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Developing Clinical Judgment for Professional Nursing and the Next-Generation NCLEX-RN® Examination (2020)

Developing Clinical Judgment for Professional Nursing and the Next-Generation NCLEX-RN® Examination (2020) helps you pass with expert-reviewed materials and study tips.

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    Instructions for online access Thank you for your purchase. Please note that your purchase of this Elsevier eBook also includes access to an online version. Please click here (or go to hp://ebooks.elsevier.com) to request an activation code and registration instructions in order to gain access to the web version.

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    Developing Clinical Judgment for Professional Nursing and the Next-Generation NCLEX-RN ® Examination Donna D. Ignatavicius, MS, RN, CNE, ANEF Speaker and Curriculum Consultant for Academic Nursing Programs; Founder, Boot Camp for Nurse Educators; President, DI Associates, Inc. , Lileton, Colorado

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    Table of Contents Instructions for online access Cover image Title page Copyright Contributors Reviewers Preface Dedication About the author Acknowledgments Exemplars

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    PART 1. Introduction: Developing Clinical Judgment 1. Transitioning from the nursing process to clinical judgment Review of the nursing process and critical thinking Expanding from the nursing process to clinical judgment New nursing graduates and clinical judgment The National Council of State Boards of Nursing Clinical Judgment Measurement Model Thinking and discussion questions References 2. Applying the NCSBN clinical judgment measurement model to ensure client safety Overview of the NCSBN CJMM Applying the cognitive skills of the NCSBN CJMM Applying the NCSBN CJMM for thinking exercises in this workbook Enhanced hot spot thinking exercises Cloze thinking exercises Extended drag and drop thinking exercises Extended multiple response thinking exercises Matrix thinking exercises

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    Thinking and discussion questions Bibliography PART 2. Clinical Judgment for Clients Across the Life Span Experiencing Commonly Occurring Health Problems 3. Perfusion: Common Health Problems Exemplar 3A. Heart failure (Medical-surgical nursing: Older adult) Exemplar 3B. Sickle cell disease (Pediatric nursing: Adolescent) 4. Cloing: Deep Vein Thrombosis Exemplar 4. Deep vein thrombosis (Medical-surgical nursing: Middle-age adult) 5. Gas exchange: Common Health Problems Exemplar 5A. Asthma (Pediatric nursing: School-age child) Exemplar 5B. Chronic obstructive pulmonary disease (Medical- surgical nursing: Middle-age adult) 6. Elimination: Benign Prostatic Hyperplasia Exemplar 6. Benign prostatic hyperplasia (Medical-surgical nursing: Older adult) 7. Nutrition: Common Health Problems

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    Exemplar 7A. Cholecystitis/cholecystectomy (Medical-surgical nursing: Middle-age adult) Exemplar 7B. Peptic ulcer disease (Medical-surgical nursing: Middle-age adult) 8. Mobility: Common Health Problems Exemplar 8A. Fractured hip/open reduction internal fixation (Medical-surgical nursing: Older adult) Exemplar 8B. Fractured radius and medial epicondyle (Pediatric nursing: Preschool child) Exemplar 8C. Osteoarthritis/total knee arthroplasty (Medical- surgical nursing: Middle-age adult) Exemplar 8D. Parkinson disease (Medical-surgical nursing/mental health nursing: Older adult) 9. Metabolism: Common Health Problems Exemplar 9A. Diabetes mellitus (Medical-surgical nursing: Middle-age adult) Exemplar 9B. Hyperthyroidism/thyroidectomy (Medical-surgical nursing: Middle-age adult) 10. Cellular regulation: Breast Cancer Exemplar 10. Breast cancer (Medical-surgical nursing: Middle- age adult) 11. Inflammation: Common Health Problems

