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

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Instructions for online accessThank you for your purchase. Please note that your purchase of thisElsevier eBook also includes access to an online version. Please clickhere (or go to hp://ebooks.elsevier.com) to request an activationcode and registration instructions in order to gain access to the webversion.

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Developing Clinical Judgmentfor Professional Nursing and theNext-Generation NCLEX-RN®ExaminationDonna D. Ignatavicius, MS, RN, CNE,ANEFSpeaker 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 ContentsInstructions for online accessCover imageTitle pageCopyrightContributorsReviewersPrefaceDedicationAbout the authorAcknowledgmentsExemplars

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PART 1. Introduction: Developing ClinicalJudgment1. Transitioning from the nursing process to clinical judgmentReview of the nursing process and critical thinkingExpanding from the nursing process to clinical judgmentNew nursing graduates and clinical judgmentThe National Council of State Boards of Nursing ClinicalJudgment Measurement ModelThinking and discussion questionsReferences2. Applying the NCSBN clinical judgment measurement model toensure client safetyOverview of the NCSBN CJMMApplying the cognitive skills of the NCSBN CJMMApplying the NCSBN CJMM for thinking exercises in thisworkbookEnhanced hot spot thinking exercisesCloze thinking exercisesExtended drag and drop thinking exercisesExtended multiple response thinking exercisesMatrix thinking exercises

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Thinking and discussion questionsBibliographyPART 2. Clinical Judgment for Clients Across theLife Span Experiencing Commonly OccurringHealth Problems3. Perfusion: Common Health ProblemsExemplar 3A. Heart failure (Medical-surgical nursing: Olderadult)Exemplar 3B. Sickle cell disease (Pediatric nursing: Adolescent)4. Cloing: Deep Vein ThrombosisExemplar 4. Deep vein thrombosis (Medical-surgical nursing:Middle-age adult)5. Gas exchange: Common Health ProblemsExemplar 5A. Asthma (Pediatric nursing: School-age child)Exemplar 5B. Chronic obstructive pulmonary disease (Medical-surgical nursing: Middle-age adult)6. Elimination: Benign Prostatic HyperplasiaExemplar 6. Benign prostatic hyperplasia (Medical-surgicalnursing: Older adult)7. Nutrition: Common Health Problems

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Exemplar 7A. Cholecystitis/cholecystectomy (Medical-surgicalnursing: Middle-age adult)Exemplar 7B. Peptic ulcer disease (Medical-surgical nursing:Middle-age adult)8. Mobility: Common Health ProblemsExemplar 8A. Fractured hip/open reduction internal fixation(Medical-surgical nursing: Older adult)Exemplar 8B. Fractured radius and medial epicondyle (Pediatricnursing: Preschool child)Exemplar 8C. Osteoarthritis/total knee arthroplasty (Medical-surgical nursing: Middle-age adult)Exemplar 8D. Parkinson disease (Medical-surgicalnursing/mental health nursing: Older adult)9. Metabolism: Common Health ProblemsExemplar 9A. Diabetes mellitus (Medical-surgical nursing:Middle-age adult)Exemplar 9B. Hyperthyroidism/thyroidectomy (Medical-surgicalnursing: Middle-age adult)10. Cellular regulation: Breast CancerExemplar 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 ProblemsExemplar 12A. Cellulitis (Medical-surgical nursing: Middle-ageadult)Exemplar 12B. Respiratory syncytial virus (RSV) (Pediatricnursing: Infant)13. Sensory perception: CataractsExemplar 13. Cataracts (Medical-surgical nursing: Older adult)14. Cognition: Common Health ProblemsExemplar 14A. Delirium (Mental health nursing: Older adult)Exemplar 14B. Alzheimer’s disease (Mental health nursing:Middle-age adult)15. Mood and affect: DepressionExemplar 15. Depression (Mental health nursing: Adolescent)16. Stress and coping: Generalized Anxiety DisorderExemplar 16. Generalized anxiety disorder (Mental healthnursing: Young adult)

