Clinical Judgment, Nursing Process, and Drug Calculations

Vocabulary flashcards covering key terms in clinical judgment, the nursing process, drug calculations, measurement systems, medication administration, and IV therapy.

Clinical Judgment Measurement

The nurse’s thought‐process that involves recognizing cues,analyzing cues, prioritizing hypotheses, generating solutions and, taking action, and evaluating outcomes.

Nursing Process

A systematic framework (Assessment, Analysis, Planning, Implementation, Evaluation) used to identify and solve patient problems and guide care.

Recognize Cues

Step in clinical judgment where the nurse gathers and notices relevant subjective and objective data.

Subjective Data

Information reported verbally by the patient, family, or friends (e.g., pain 1-10).

Objective Data

Measurable or directly observed patient information, such as vital signs or lab results.

Prioritize Hypotheses

Analyzing gathered cues to rank patient problems or nursing diagnoses by urgency and importance.

Generate Solutions

Planning step that sets patient-centered, SMART goals and determines nursing interventions.

Take Action

Implementation step where planned nursing interventions (e.g., meds, teaching) are carried out.

Evaluate Outcomes

Determines whether goals were met and interventions were effective, then documents findings.

ABC (Airway, Breathing, Circulation)

Priority framework ensuring airway is clear, breathing is adequate, and circulation is maintained.

SMART Goals

Patient outcomes that are Specific, Measurable, Achievable, Realistic, and Time-bound.

NAQC

Nursing Alliance for Quality Care—a body that promotes safe, highest-quality patient-centered care.

ANA Guidelines

Standards published by the American Nurses Association that support core nursing principles and quality care.

Metric System

Primary measurement system in health care using units such as gram, liter, and meter.

Gram (g)

Metric base unit for weight; 1 g = 1,000 mg.

Liter (L)

Metric base unit for volume; 1 L = 1,000 mL.

Meter (m)

Metric base unit for length; 1 m = 100 cm.

Teaspoon (tsp)

English volume unit; 1 tsp = 5 mL.

Tablespoon (Tbsp)

English volume unit; 1 Tbsp = 3 tsp = 15 mL.

Ounce (oz)

English volume/weight unit; 1 oz = 30 mL.

Kilogram (kg)

Metric weight unit; 1 kg = 1,000 g or 2.2 lb.

Milligram (mg)

Metric weight unit; 1 mg = 1,000 mcg.

Microgram (mcg)

Metric weight unit; 1 mcg = 1,000 ng.

Temperature Conversion Formula

°F = (°C × 9⁄5) + 32; °C = (°F − 32) × 5⁄9.

Drug Label

Manufacturer information panel that lists trade name, generic name, strength, lot number, and expiration date.

Trade Name

Brand or proprietary name given to a drug by the manufacturer.

Generic Name

Non-proprietary, official drug name recognized universally.

Lot Number

Identifier assigned to a specific drug batch for tracking and recall purposes.

Expiration Date

Date after which a drug should not be used because potency and safety cannot be guaranteed.

Drug Reconstitution

Process of adding a diluent to a powdered medication to prepare it for administration.

Suspension

Liquid dosage form containing undissolved particles that must be shaken before use.

Rounding Rules

Guidelines preventing unnecessary zeros and determining when to round values for tablets, mL/hr, or decimal places.Tablets are rounded to whole unless scored. IV drip is always rounded to whole number.

Enteral Administration

Delivery of medication through the GI tract, such as via NG tube, requiring dilution and flushes with water.

Parenteral Administration

Giving medications by injection (IM, IV, Sub-Q), bypassing the GI tract.

Vial

Multi-dose or single-dose container with a rubber stopper for withdrawing parenteral medications.

Primary IV Line

Continuous infusion line, e.g., normal saline at a set mL/hr rate.

Secondary IVPB

Intermittent infusion (piggyback) line used to deliver medications like antibiotics in addition to primary fluid.

Drop Factor

Number of drops per milliliter delivered by IV tubing (e.g., 10, 15, 20, or 60 gtt/mL).

Flow Rate (mL/hr)

IV infusion rate expressed in milliliters per hour, calculated from volume and time.

