CHAPTER 15 CRITICAL THINKING AND CLINICAL JUDGMENT

Which findings will alert thenurse that stress is present when making a clinical decision? (Select all that apply.) a. Tense muscles b. Reactive responses c. Trouble concentrating d. Feeling very tired e. Managed emotions

A,B,C,D Learn to recognize when you are feeling stressed—your muscles will tense, you become reactive when others communicate with you, you have trouble concentrating, and you feel very tired. Emotions are not managed when stressed.

0. In which order will thenurse use thenursing process steps during theclinical decision-making process? 1. Evaluating goals 2. Assessing patient needs 3. Planning priorities of care 4. Determining nursing diagnoses 5. Implementing nursing interventions a. 2, 4, 3, 5, 1 b. 4, 3, 2, 1, 5 c. 1, 2, 4, 5, 3 d. 5, 1, 2, 3, 4

A. 2,4,3,5,1 The American Nurses Association developed standards that set forth theframework necessary for critical thinking in theapplication of thefive-step nursing process: assessment, diagnosis, planning, implementation, and evaluation.

A nursing instructor needs to evaluate students' abilities to synthesize data and identify relationships between nursing diagnoses. Which learning assignment is best suited for this instructor's needs? a. Concept mapping b. Reflective journaling c. Lecture and discussion d. Reading assignment with a written summary

A. Concept mapping Concept mapping challenges thestudent to synthesize data and identify relationships between nursing diagnoses. theprimary purpose of concept mapping is to better synthesize relevant data about a patient, including assessment data, nursing diagnoses, health needs, nursing interventions, and evaluation measures. Reflective journaling involves thinking back to clarify concepts. Reading assignments and lecture do not best provide an instructor theability to evaluate students' abilities to synthesize data.

A patient continues to report postsurgical incision pain at a level of 9 out of 10 after pain medicine is given. The next dose of pain medicine is not due for another hour. What should the critically thinking nurse do first? a. Explore other options for pain relief. b. Discuss the surgical procedure and reason for the pain. c. Explain to the patient that nothing else has been ordered. d. Offer to notify the health care provider after morning rounds are completed.

A. Explore other options for pain relief. The critically thinking nurse should explore all options for pain relief first. thenurse should use critical thinking to determine thecause of thepain and determine various options for pain, not just ordered pain medications. thenurse can act independently to determine all options for pain relief and does not have to wait until after thehealth care provider rounds are completed. Explaining thecause of thepain does not address options for pain relief.

While caring for a hospitalized older-adult female post hip surgery, the nurse is faced with the task of inserting an indwelling urinary catheter, which involves rotating the hip into a contraindicated position. Which action should the nurse take? a. Postpone catheter insertion until the next shift. b. Adapt the positioning technique to the situation. c. Notify the health care provider for a urologist consult. d. Follow textbook procedure with contraindicated position.

B. Adapt the positioning technique to the situation. The nurse must use critical thinking skills in this situation to adapt positioning technique. In practice, patient procedures are not always presented as in a textbook, but they are individualized. A urologist consult is not warranted for positioning problems. Postponing insertion of thecatheter is not an appropriate action.

A nurse is pulled from the surgical unit to work on the oncology unit. Which action by the nurse displays humility and responsibility? a. Refusing the assignment b. Asking for an orientation to the unit c. Admitting lack of knowledge and going home d. Assuming that patient care will be the same as on the other units

B. Asking for an orientation to the unit Humility and responsibility are displayed when thenurse realizes lack of knowledge and requests an orientation to theunit. theother answer choices represent inappropriate actions in this situation and are not examples of humility and responsibility. thenurse should explore all options before refusing an assignment. thenurse should not make assumptions. Assuming is not an example of critical thinking. Admitting lack of knowledge is an example of humility but going home does not illustrate an example of responsibility.

A patient is having trouble reaching the water fountain while holding on to crutches. The nurse suggests that the patient place the crutches against the wall while stabilizing him or herself with two hands on the water fountain. Which critical thinking attitude did the nurse use in this situation? a. Humility b. Creativity c. Risk taking d. Confidence

B. Creativity The nurse uses creativity in this situation to figure out how thepatient can safely get a drink of water. Humility is recognizing when more information is needed to make a decision. Confidence is being well prepared to perform nursing care safely. This question best illustrates theattitude of creativity. Risk taking is demonstrating thecourage to speak out or to question orders based on thenurse's own knowledge base.

