Nursing Exam 1: Critical Thinking, Communication, Health History & Physical Assessment

What is the difference between Critical Thinking and Clinical Reasoning?

Critical Thinking involves analyzing information and questioning assumptions, while Clinical Reasoning applies knowledge to a specific patient and connects assessment findings.

What does Clinical Judgment involve?

Clinical Judgment involves recognizing what is happening, determining what is most important, deciding on necessary actions, and evaluating the patient's response.

What is the progression of thought from Critical Thinking to Clinical Judgment?

What do I know? → What does it mean? → What should I do?

What are the ANA Standards of Professional Nursing Practice?

The ANA Standards include Assessment, Diagnosis, Outcomes Identification, Planning, Implementation, and Evaluation.

How does the ANA Standards differ from state law?

ANA Standards define professional nursing practice, while state law, such as the Nurse Practice Act, establishes legal requirements.

What does ADPIE stand for in the Nursing Process?

ADPIE stands for Assessment, Diagnosis, Planning, Implementation, and Evaluation.

What is the purpose of the NCJMM?

The NCJMM (Nursing Clinical Judgment Model) guides nurses through recognizing cues, analyzing them, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

What is the first step in the NCJMM?

Recognize Cues: Identify relevant information.

What does SBAR stand for?

SBAR stands for Situation, Background, Assessment, and Recommendation.

What is the best first response to a patient stating they are tired all the time?

Allow them to describe their concern in their own words.

What is the purpose of Motivational Interviewing?

To help the client discover their own motivation for change.

What role does the nurse play in Motivational Interviewing?

The nurse acts as a partner, supporter, and guide, not as a lecturer or judge.

What are some facilitators of effective communication?

Privacy, enough time, comfortable positioning, plain language, and a nonjudgmental attitude.

What are common barriers to effective communication?

Noise, interruptions, pain, fatigue, anxiety, language barriers, medical jargon, rushing, and bias.

What is therapeutic communication?

Therapeutic communication includes listening responses, silence, facilitation, reflection, clarification, and perception checking.

What is an example of an action response in communication?

Providing information, offering self, focusing, or summarizing.

What is the therapeutic formula for communication?

Acknowledge feeling → Clarify → Give information → Confirm understanding.

What should a nurse do if a patient is anxious or in pain during communication?

Fix the barrier first whenever possible.

What are the key components of a client-centered interview?

Establish trust, provide privacy, explain the purpose, and allow the client to describe concerns.

What is the significance of the phrase 'Recognize → Analyze → Prioritize → Generate → Take → Evaluate'?

It summarizes the steps in the NCJMM process.

What is the best way to respond to a patient expressing a concern?

Encourage them to describe their feelings and concerns in their own words.

What does the term 'nontherapeutic communication' refer to?

Communication that hinders the therapeutic relationship or fails to address the patient's needs.

What is the importance of evaluating outcomes in the nursing process?

To determine whether the interventions were effective and if patient goals were met.

What is the role of assessment in the nursing process?

To collect data about the patient's health status.

What is meant by 'client problems/responses' in the nursing diagnosis?

Identifying the issues that the patient is facing based on assessment data.

What should a nurse prioritize during patient care?

The most urgent and important concerns based on clinical judgment.

What is the purpose of planning in the nursing process?

To set priorities, outcomes, and interventions for patient care.

What type of communication should be avoided when giving advice?

Unsolicited advice

What is an example of false reassurance?

Saying 'Everything will be fine.'

What type of statement is considered judgmental?

'That's a bad decision.'

How should you phrase a question to avoid sounding accusatory?

Use 'What made it difficult to take your medication as prescribed?' instead of 'Why didn't you take your medication?'

What should you use when communicating with sexual/gender minorities?

Use stated name/pronouns and avoid assumptions.

What is the purpose of using inclusive terms in communication?

To ensure sensitivity and respect for all individuals.

What is the first step when communicating with clients with differing abilities?

Speak directly to the client.

What should you do to accommodate clients with differing abilities?

Ask how they prefer to communicate and allow extra response time.

What is the acronym OLDCARTS used for?

To remember the components of the History of Present Illness: Onset, Location, Duration, Character, Aggravating/Alleviating factors, Radiation, Timing, Setting/Severity.

What does the 'O' in OLDCARTS stand for?

Onset - When did it start?

What does the 'L' in OLDCARTS refer to?

Location - Where is it?

What does the 'D' in OLDCARTS indicate?

Duration - How long does it last?

What does the 'C' in OLDCARTS represent?

Character/Quality - What does it feel like?

What does the 'A' in OLDCARTS signify?

Aggravating/Alleviating - What makes it worse/better?

What does the 'R' in OLDCARTS stand for?

Radiation/Relieving - Does it spread? What relieves it?