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17. Reproduction: Uterine Leiomyoma/HysterectomyExemplar 17. Uterine leiomyoma/hysterectomy (Medical-surgical nursing: Middle-age adult)PART 3. Clinical Judgment for ChildbearingFamilies18. Reproduction: Childbearing FamilyExemplar 18A. Uncomplicated prenatal womanExemplar 18B. Complicated prenatal womanExemplar 18C. Uncomplicated intrapartum careExemplar 18D. Complicated intrapartum careExemplar 18E. Uncomplicated postpartum careExemplar 18F. Complicated postpartum careExemplar 18G. Uncomplicated newborn carePART 4. Clinical Judgment for Clients Across theLife Span Experiencing Complex MultisystemHealth Problems19. Perfusion: Complex Health ProblemsExemplar 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 InjuryExemplar 20. Spinal cord injury (Pediatric nursing: Adolescent)21. Cognition: Traumatic Brain InjuryExemplar 21. Traumatic brain injury (Medical-surgical nursing:Older adult and young adult)22. Infection: SepsisExemplar 22. Sepsis (Medical-surgical nursing: Older adult)23. Gas exchange: Chest TraumaExemplar 23. Chest trauma (Medical-surgical nursing: Middle-age adult)24. Elimination: Complex Health ProblemsExemplar 24A. Chronic kidney disease (Medical-surgicalnursing: Middle-age adult)Exemplar 24B. Intestinal obstruction (Medical-surgical nursing:Young adult; older adult)25. Metabolism: Complex Health ProblemsExemplar 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: BurnsExemplar 26. Burns (Medical-surgical nursing: Young adult)27. Stress and coping: Substance Use DisorderExemplar 27. Substance use disorder (Pediatric nursing/mentalhealth nursing: Adolescent)28. Management of care: Complex Health ProblemsExemplar 28. Complex health problems (Medical-surgicalnursing: Middle-age and older adult)PART 5. Pharmacology for Nursing29. Pharmacology in management of common health problemsExemplar 29A. Drugs that affect nutrition and elimination(Medical-surgical nursing: Older adult; pediatric nursing)Exemplar 29B. Drugs that affect clotting (Medical-surgicalnursing: Middle-age and older adult)Exemplar 29C. Drugs that affect perfusion (Medical-surgicalnursing: 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-surgicalnursing [young and middle-age adult]; pediatric nursing)30. Pharmacology in management of complex health problemsExemplar 30A. Drugs that affect perfusion and gas exchange(Medical-surgical nursing: older adult; pediatric nursing:Adolescent)Exemplar 30B. Drugs that affect immunity (Medical-surgicalnursing: Young adult; middle-age adult)Exemplar 30C. Drugs that manage psychoses (Mental healthnursing: Young adult)Exemplar 30D. Drugs that manage emergencies (Medical-surgical nursing: Young adult; older adult)Answer keyChapter 3 Perfusion: Common health problemsChapter 4 Clotting: Deep vein thrombosisChapter 5 Gas exchange: Common health problemsChapter 6 Elimination: Benign prostatic hyperplasiaChapter 7 Nutrition: Common health problemsChapter 8 Mobility: Common health problemsChapter 9 Metabolism: Common health problemsChapter 10 Cellular regulation: Breast cancerChapter 11 Inflammation: Common health problems

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Chapter 12 Infection: Common health problemsChapter 13 Sensory perception: CataractsChapter 14 Cognition: Common health problemsChapter 15 Mood and affect: DepressionChapter 16 Stress and coping: Generalized anxiety disorderChapter 17 Reproduction: Uterine leiomyoma/hysterectomyChapter 18 Reproduction: Childbearing familyChapter 19 Perfusion: Complex health problemsChapter 20 Mobility: Spinal cord injuryChapter 21 Cognition: Traumatic brain injuryChapter 22 Infection: SepsisChapter 23 Gas exchange: Chest traumaChapter 24 Elimination: Complex health problemsChapter 25 Metabolism: Complex health problemsChapter 26 Tissue integrity: BurnsChapter 27 Stress and coping: Substance use disorderChapter 28 Management of care: Complex health problemsChapter 29 Pharmacology in management of common healthproblemsChapter 30 Pharmacology in management of complex healthproblems

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References

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CopyrightElsevier3251 Riverport LaneSt. Louis, Missouri 63043DEVELOPING CLINICAL JUDGMENT FOR PROFESSIONALNURSING AND THE NEXT-GENERATION NCLEX-RN®EXAMINATIONISBN: 978-0-323-71858-5Copyright © 2021 by Elsevier Inc. All rights reserved.No part of this publication may be reproduced or transmied in anyform or by any means, electronic or mechanical, includingphotocopying, recording, or any information storage and retrievalsystem, without permission in writing from the publisher. Details onhow to seek permission, further information about the Publisher’spermissions policies and our arrangements with organizations suchas the Copyright Clearance Center and the Copyright LicensingAgency, can be found at our website:www.elsevier.com/permissions.This book and the individual contributions contained in it areprotected under copyright by the Publisher (other than as may benoted herein).NoticePractitionersandresearchersmustalwaysrelyontheirownexperienceandknowledgeinevaluatingandusingany