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    Exemplar 11A. Crohn’s disease (Medical-surgical nursing: Young adult; middle-age adult) Exemplar 11B. Appendicitis/appendectomy (Pediatric nursing: Late school-age child) 12. Infection: Common Health Problems Exemplar 12A. Cellulitis (Medical-surgical nursing: Middle-age adult) Exemplar 12B. Respiratory syncytial virus (RSV) (Pediatric nursing: Infant) 13. Sensory perception: Cataracts Exemplar 13. Cataracts (Medical-surgical nursing: Older adult) 14. Cognition: Common Health Problems Exemplar 14A. Delirium (Mental health nursing: Older adult) Exemplar 14B. Alzheimer’s disease (Mental health nursing: Middle-age adult) 15. Mood and affect: Depression Exemplar 15. Depression (Mental health nursing: Adolescent) 16. Stress and coping: Generalized Anxiety Disorder Exemplar 16. Generalized anxiety disorder (Mental health nursing: Young adult)

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    17. Reproduction: Uterine Leiomyoma/Hysterectomy Exemplar 17. Uterine leiomyoma/hysterectomy (Medical- surgical nursing: Middle-age adult) PART 3. Clinical Judgment for Childbearing Families 18. Reproduction: Childbearing Family Exemplar 18A. Uncomplicated prenatal woman Exemplar 18B. Complicated prenatal woman Exemplar 18C. Uncomplicated intrapartum care Exemplar 18D. Complicated intrapartum care Exemplar 18E. Uncomplicated postpartum care Exemplar 18F. Complicated postpartum care Exemplar 18G. Uncomplicated newborn care PART 4. Clinical Judgment for Clients Across the Life Span Experiencing Complex Multisystem Health Problems 19. Perfusion: Complex Health Problems Exemplar 19A. Myocardial infarction (Medical-surgical nursing: Middle-age adult) Exemplar 19B. Atrial fibrillation/stroke (Medical-surgical nursing: Older adult)

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    Exemplar 19C. Hypovolemic shock (Medical-surgical nursing: Older adult) 20. Mobility: Spinal Cord Injury Exemplar 20. Spinal cord injury (Pediatric nursing: Adolescent) 21. Cognition: Traumatic Brain Injury Exemplar 21. Traumatic brain injury (Medical-surgical nursing: Older adult and young adult) 22. Infection: Sepsis Exemplar 22. Sepsis (Medical-surgical nursing: Older adult) 23. Gas exchange: Chest Trauma Exemplar 23. Chest trauma (Medical-surgical nursing: Middle- age adult) 24. Elimination: Complex Health Problems Exemplar 24A. Chronic kidney disease (Medical-surgical nursing: Middle-age adult) Exemplar 24B. Intestinal obstruction (Medical-surgical nursing: Young adult; older adult) 25. Metabolism: Complex Health Problems Exemplar 25A. Diabetic ketoacidosis (Pediatric nursing: Adolescent)

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    Exemplar 25B. Cirrhosis (Medical-surgical nursing: Older adult) Exemplar 25C. Acute pancreatitis (Medical-surgical nursing: Middle-age adult) 26. Tissue integrity: Burns Exemplar 26. Burns (Medical-surgical nursing: Young adult) 27. Stress and coping: Substance Use Disorder Exemplar 27. Substance use disorder (Pediatric nursing/mental health nursing: Adolescent) 28. Management of care: Complex Health Problems Exemplar 28. Complex health problems (Medical-surgical nursing: Middle-age and older adult) PART 5. Pharmacology for Nursing 29. Pharmacology in management of common health problems Exemplar 29A. Drugs that affect nutrition and elimination (Medical-surgical nursing: Older adult; pediatric nursing) Exemplar 29B. Drugs that affect clotting (Medical-surgical nursing: Middle-age and older adult) Exemplar 29C. Drugs that affect perfusion (Medical-surgical nursing: Middle-age and older adult) Exemplar 29D. Drugs that promote comfort and metabolism (Medical-surgical nursing: Middle-age and older adult)

