critical thinking and clinical judgement

Which critical thinking model component will the nurse use to deliver empathetic, high-quality, supportive care while planning treatment for a patient experiencing grief and loss? 1. Attitudes 2. Standards 3. Experience 4. Knowledge

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Which technique would the student nurse follow to develop critical thinking skills and bring theory into practice? 1. Reflective journaling 2. Concept mapping 3. Meeting with colleagues 4. Meeting with patients

1 Reflective journaling involves recollecting daily incidents and writing them down for further reference. This helps improve critical thinking skills and clarifies concepts for further reference. Concept mapping helps nurses better understand the patient's problems and secondary disease conditions. Meeting with colleagues and patients helps develop knowledge and expertise in clinical situations.

Arrange the steps of the scientific method of critical thinking in the correct order. 1.Requesting diagnostic tests 2.Collecting essential data 3.Identifying the problem 4.Diagnosing the problem 5.Formulating questions

1.Identifying the problem 2.Collecting essential data 3.Formulating questions 4.Requesting diagnostic tests 5.Diagnosing the problem The scientific method of critical thinking is a systematic approach to gathering data about the patient and solving problems. The nurse uses the scientific method when testing research questions in nursing practice scenarios. The steps of the scientific method of critical thinking are identifying the problem, collecting essential data regarding the problem, formulating questions to explore the problem, testing the questions, and evaluating the results of tests.

The nurse is practicing according to the professional nursing code of ethics. Which action is in accordance with the standards of responsibility? Select all that apply. One, some, or all responses may be correct. 1. Protecting the patient's right to privacy 2. Trying to remain competent to practice 3. Being responsible for delegated tasks 4. Being willing to respect professional obligations 5. Supporting the health, safety, and rights of the patients

2,3,4 Nurses should strive to remain competent to practice in order to perform responsibly. All nursing interventions are the responsibility of the nurse, including those that the nurse has delegated. The standards of practice involving responsibility include the nurse's willingness to respect professional obligations and keep promises to patients. Protecting a patient's right to privacy and supporting the health, safety, and rights of a patient are standards of advocacy, not responsibility.

Which role is true about the general practice of advanced practice registered nurses? 1. Function independently 2. Function as unit directors 3. Work in acute care settings 4. Work in university settings

1 An advanced practice registered nurse (APRN) functions independently as a clinician, educator, case manager, consultant, and researcher within his or her area of practice to plan or improve the quality of nursing care for the patient and family. Registered nurses without an APRN license can function as unit directors and work in acute care settings and university settings, but they cannot practice independent of a primary care provider.

The nurse finds that a surgical patient has incision pain, fever, and nausea. Based on the findings, the nurse concludes that the patient has infection at the surgical site. Which critical thinking skill has the nurse applied? 1. Analysis 2. Inference 3. Evaluation 4. Interpretation

1 Critical thinking skills are applied in nursing practice to make complex decisions. In the given scenario, the nurse has drawn a conclusion from the data. This indicates the application of analysis in nursing practice. Inference involves looking at the meaning and significance of the findings. When the nurse looks at all patients' situations objectively, the nurse is using evaluation skills. Interpretation involves finding patterns after organizing or collecting a patient's data during assessment.

Which component can restrict the student nurse's ability to move from a basic level to a complex level of critical thinking? Select all that apply. One, some, or all responses may be correct. 1. Inexperience 2. Inflexible attitude 3. Weak competency 4. Lack of specific knowledge base 5. Lack of policy related to procedures

1,2,3 Student nurses mostly apply the basic level of critical thinking in practice because they are still learning and are task oriented. The student's inexperience from less exposure, inflexible attitude as a result of less practice, and weak competency from less exposure can restrict the ability to move from a basic level to a complex level of critical thinking in practice. Student nurses work in all domains and may believe that experts have the right answer for every problem. Therefore they do not acquire a domain-specific knowledge base. The student nurse uses a specific hospital procedure manual in practice, which is developed with a good set of standards. Therefore lack of policy related to procedures will have no role in the student nurse's advancement in critical thinking skills.

Which step would the nurse follow when performing an unfamiliar procedure? Select all that apply. One, some, or all responses may be correct. 1. Seeks necessary knowledge 2. Reassesses the patient's condition 3. Collects all necessary equipment 4. Delegates the procedure to a more experienced staff member 5. Considers possible consequences of the procedure

1,2,3,5 The nurse would implement the following steps: seek necessary knowledge, reassess the patient's condition, collect all necessary equipment, and consider possible consequence of the procedure. The nurse would seek additional knowledge and skills about the procedure to be safe. When performing any procedure, especially an unfamiliar procedure, reassessing the patient is a priority. Collecting the necessary equipment and considering potential consequences are actions needed for all procedures. Unfamiliarity with a procedure is not a valid rationale for delegating to an experienced staff member; the experienced staff member should provide assistance and guidance.