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information,methods,compoundsorexperimentsdescribedherein. Because of rapid advances in the medical sciences, inparticular,independentverificationofdiagnosesanddrugdosages should be made. To the fullest extent of the law, noresponsibilityisassumedbyElsevier,authors,editorsorcontributors for any injury and/or damage to persons or propertyas a maer of products liability, negligence or otherwise, or fromany use or operation of any methods, products, instructions, orideas contained in the material herein.International Standard Book Number:978-0-323-71858-5Executive Content Strategist:Lee HendersonDirector, Content Development:Laurie GowerSenior Content Development Specialist:Laura GoodrichPublishing Services Manager:Julie EddySenior Project Manager:Jodi M. WillardDesign Direction:Amy BuxtonPrinted in ChinaLast digit is the print number:987654321

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ContributorsJessica Hoy, RN, MSNE, PCCN-K,Assistant Professor ofNursing, College of Saint Scholastica, Duluth, MinnesotaTami Lile, DNP, MSN, BSN,Corporate Director of Nursing,Vista College, Richardson, TexasSabrina Olson, MSN, RN,Professor, Butler Community College,El Dorado, KansasJanet Schueller, MSN, RN,Curriculum Chairperson, Professor,Butler Community College, El Dorado, Kansas

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ReviewersKiyCashion,RN-BC,MSN,ClinicalNurseSpecialist,Department of Obstetrics and Gynecology, Division of Maternal-FetalMedicine,UniversityofTennesseeHealthScienceCenter,Memphis, TennesseeBrigidChvilicek,MSN,RN,CPNP,FacultyofNursing,Wenatchee Valley College, Wenatchee, WashingtonMonica Dobbins, RN,Nursing Instructor, Butler CommunityCollege, El Dorado, KansasJessicaHoy,RN,MSNE,PCCN-K,AssistantProfessorofNursing, College of Saint Scholastica, Duluth, MinnesotaKay R. Jansen, DNP, RN,Undergraduate Program Director,UniversityofWisconsin—Milwaukee,CollegeofNursing,Milwaukee, WisconsinTami Lile, DNP, MSN, BSN,Corporate Director of Nursing,Vista College, Richardson, TexasLisa M. Pugsley, MSN, RN, CNE, CPN,Instructor of Nursing,Georgia Gwinne College, Lawrenceville, Georgia

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PrefaceDonna D. “Iggy” IgnataviciusPurpose of this workbookIn 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 clinicaljudgment. This one-of-a-kind workbook is designed for studentsenrolledinprelicensureprogramsinpreparationforregisterednursing (RN) practice to help:• Develop clinical judgment skills for professional nursingpractice to ensure patient safety and quality of care.• Prepare for success on the Next-Generation NCLEX®Examination (NGN) through practical thinking exercises inwhich students apply clinical reasoning skills to makeappropriate clinical judgments.This book is intended for students to use throughout their nursingprogram. Thinking exercises are available for all major areas ofclinicalspecialtypracticeandareleveledfrombasicandfoundationaltomorecomplexandmultisystem.Eachexerciseprovides challenging client situations with multiple NGN-style testitems. For many thinking exercises, the clinical situation evolves intocontinuing care requiring the student to address changing clientconditions.

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Organization of this workbookThis student-friendly workbook is organized by nursing conceptsbut is easy to use in any type of prelicensure RN nursing program. Itis divided into five distinct parts for a total of 30 chapters. Eachhealth problem throughout the book consists of between 4 and 7thinking exercises for student practice:Part 1 (Chapters 1and2). Chapter 1 provides an introductionto clinical judgment as a primary skill needed by practicingnurses. Chapter 2 offers tips for answering the practicalthinking exercises in the workbook.Part 2 (Chapters 3 to 17).This section focuses on thinkingexercises that address nursing care for clients experiencingcommonly occurring medical-surgical, pediatric, and mentalhealth problems across the life span.Part 3 (Chapter 18).This chapter provides multipleopportunities for students to address the care of childbearingwomen with uncomplicated and complicated clinicalsituations. Care of the normal newborn is also included.Part 4 (Chapters 19 to 28).This section includes thinkingexercises that address nursing care for clients experiencingcomplex multisystem medical-surgical, pediatric, and mentalhealth problems across the life span.Part 5 (Chapter 29and30). Although many pharmacologythinking exercises are integrated throughout Chapters 3 to28, Chapters 29 and 30 are dedicated solely to the nurse’srole in administering commonly used drugs for adult andpediatric clients who have commonly occurring and complexhealth problems.Answer Key.The last section of this workbook presents theanswers and rationales for each thinking exercise. Inaddition, the student is provided with reference pages wherethey can read more about each health problem.References.At the end of the book is the list of textbookcitations that are used for reference for the thinkingexercises.

