure, make it happen, and evaluate. (2, 4) are not
evidence. steps in the process.
4. (4) is correct. The proposed change will need to go 9. (1, 2, 5, 6) are correct. Research supports they are best
through the policy and procedure committee for evalu- practice for oral care. (3, 4) are not best practice for oral
ation for feasibility of using it at the agency. (1, 2, 3) do care. They do not remove plaque and only freshen the
not follow appropriate protocols for the evidence-based mouth.
practice process. 10. (4) is correct. The search should be narrowed to include
5. (1) Systematic reviews of randomized controlled trials keywords of the focus of the question. (1, 2, 3) do not
are the best place to look for evidence. (2, 3, 4) are not narrow the search in order to focus only on the question
Level I sources of evidence. being asked.
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