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    Exemplar 29E. Drugs that manage infection (Medical-surgical nursing [young and middle-age adult]; pediatric nursing) 30. Pharmacology in management of complex health problems Exemplar 30A. Drugs that affect perfusion and gas exchange (Medical-surgical nursing: older adult; pediatric nursing: Adolescent) Exemplar 30B. Drugs that affect immunity (Medical-surgical nursing: Young adult; middle-age adult) Exemplar 30C. Drugs that manage psychoses (Mental health nursing: Young adult) Exemplar 30D. Drugs that manage emergencies (Medical- surgical nursing: Young adult; older adult) Answer key Chapter 3 Perfusion: Common health problems Chapter 4 Clotting: Deep vein thrombosis Chapter 5 Gas exchange: Common health problems Chapter 6 Elimination: Benign prostatic hyperplasia Chapter 7 Nutrition: Common health problems Chapter 8 Mobility: Common health problems Chapter 9 Metabolism: Common health problems Chapter 10 Cellular regulation: Breast cancer Chapter 11 Inflammation: Common health problems

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    Chapter 12 Infection: Common health problems Chapter 13 Sensory perception: Cataracts Chapter 14 Cognition: Common health problems Chapter 15 Mood and affect: Depression Chapter 16 Stress and coping: Generalized anxiety disorder Chapter 17 Reproduction: Uterine leiomyoma/hysterectomy Chapter 18 Reproduction: Childbearing family Chapter 19 Perfusion: Complex health problems Chapter 20 Mobility: Spinal cord injury Chapter 21 Cognition: Traumatic brain injury Chapter 22 Infection: Sepsis Chapter 23 Gas exchange: Chest trauma Chapter 24 Elimination: Complex health problems Chapter 25 Metabolism: Complex health problems Chapter 26 Tissue integrity: Burns Chapter 27 Stress and coping: Substance use disorder Chapter 28 Management of care: Complex health problems Chapter 29 Pharmacology in management of common health problems Chapter 30 Pharmacology in management of complex health problems

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    References

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    Copyright Elsevier 3251 Riverport Lane St. Louis, Missouri 63043 DEVELOPING CLINICAL JUDGMENT FOR PROFESSIONAL NURSING AND THE NEXT-GENERATION NCLEX-RN ® EXAMINATION ISBN: 978-0-323-71858-5 Copyright © 2021 by Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmied in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notice Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any

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    information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a maer of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. International Standard Book Number: 978-0-323-71858-5 Executive Content Strategist: Lee Henderson Director, Content Development: Laurie Gower Senior Content Development Specialist: Laura Goodrich Publishing Services Manager: Julie Eddy Senior Project Manager: Jodi M. Willard Design Direction: Amy Buxton Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1

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    Contributors Jessica Hoy, RN, MSNE, PCCN-K , Assistant Professor of Nursing, College of Saint Scholastica, Duluth, Minnesota Tami Lile, DNP, MSN, BSN , Corporate Director of Nursing, Vista College, Richardson, Texas Sabrina Olson, MSN, RN , Professor, Butler Community College, El Dorado, Kansas Janet Schueller, MSN, RN , Curriculum Chairperson, Professor, Butler Community College, El Dorado, Kansas

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    Reviewers Kiy Cashion, RN-BC, MSN , Clinical Nurse Specialist, Department of Obstetrics and Gynecology, Division of Maternal- Fetal Medicine, University of Tennessee Health Science Center, Memphis, Tennessee Brigid Chvilicek, MSN, RN, CPNP , Faculty of Nursing, Wenatchee Valley College, Wenatchee, Washington Monica Dobbins, RN , Nursing Instructor, Butler Community College, El Dorado, Kansas Jessica Hoy, RN, MSNE, PCCN-K , Assistant Professor of Nursing, College of Saint Scholastica, Duluth, Minnesota Kay R. Jansen, DNP, RN , Undergraduate Program Director, University of Wisconsin—Milwaukee, College of Nursing, Milwaukee, Wisconsin Tami Lile, DNP, MSN, BSN , Corporate Director of Nursing, Vista College, Richardson, Texas Lisa M. Pugsley, MSN, RN, CNE, CPN , Instructor of Nursing, Georgia Gwinne College, Lawrenceville, Georgia