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In summary,Developing Clinical Judgment for Professional Nursingand the Next-Generation NCLEX-RN®Examinationis the first productfocusedexclusivelyondevelopingtheclinicaljudgmentskillsneeded for student success on the NGN and in clinical practice.

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DedicationTo all the nursing educators who are passionate about teaching, and to allthe nursing students who are passionate about learning.

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About the authorDonna D. Ignataviciusreceived her diploma in nursing from thePeninsula General School of Nursing in Salisbury, Maryland. Afterworking as a charge nurse in medical-surgical nursing, she becamean instructor in staff development at the University of MarylandMedical Center. She then received her BSN from the University ofMaryland School of Nursing. For 5 years she taught in severalschools of nursing while working toward her MS in Nursing, whichshe received in 1981. Donna then taught in the BSN program at theUniversity of Maryland, after which she continued to pursue herinterest in gerontology and accepted the position of Director ofNursing of a major skilled-nursing facility in her home state ofMaryland. Since that time, she has served as an instructor in severalassociatedegreenursingprograms.Throughherconsultingactivities, faculty development workshops, and international nursingeducation conferences (such as Boot Camp for Nurse Educators®),Donna is nationally recognized as an expert in nursing education.SheiscurrentlythePresidentofDIAssociates,Inc.(hp://www.diassociates.com/), a company dedicated to improvinghealthcarethrougheducationandconsultationforfaculty.Inrecognition of her contributions to the field, she was inducted as acharter Fellow of the prestigious Academy of Nursing Education in2007 and received her Certified Nurse Educator credential in 2016.

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AcknowledgmentsPublishing a textbook would not be possible without the combinedefforts of many people. With that in mind, I would like to extend mydeepest gratitude to many people who were such an integral part ofthis journey.Mycontributingauthorsprovidedexcellentmanuscriptstounderscore the clinical relevancy of this publication. I give specialgratitude to Meg Blair, who was extremely valuable as a projectresource from beginning to end. The reviewers—expert cliniciansand instructors from around the United States—provided invaluablesuggestions and encouragement throughout the development of thisbook.The staff of Elsevier has, as always, provided us with meaningfulguidanceandsupportthroughouteverystepoftheplanning,writing, revision, and production of this new title. Executive ContentStrategist Lee Henderson worked closely with me from the earlystages of this title to help me hone and focus the project from start tofinish. Senior Content Development Specialist Laura Goodrich thenworked with me from vision to publication.Senior Project Manager Jodi Willard was, as always, an absolutejoywithwhomtowork.Herunwaveringaentiontodetail,flexibility,andconscientiousnesshelpedtomakethistitleconsistentlyreadablewhilemakingtheproductionprocessincredibly smooth. Also, a special thanks to Publishing ServicesManager Julie Eddy. Designer Amy Buxton is responsible for thebeautiful cover and the interior design.My acknowledgments would not be complete without recognizingthe dedicated team of Educational Solutions Consultants and otherkey members of the Sales and Marketing staff who helped to put thisbook into your hands.

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

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

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

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PA R T 1Introduction: Developing ClinicalJudgmentOUTLINE1. Transitioning from the nursing process toclinical judgment2. Applying the NCSBN clinical judgmentmeasurement model to ensure client safety

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1Transitioning from the nursingprocess to clinical judgmentLearning outcomes1. Review the evolution of the nursing process and itsemphasis on the current NCLEX®.2. Explain why the National Council of State Boards ofNursing (NCSBN) is planning to add a focus on clinicaljudgment for the Next Generation NCLEX®(NGN).3. Identify the six cognitive skills of the NCSBN ClinicalJudgment Measurement Model (CJMM).4. Compare the steps of the nursing process, stages ofTanner’s Model of Clinical Judgment, and the six cognitiveskills of the NCSBN CJMM.KEY TERMSADPIEA five-step problem-solving approach that includes assessment,diagnosis, planning, implementation, and evaluation.clinical judgment

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