Which action by a nursing student indicates a need for correction regarding the patient's care? Select all that apply. One, some, or all responses may be correct. 1. Discussing the patient's case on social media 2. Providing information about the time of the surgery at the bedside 3. Educating the patient about the preanesthesia in the public hospital hall 4. Explaining dietary restrictions to the patient in the counseling room 5. Teaching the patient about the importance of bowel preparation and personal hygiene

1,3 The nurse is required to protect the patient's privacy and medical information, and discussing it on social media or educating the patient about preanesthesia in the public hospital hall violates this. Providing information about the scheduled time of surgery at the bedside maintains privacy. It is always advisable to educate the patient about dietary restrictions in the counseling room, because it is confined and provides a private environment. Bowel preparation reduces discomfort and the risk of incontinence during surgery, and personal hygiene before surgery helps main asepsis.

Which action would a student nurse take when asked to perform a procedure that the student nurse has been trained in but has not performed in the hospital? Select all that apply. One, some, or all responses may be correct. 1. Check the hospital's procedure manual to obtain more information. 2. Request the unit manager assign the procedure to another student nurse. 3. Ask an experienced nurse for supervision and guidance during the procedure. 4. Verbalize the steps of the procedure with an instructor before performing it. 5. Refuse to perform the procedure.

1,3,4 Checking the hospital's procedure manual, asking an experienced nurse for supervision and guidance, and verbalizing the steps of the procedure with an instructor are actions the student nurse would take. If the student nurse feels the need for additional knowledge or assistance in performing any task, the student nurse should try to acquire knowledge about it by reading the procedure manual. This can also be done by consulting with people who are experienced in that procedure. The student nurse can also ask another nurse to supervise while performing the procedure. The student nurse can verbalize the steps of the procedure and ask an instructor for confirmation before performing the procedure. It is inappropriate for the student nurse to ask the unit manager to assign the procedure to another student nurse. Refusing to perform the procedure is unethical, especially since the student nurse has been trained in the procedure.

The nurse is assessing a patient with bowel infection secondary to a colostomy. The nurse learns that the patient has not followed the care recommendations received upon discharge. Which critical thinking attitude is appropriate for the nurse to exhibit when dealing with this patient? Select all that apply. One, some, or all responses may be correct. 1. Fairness 2. Hostility 3. Integrity 4. Confidence 5. Punctuality

1,3,4 the nurse must always treat the patient with fairness, integrity, and confidence to promote positive outcomes for the patient. The nurse should never be hostile to the patient. Punctuality is an important factor for the nurse but does not affect the patient's compliance.

Which component is an element of the American Nurses Association (ANA) standards of practice and scope of nursing practice? Select all that apply. One, some, or all responses may be correct. 1. Describes what a nurse is licensed to perform 2. Is a definition of skills competencies for nurses 3. Sets standards for diagnosing diseases and disorders 4. Identifies the nature and intent of the ways nurses intervene for patients 5. Is an authoritative statement regarding the duties all nurses are expected to perform

1,4,5 Elements of the ANA standards of practice and scope of nursing practice include describing what a nurse is licensed to perform, identifying the nature and intent of the ways nurses intervene for patients, and is an authoritative statement regarding the duties all nurses are expected to perform. The ANA defines scope of practice, which contains what a nurse is licensed to perform and standards of professional nursing practice, which include authoritative statements regarding the duties that all nurses are expected to perform competently, regardless of role, patient population they serve, or specialty. Quality and Safety Education for Nurses defines skills competencies, not ANA. The ANA does not issue standards for diagnosing diseases and disorders; this is the responsibility of the medical profession, not nursing.

The registered nurse provides education to a group of nursing students about critical thinking. Which statement by a student indicates the need for further teaching? 1. "All factors should be considered during assessment." 2. "Anticipating information is not part of making clinical judgments." 3. "The nursing knowledge should be integrated with the knowledge from other disciplines." 4. "It requires the synthesis of knowledge, experience, and information gathered from the patients."

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Which action by the nurse reflects critical thinking while implementing interventions with patients? 1. Implement interventions as per standing orders without question. 2. Review all potential complications associated with the interventions. 3. Carry out the interventions while reviewing for any complications. 4. Perform interventions as per the prescriptions given by the health care provider.

2

Which critical thinking attitude would the nurse possess to identify new solutions to patient-related problems? 1. Curiosity 2. Creativity 3. Integrity 4. Humility

2 Creativity is a critical thinking attitude that helps the nurse identify new ways to help a patient when traditional techniques are not working. Curiosity is an attitude by which the nurse can explore the patient's conditions and emotions. Integrity is related to the honesty of the nurse. The nurse can show humility, but this is not an attitude that leads to new solutions.