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    Preface Donna D. “Iggy” Ignatavicius Purpose of this workbook In just a few years, the National Council of State Boards of Nursing (NCSBN) is expected to begin using the Next-Generation NCLEX ® Examination for nursing licensure based on its new model of clinical judgment. This one-of-a-kind workbook is designed for students enrolled in prelicensure programs in preparation for registered nursing (RN) practice to help: • Develop clinical judgment skills for professional nursing practice to ensure patient safety and quality of care. • Prepare for success on the Next-Generation NCLEX ® Examination (NGN) through practical thinking exercises in which students apply clinical reasoning skills to make appropriate clinical judgments. This book is intended for students to use throughout their nursing program. Thinking exercises are available for all major areas of clinical specialty practice and are leveled from basic and foundational to more complex and multisystem. Each exercise provides challenging client situations with multiple NGN-style test items. For many thinking exercises, the clinical situation evolves into continuing care requiring the student to address changing client conditions.

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    Organization of this workbook This student-friendly workbook is organized by nursing concepts but is easy to use in any type of prelicensure RN nursing program. It is divided into five distinct parts for a total of 30 chapters. Each health problem throughout the book consists of between 4 and 7 thinking exercises for student practice: Part 1 (Chapters 1 and 2 ). Chapter 1 provides an introduction to clinical judgment as a primary skill needed by practicing nurses. Chapter 2 offers tips for answering the practical thinking exercises in the workbook. Part 2 (Chapters 3 to 17). This section focuses on thinking exercises that address nursing care for clients experiencing commonly occurring medical-surgical, pediatric, and mental health problems across the life span. Part 3 (Chapter 18). This chapter provides multiple opportunities for students to address the care of childbearing women with uncomplicated and complicated clinical situations. Care of the normal newborn is also included. Part 4 (Chapters 19 to 28). This section includes thinking exercises that address nursing care for clients experiencing complex multisystem medical-surgical, pediatric, and mental health problems across the life span. Part 5 (Chapter 29 and 30 ). Although many pharmacology thinking exercises are integrated throughout Chapters 3 to 28, Chapters 29 and 30 are dedicated solely to the nurse’s role in administering commonly used drugs for adult and pediatric clients who have commonly occurring and complex health problems. Answer Key. The last section of this workbook presents the answers and rationales for each thinking exercise. In addition, the student is provided with reference pages where they can read more about each health problem. References. At the end of the book is the list of textbook citations that are used for reference for the thinking exercises.

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    In summary, Developing Clinical Judgment for Professional Nursing and the Next-Generation NCLEX-RN ® Examination is the first product focused exclusively on developing the clinical judgment skills needed for student success on the NGN and in clinical practice.

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    Dedication To all the nursing educators who are passionate about teaching, and to all the nursing students who are passionate about learning.

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    About the author Donna D. Ignatavicius received her diploma in nursing from the Peninsula General School of Nursing in Salisbury, Maryland. After working as a charge nurse in medical-surgical nursing, she became an instructor in staff development at the University of Maryland Medical Center. She then received her BSN from the University of Maryland School of Nursing. For 5 years she taught in several schools of nursing while working toward her MS in Nursing, which she received in 1981. Donna then taught in the BSN program at the University of Maryland, after which she continued to pursue her interest in gerontology and accepted the position of Director of Nursing of a major skilled-nursing facility in her home state of Maryland. Since that time, she has served as an instructor in several associate degree nursing programs. Through her consulting activities, faculty development workshops, and international nursing education conferences (such as Boot Camp for Nurse Educators ® ), Donna is nationally recognized as an expert in nursing education. She is currently the President of DI Associates, Inc. (hp://www.diassociates.com/), a company dedicated to improving health care through education and consultation for faculty. In recognition of her contributions to the field, she was inducted as a charter Fellow of the prestigious Academy of Nursing Education in 2007 and received her Certified Nurse Educator credential in 2016.

