Chapter 4: Competencies for Professional Nursing Practice

1.    You are assigned to care for Ms. C., an 81-year-old patient who was admitted today with symptoms of increasing shortness of breath over the last week. She is currently receiving oxygen through a nasal cannula at 3 L/min. You go into the room to assess her. You find that she is sitting up in bed at a 60-degree angle. She is restless and her respirations appear labored and rapid. Her skin is pale with circumoral cyanosis. You ask if she feels more short of breath. Because she is unable to catch her breath enough to speak, she nods her head yes. Which action should you take first?
•    Listen to her breath sounds.
•    Ask when the shortness of breath started.
•    Increase her oxygen flow rate to 6 L/min.
•    Raise the head of the bed from 75 to 85 degrees
Based on knowledge you have learned, you realize the patient’s symptoms indicate acute hypoxemia, so improving oxygen delivery is the priority. The other actions also are appropriate, but they are not as critical as the initial action.

2.    What do all of the following scenarios have in common?
•    An elderly male becomes acutely confused and refuses to follow directions for his safety.
•    A teen comes into an urgent care setting requesting information about sexually transmitted infections.
•    A mother visits a school nurse and requests information about how the school handles sex education.
•    A team leader needs to rearrange assignments when one team member goes home sick.
•    Nursing staff in an intensive care unit need to develop an evacuation plan.
Answer: They all require critical thinking skills.

3.    You will be taking care of a patient in a nursing home for the first time. Your assignment is to care for an older man who has heart disease. In addition, he has five other medical problems and takes 20 medications. While developing a plan of care for this patient, you can identify 8 to 10 nursing problems. You have no previous experience with nursing homes, and most of what you have heard and read about them is negative. Will you find yourself dreading the clinical day and expecting a negative experience before you even begin?

4.    Think about a clinical experience that was troubling to you. Reflect on what bothered you about the experience. What could you have done differently? What were the reasons behind your actions? Try to create and clarify meaning or a new understanding of the particular situation.

5.    Beginning nursing students often tend to focus primarily on their routines, including to get their list of tasks done, including assessments, ordered treatments, daily care, and charting. What if an unexpected situation occurred during the day? Do you think you would be able to reason, plan, and take appropriate action—think critically?

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