A nurse is reviewing care plans. Which finding, if identified in a plan of care, should the registered nurse revise? a. Patient's outcomes for learning b. Nurse's assumptions about hospital discharge c. Identification of several actual health problems d. Documentation of patient's ability to meet the goal

B. Nurse's assumptions about hospital discharge The nurse should not assume when a patient is going to be discharged and document this information in a plan of care. Making assumptions is not an example of a critical thinking skill. thepurpose of thenursing process is to diagnose and treat human responses (e.g., patient symptoms, need for knowledge) to actual or potential health problems. Use of theprocess allows nurses to help patients meet agreed-on outcomes for better health. thepatient's outcomes, having several actual health problems, and a description of thepatient's abilities to meet thegoal are all appropriate to document in thenursing plan of care.

Which action indicates a registered nurse is being responsible for making clinical decisions? a. Applies clear textbook solutions to patients' problems b. Takes immediate action when a patient's condition worsens c. Uses only traditional methods of providing care to patients d. Formulates standardized care plans solely for groups of patients

B. Takes immediate action when a patient's condition worsens Registered nurses are responsible for making clinical decisions to take immediate action when a patient's condition worsens. Patient care should be based on evidence-based practice, not on tradition. Most patients have health care problems for which there are no clear textbook solutions. Care plans should be individualized for each patient, not just for groups.

Which action should the nurse take to best develop critical thinking skills? a. Study 3 hours more each night. b. Attend all inservice opportunities. c. Actively participate in clinical experiences. d. Interview staff nurses about their nursing experiences.

C. Actively participate in clinical experiences Nursing is a practice discipline. Clinical learning experiences are necessary to acquire clinical decision-making skills. Studying for longer hours, interviewing nurses, and attending inservices do not provide opportunities for clinical decision making, as do actual clinical experiences..

Which patient scenario of a surgical patient in pain is most indicative of critical thinking? a. Administering pain-relief medication according to what was given last shift b. Offering pain-relief medication based on the health care provider's orders c. Asking the patient what pain-relief methods, pharmacological and nonpharmacological, have worked in the past d. Explaining to the patient that self-reporting of severe pain is not consistent with the minor procedure that was performed

C. Asking the patient what pain-relief methods, pharmacological and nonpharmacological, have worked in the past Asking thepatient what pain-relief methods have worked in thepast is an example of exploring many options for pain relief. Nonpharmacological pain-relief methods are available, as are medications for pain. Administering medication based on a previous assessment is not practicing according to standards of care. thenurse is to conduct an assessment each shift on assigned patients and intervene accordingly. Pain is subjective. thenurse should offer painrelief methods based on thepatient's reports without being judgmental

Which action should the nurse take when using critical thinking to make clinical decisions? a. Make decisions based on intuition. b. Accept one established way to provide care. c. Consider what is important in a given situation. d. Read and follow the heath care provider's orders.

C. Consider what is important in a given situation. A critical thinker considers what is important in each clinical situation, imagines and explores alternatives, considers ethical principles, and makes informed decisions about thecare of patients. Patient care can be provided in many ways. theuse of evidence-based knowledge, or knowledge based on research or clinical expertise, makes you an informed critical thinker. Following health care provider's orders is not considered a critical thinking skill. If your knowledge causes you to question a health care provider's order, do so.

Which action demonstrates a nurse utilizing reflection to improve clinical decision making? a. Obtains data in an orderly fashion b. Uses an objective approach in patient situations c. Improves a plan of care while thinking back on interventions effectiveness d. Provides evidence-based explanations and research for care of assigned patients

C. Improves a plan of care while thinking back on interventions effectiveness Reflection utilizes critical thinking when thinking back on theeffectiveness of interventions and how they were performed. It involves purposeful thinking back or recalling a situation to discover its purpose or meaning. theother options are not examples of reflection but do represent good nursing practice. Using an objective approach and obtaining data in an orderly fashion do not involve purposefully thinking back to discover themeaning or purpose of a situation. Providing evidence-based explanations for nursing interventions does not always involve thinking back to discover themeaning of a situation.

The patient appears to be in no apparent distress, but vital signs taken by assistive personnel reveal an extremely low pulse. The nurse then auscultates an apical pulse and asks the patient whether there is any history of heart problems. The nurse is utilizing which critical thinking skill? a. Evaluation b. Explanation c. Interpretation d. Self-regulation

C. Interpretation Interpretation involves being orderly in data collection, looking for patterns to categorize data, and clarifying uncertain data. This nurse is clarifying thedata in this situation. Evaluation involves determining theeffectiveness of interventions or care provided. thenurse in this scenario is assessing thepatient, not evaluating interventions. Self-regulation is reflecting on experiences. Explanation is supporting findings and conclusions. thenurse in this question is clarifying uncertain data (determining cause of thelow pulse), not supporting thefinding of a low pulse.