Flow Rate (gtt/min)

IV infusion rate expressed in drops per minute, based on volume, time, and drop factor.

Critical Care Drug Titration

Adjusting potent medications in response to patient parameters to achieve desired clinical effects.

IV Push

Rapid injection of medication directly into the venous system using a syringe and needleless port.

Needleless System

Safety equipment with blunt tips or hubs that allows medication administration without needles to reduce sharps injuries.

Primary Change in the Next Generation NCLEX (NGN):

NGN now emphasizes clinical judgment as a critical competency for safe nursing practice. The new test format uses case-based scenarios to measure a nurse’s ability to apply the Clinical Judgment Measurement Model (CJMM) in real-world medication and patient-care situations. It aims to better reflect how nurses make decisions in complex care environments

Patient-Centered Outcomes (Medication-Focused Examples):

• Patient will verbalize understanding of prescribed medication regimen before discharge.

• Patient will report no signs of allergic reaction 24 hours after receiving new medication.

• Patient will maintain blood pressure within target range (e.g., <130/80 mmHg) after initiating antihypertensive therapy.

• Patient will demonstrate correct use of insulin pen during return demonstration.

. Three Principles for Health Teaching Related to Drug Therapy:

• Assess Learning Needs – Consider the patient's literacy, cognitive ability, language, and readiness to learn.

• Promote Adherence – Teach the why behind the medication to encourage compliance.

• Teach Safety – Emphasize how to properly store, administer, and monitor drugs (e.g., side effects, missed doses).

Include drug name, purpose, side effects, and schedule. Involve family in teaching these principles to ensure effective patient education and promote safe medication practices. Assess patients’ readiness to learn. Avoid assumptions and use plain language.

Nurse’s Role in Planning Medication Administration:

• Set goals and expected outcomes specific to the patient’s medication needs.

• Identify priorities in drug therapy (e.g., pain relief vs. infection control).

• Ensure individualized care by considering patient age, cultural background, organ function, and comorbidities.

• Coordinate with the healthcare team to prevent drug interactions and enhance safety.

Clarify unclear medication orders, review medication orders, assess patient, understand meds, check for drug interactions, determine timing/schedule, patient educational planning, ensure safety measures, and uphold medication rights.

Differentiate the Steps of the Nursing Process and Their Purpose in Relation to Drug Therapy:

• Assessment: Gather baseline data (e.g., vital signs, IV site condition, lab values).

• Analysis: Identify issues like “Risk for fluid volume excess” or “Risk for infection” related to IV therapy.

• Planning: Set goals (e.g., maintain therapeutic drug level, prevent complications).

• Implementation: Administer IV meds safely, use correct technique, monitor rate.

• Evaluation: Check for therapeutic effect or adverse reactions (e.g., infiltration, phlebitis).

. Explain the Steps of the Nursing Process as They Relate to Safe Medication Administration:

• Assessment: Check drug compatibility, rate, patient allergies, and IV patency.

• Analysis: Use clinical data to support decisions (e.g., risk for ineffective perfusion).

• Planning: Verify the correct drug, route, dose, timing, and patient. Double-check calculations.

• Implementation: Use aseptic technique, program the IV pump correctly, label lines.

• Evaluation: Monitor patient for desired drug effects and side effects; reassess flow rate and site frequently.

Describe the Differences Between Continuous IV Infusion and Intermittent IV Infusion:

• Continuous IV Infusion:

  • Runs consistently over a period (e.g., 50 mL/hr).

  • Used for drugs needing constant blood levels.

  • Requires regular monitoring of flow rate and site.

• Intermittent IV Infusion:

  • Given at intervals, typically via IV piggyback (e.g., every 6 hours).

  • Includes flushes before/after to maintain line patency.

  • Used for antibiotics or medications not requiring constant plasma levels.

SMART Goal example

A specific, measurable, achievable, relevant, and time-bound objective set for patient care, such as achieving a pain level of 3 or less within 48 hours of treatment. Has to be patient centered.

Ex: "Patient will demonstrate a pain level of 3 or less within 48 hours after initiating pain management interventions."