What does the 'T' in OLDCARTS refer to?

Timing - When does it occur/how often?

What does the 'S' in OLDCARTS indicate?

Setting/Severity - Where were you/what was happening? How severe?

What is included in a comprehensive health history?

Childhood illnesses, chronic conditions, hospitalizations, surgeries, obstetric history, immunizations, allergies, and current medications.

What is the purpose of a family history/genogram?

To identify hereditary/genetic risks across three generations.

What is the Intensity of flatness

Soft

What is the pitch of flatness

high

What is the normal location of flatness

muscle and bone

What is the abnormal location of flatness

lungs (severe pneumonia)

What is the Intensity of dullness

moderate

What is the pitch of dullness

high

What is the normal of dullness

organs (liver)

What is the abnormal location of dullness

lungs (atelectasis

What is the Intensity of resonance

loud

What is the pitch of resonance

very low

What is the normal location of resonance

no normal location in adults, but normal for children

What is the abnormal location of resonance

lungs (emphysema)

What is the Intensity of hyperresonance

very loud

what is the intensity of tympany?

loud

what is the pitch of tympany?

high

what is the normal location of tympany?

gastric air bubble

what is the abnormal location of tympany?

lungs (pneumothorax)

What does the F.A.C.T. documentation acronym stand for?

Factual, Accurate, Complete, Timely.

what is quality in percussion

How the sound is perceived musically

What is intensity in percussion

Relative loudness or softness of the sound

What is the sequence of examination for most body systems?

Inspection → Palpation → Percussion → Auscultation.

What is the exception to the examination sequence for the abdomen?

Inspection → Auscultation → Percussion → Palpation.

What does the acronym IPPA help you remember?

Normal examination sequence: Inspection → Palpation → Percussion → Auscultation.

What is the purpose of a physical examination?

To provide objective data, establish baseline data, validate subjective information, screen for disease, and evaluate response to care.

What are standard precautions?

Infection control measures used with every patient, including hand hygiene and PPE based on risk.

What are transmission-based precautions?

Precautions used in addition to standard precautions based on the mode of transmission.

What is the purpose of inspection in a physical examination?

To assess posture, gait, skin color, lesions, symmetry, and other visible characteristics.

What is palpation used for in a physical examination?

To assess temperature, texture, moisture, swelling, size, tenderness, rigidity, and pulses.

What does percussion assess in a physical examination?

Underlying tissue density, air, fluid, solid structures, and borders.

What is auscultation used for?

To listen to internal sounds using a stethoscope.

What is the normal respiratory rate for adults?

12-20 breaths per minute

Name two factors that can affect respiratory rate.

Age and exercise

What effect do opioids have on respiration?

They can depress respiration.

What is the normal pulse rate for adults?

60-100 beats per minute

What should be assessed in a pulse check?

Rate, rhythm, and volume/amplitude

What can a small blood pressure cuff lead to?

Falsely high blood pressure readings

What is the normal temperature range for adults?

36.5-37.3°C (97.8-99.1°F)

What is the most accurate method for measuring core temperature?

Rectal temperature

Define pain.

An unpleasant sensory and emotional experience.

What are the two major classifications of pain?

Duration (acute and chronic) and mechanism (nociceptive, neuropathic)

What does OLDCARTS stand for in pain assessment?

Onset, Location, Duration, Characteristics, Aggravating factors, Relieving factors, Treatment

What is the sequence for abdominal assessment?

Inspection, Auscultation, Percussion, Palpation

What precautions should be taken for a patient with suspected C. difficile infection?

Contact precautions, including hand hygiene and wearing gloves.

What type of pain is described as burning and shooting?

Neuropathic pain

Nociceptive pain:

Originates from somatic or visceral stimulation due to tissue

damage (e.g., trauma, inflammation, or chemical exposure)

Nociplastic pain

Arises from altered pain processing without clear tissue damage

or nerve lesions

• Typically multifocal and more intense than expected for the situation (fibromyalgia)

What is the effect of using a blood pressure cuff that is too large?

Falsely low blood pressure readings

What characteristic of pain does the question 'What does the pain feel like?' assess?

Quality of pain

What is the first action a nurse should take when recognizing concerning vital signs?

Take immediate action based on clinical judgment.

What is a key consideration when documenting patient statements?

Document direct quotes from the patient.

What does the term 'noncompliant' indicate in patient documentation?

It can be considered judgmental and should be avoided.

What is the significance of the term 'critical thinking' in nursing?

It refers to the process of thinking clearly and rationally about what to do.

What does the acronym ADPIE stand for?

Assessment, Diagnosis, Planning, Implementation, Evaluation

What should a nurse do if a patient states their pain medication isn't working?

Assess the pain before considering stronger medication.