A nurse is using the critical thinking skill of evaluation. Which action will the nurse take? a. Examine the meaning of data. b. Support findings and conclusions. c. Review the effectiveness of nursing actions. d. Search for links between the data and the nurse's assumptions.

C. Review the effectiveness of nursing actions. Reviewing theeffectiveness of interventions best describes evaluation. Examining themeaning of data is inference. Supporting findings and conclusions provides explanations. Searching for links between thedata and thenurse's assumptions describes analysis.

The nurse enters a room to find the patient sitting up in bed crying. How will the nurse display a critical thinking attitude in this situation? a. Provide privacy and check on the patient 30 minutes later. b. Set a box of tissues at the patient's bedside before leaving the room. c. Limit visitors while the patient is upset. d. Ask the patient about the crying.

D. Ask the patient about the crying. A clinical sign or symptom (crying) often indicates a variety of problems. Explore and learn more about thepatient so as to make appropriate clinical judgments. This is demonstrating curiosity, which is an attitude of critical thinking. Checking on thepatient 30 minutes later, providing tissues, and limiting visitors may be appropriate actions but these actions do not address critical thinking.

A nurse who is caring for a patient with a pressure ulcer applies the recommended dressing according to hospital policy. Which standard is the nurse following? a. Fairness b. Intellectual standards c. Independent reasoning d. Institutional practice guidelines

D. Institutional practice guidelines The standards of professional responsibility that a nurse tries to achieve are thestandards cited in Nurse Practice Acts, institutional practice guidelines (hospital/facility policy), and professional organizations' standards of practice (e.g., theAmerican Nurses Association Standards of Professional Performance). Intellectual standards are guidelines or principles for rational thought. Fairness and independent reasoning are two examples of critical thinking attitudes that are designed to help nurses make clinical decisions.

A charge nurse is supervising the care of a new nurse. Which action by a new nurse indicates the charge nurse needs to intervene? a. Making an ethical clinical decision b. Making an informed clinical decision c. Making a clinical decision in the patient's best interest d. Making a clinical decision based on previous shift assessments

D. Making a clinical decision based on previous shift assessments The charge nurse must intervene when thenurse is using previous shift assessments to plan; this is inappropriate. Nurses are responsible for assessing their own patients to make decisions. Making informed, ethical decisions in thepatient's best interest is practicing responsibly and does not need follow-up from thecharge nurse.

A nurse is using a critical thinking model to provide care. Which component is first that helps a nurse make clinical decisions? a. Attitude b. Experience c. Nursing process d. Specific knowledge base

D. Specific knowledge base The first component of thecritical thinking model is a nurse's specific knowledge base. After acquiring a sound knowledge base, thenurse can then apply knowledge to different clinical situations using thenursing process to gain valuable experience. Clinical learning experiences are necessary to acquire clinical decision-making skills. thenursing process competency is thethird component of thecritical thinking model. Eleven attitudes define thecentral features of a critical thinker and how a successful critical thinker approaches a problem.

A nurse is using professional standards to influence clinical decisions. What is the rationale for the nurse's actions? a. Establishes minimal passing standards for testing b. Utilizes evidence-based practice based on nurses' needs c. Bypasses the patient's feelings to promote ethical standards d. Uses critical thinking for the highest level of quality nursing care

D. Uses critical thinking for the highest level of quality nursing care Professional standards promote thehighest level of quality nursing care. Application of professional standards requires you to use critical thinking for thegood of individuals or groups. Bypassing thepatient's feelings is not practicing according to professional standards. theprimary purpose of professional standards is not to establish minimal passing standards for testing. Patient care should be based on patient needs, not on nurses' needs.

Which action by a nurse indicates application of the critical thinking model to make the best clinical decisions? a. Drawing on past clinical experiences to formulate standardized care plans b. Relying on recall of information from past lectures and textbooks c. Depending on the charge nurse to determine priorities of care d. Using the nursing process

D. Using the nursing process The nursing process competency is thethird component of thecritical thinking model. In your practice, you will apply critical thinking components during each step of thenursing process. Care plans should be individualized and recalling facts does not utilize critical thinking skills to make clinical decisions. thenew nurse should not rely on thecharge nurse to determine priorities of care.