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    Acknowledgments Publishing a textbook would not be possible without the combined efforts of many people. With that in mind, I would like to extend my deepest gratitude to many people who were such an integral part of this journey. My contributing authors provided excellent manuscripts to underscore the clinical relevancy of this publication. I give special gratitude to Meg Blair, who was extremely valuable as a project resource from beginning to end. The reviewers—expert clinicians and instructors from around the United States—provided invaluable suggestions and encouragement throughout the development of this book. The staff of Elsevier has, as always, provided us with meaningful guidance and support throughout every step of the planning, writing, revision, and production of this new title. Executive Content Strategist Lee Henderson worked closely with me from the early stages of this title to help me hone and focus the project from start to finish. Senior Content Development Specialist Laura Goodrich then worked with me from vision to publication. Senior Project Manager Jodi Willard was, as always, an absolute joy with whom to work. Her unwavering aention to detail, flexibility, and conscientiousness helped to make this title consistently readable while making the production process incredibly smooth. Also, a special thanks to Publishing Services Manager Julie Eddy. Designer Amy Buxton is responsible for the beautiful cover and the interior design. My acknowledgments would not be complete without recognizing the dedicated team of Educational Solutions Consultants and other key members of the Sales and Marketing staff who helped to put this book into your hands.

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    Exemplars Medical-surgical nursing Young adult Burns, Exemplar 26, 163 Crohn’s Disease, Exemplar 11A, 70 Drugs That Affect Immunity, Exemplar 30B, 187 Drugs That Manage Emergencies, Exemplar 30D, 191 Drugs That Manage Infection, Exemplar 29E, 182 Intestinal Obstruction, Exemplar 24B, 152 Traumatic Brain Injury, Exemplar 21, 136 Middle-age adult Acute Pancreatitis, Exemplar 25C, 160 Breast Cancer, Exemplar 10, 67 Cellulitis, Exemplar 12A, 77 Chest Trauma, Exemplar 23, 145 Cholecystitis/Cholecystectomy, Exemplar 7A, 44 Chronic Kidney Disease, Exemplar 24A, 149 Chronic Obstructive Pulmonary Disease, Exemplar 5B, 35 Crohn’s Disease, Exemplar 11A, 70 Deep Vein Thrombosis, Exemplar 4, 28 Diabetes Mellitus, Exemplar 9A, 61 Drugs That Affect Cloing, Exemplar 29B, 175 Drugs That Affect Immunity, Exemplar 30B, 187 Drugs That Affect Perfusion, Exemplar 29C, 177 Drugs That Manage Infection, Exemplar 29E, 182 Drugs That Promote Comfort and Metabolism, Exemplar 29D, 179

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    Hyperthyroidism/Thyroidectomy, Exemplar 9B, 65 Management of Care: Complex Health Problems, Exemplar 28, 170 Myocardial Infarction, Exemplar 19A, 121 Osteoarthritis/Total Knee Arthroplasty, Exemplar 8C, 56 Parkinson Disease, Exemplar 8D, 58 Peptic Ulcer Disease, Exemplar 7B, 47 Uterine Leiomyoma/Hysterectomy, Exemplar 17, 98 Older adult Atrial Fibrillation/Stroke, Exemplar 19B, 123 Benign Prostatic Hyperplasia, Exemplar 6, 40 Cataracts, Exemplar 13, 84 Cirrhosis, Exemplar 25B, 158 Delirium, Exemplar 14A, 87 Drugs That Affect Cloing, Exemplar 29B, 175 Drugs That Affect Nutrition and Elimination, Exemplar 29A, 173 Drugs That Affect Perfusion, Exemplar 29C, 177 Drugs That Affect Perfusion and Gas Exchange, Exemplar 30A, 184 Drugs That Manage Emergencies, Exemplar 30D, 191 Drugs That Promote Comfort and Metabolism, Exemplar 29D, 179 Fractured Hip/Open Reduction Internal Fixation, Exemplar 8A, 51 Heart Failure, Exemplar 3A, 21 Hypovolemic Shock, Exemplar 19C, 127 Intestinal Obstruction, Exemplar 24B, 152 Management of Care: Complex Health Problems, Exemplar 28, 170 Sepsis, Exemplar 22, 140 Traumatic Brain Injury, Exemplar 21, 136 Childbearing family Uncomplicated Prenatal Woman, Exemplar 18A, 101 Complicated Prenatal Woman, Exemplar 18B, 105 Uncomplicated Intrapartum Care, Exemplar 18C, 108 Complicated Intrapartum Care, Exemplar 18D, 111 Uncomplicated Postpartum Care, Exemplar 18E, 114 Complicated Postpartum Care, Exemplar 18F, 116 Uncomplicated Newborn Care, 18G, 118

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    Pediatric nursing Appendicitis/Appendectomy, Exemplar 11B, 72 Asthma, Exemplar 5A, 32 Depression, Exemplar 15, 92 Diabetic Ketoacidosis, Exemplar 25A, 155 Drugs That Affect Perfusion and Gas Exchange, Exemplar 30A, 184 Drugs That Affect Nutrition and Elimination, Exemplar 29A, 173 Drugs That Manage Infection, Exemplar 29E, 182 Fractured Radius and Medial Epicondyle, Exemplar 8B, 53 Respiratory Syncytial Virus (RSV), Exemplar 12B, 80 Sickle Cell Disease, Exemplar 3B, 25 Spinal Cord Injury, Exemplar 20, 132 Substance Use Disorder, Exemplar 27, 166 Mental health nursing Alzheimer’s Disease, Exemplar 14B, 89 Delirium, Exemplar 14A, 87 Depression, Exemplar 15, 92 Drugs That Manage Psychoses, Exemplar 30C, 188 Generalized Anxiety Disorder, Exemplar 16, 95 Parkinson Disease, Exemplar 8D, 59 Substance Use Disorder, Exemplar 27, 166 Pharmacology Drugs That Affect Cloing, Exemplar 29B, 175 Drugs That Affect Immunity, Exemplar 30B, 187 Drugs That Affect Nutrition and Elimination, Exemplar 29A, 173 Drugs That Affect Perfusion, Exemplar 29C, 177 Drugs That Affect Perfusion and Gas Exchange Exemplar 30A, 184 Drugs That Manage Emergencies, Exemplar 30D, 191 Drugs That Manage Infection, Exemplar 29E, 182 Drugs That Manage Psychoses, Exemplar 30C, 188 Drugs That Promote Comfort and Metabolism, Exemplar 29D, 179

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    PA R T 1 Introduction: Developing Clinical Judgment OUTLINE 1. Transitioning from the nursing process to clinical judgment 2. Applying the NCSBN clinical judgment measurement model to ensure client safety

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    1 Transitioning from the nursing process to clinical judgment Learning outcomes 1. Review the evolution of the nursing process and its emphasis on the current NCLEX ® . 2. Explain why the National Council of State Boards of Nursing (NCSBN) is planning to add a focus on clinical judgment for the Next Generation NCLEX ® (NGN). 3. Identify the six cognitive skills of the NCSBN Clinical Judgment Measurement Model (CJMM). 4. Compare the steps of the nursing process, stages of Tanner’s Model of Clinical Judgment, and the six cognitive skills of the NCSBN CJMM. KEY TERMS ADPIE A five-step problem-solving approach that includes assessment, diagnosis, planning, implementation, and evaluation. clinical judgment

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