Which priority nursing action complies with The Joint Commission's standards and promotes patient safety when administering an enteral feeding by a nasoenteric tube? 1. Explaining the procedure to the patient 2. Identifying the patient using two identifiers 3. Checking the expiration date on the patient's formula 4. Performing hand hygiene prior to touching the patient

2 Identifying the patient using two identifiers (such as the patient's name and birthday or name and medical record) is a nursing action that complies with The Joint Commission's standards and promotes patient safety when administering an enteral feeding by a nasoenteric tube. It should be done first to limit mistakes of identification. The remaining actions promote safety as well but can be done after identification. Explaining the procedure to the patient enhances cooperation and places the patient at ease. Checking the expiration date on the patient's formula reduces the patient's risk of feeding-borne gastrointestinal infections. Performing hand hygiene reduces transmission of microorganisms.

Which action by the nurse reflects critical thinking while implementing interventions with patients? 1. Implement interventions as per standing orders without question. 2. Review all potential complications associated with the interventions. 3. Carry out the interventions while reviewing for any complications. 4. Perform interventions as per the prescriptions given by the health care provider.

2 The nurse would review all the possible complications associated with the interventions to avoid them. The nurse would apply critical thinking before implementing the interventions by reviewing the required interventions. Standing orders are followed in certain emergency medical situations but should not be followed without question; the nurse must determine safety based upon the patient's condition. The nurse would review the possible complications before performing the action, not while performing the action. The nurse would review the prescriptions and the patient before performing interventions, not blindly following interventions just because the health care provider prescribed them.

Which action is an example of the principle of patient-centered care that is focused on respect for patient's values, preferences, and expressed needs? Select all that apply. One, some, or all responses may be correct. 1. Administering daily antihypertensive medications to the patient 2. Engaging the patient in decision-making about when to ambulate 3. Following the patient's normal routine of bathing in the evening rather than in the morning 4. Explaining a colonoscopy procedure to the patient 5. Working with the family to bring in ethnic foods that the patient prefers

2,3,5 Engaging the patient in decision-making about when to ambulate, following the patient's normal routine of bathing in the evening rather than in the morning, and working with the family to bring in ethnic foods that the patient prefers are examples of patient-centered care. Patient-centered care is focused on respect, values, preferences, and expressed needs on treating the patient with dignity and respect. A component of this is keeping the patient informed and involved in decision-making. Administering daily antihypertensive medications to the patient is coordination and integration of care, not respect for patient's values, preferences, and expressed needs. Explaining a colonoscopy procedure to the patient is information and education, not respect for patient's values, preferences, and expressed needs.

The nurse is learning about the standards of nursing practice. Which activity is part of the practice of implementation? Select all that apply. One, some, or all responses may be correct. 1. Developing strategies for patient care 2. Educating patients for health awareness 3. Analyzing assessment data for diagnosis 4. Using therapeutic procedures for patient care 5. Providing consultation to enhance patient care

2,4,5 Implementation is when the nurse actually uses and performs particular actions or puts a strategy into use. Educating patients, using therapeutic knowledge, and providing consultation all provide opportunities for the nurse to implement skills. Developing strategies for patient care is a part of planning in nursing practice. Analyzing the assessment data is part of diagnosis in nursing practice.

At which point would the nurse begin discharge planning for a patient? 1. As the patient starts taking medication 2. When the patient completes the treatment plan 3. The time the patient enters the health care system 4. As soon as the patient's definitive diagnosis is confirmed Discharge planning begins when the patient enters the health care system.

3 The nurse should start planning the care, patient education, home care services, and participation in community support groups if needed. Discharge planning is performed even before the patient starts taking medication, completes the treatment plan, or has a definitive diagnosis confirmed. This ensures that holistic care is provided to the patient.

A patient requires a Foley catheter to be inserted, so the nurse reads the procedure manual for the institution to review how to insert it. Which level of critical thinking is the nurse using? 1. Commitment 2. Scientific method 3. Basic critical thinking 4. Complex critical thinking

3 This is an example of basic critical thinking, in which the nurse trusts that experts have the right answers for how to insert the Foley catheter and thus goes to the procedure manual. Thinking is concrete and based on a set of rules or principles. The nurse makes choices without assistance in commitment critical thinking. The nurse uses reasoning to solve problems with the scientific method. The nurse relies less on experts and trusts his or her own judgement with complex critical thinking.

Which observations made by the nurse when evaluating the terminally ill patient's outcomes indicate the use of experience as a critical thinking skill? 1. Clinical symptoms of an improved level of comfort 2. Perseverance in seeking successful comfort measures 3. Characteristics of the resolution of grief in the patient 4. Previous responses to planned nursing interventions for symptom management

4

Which criterion is used to evaluate efficacy of interventions? 1. Consultation 2. Critical thinking 3. Communication 4. Expected outcome

4 An expected outcome is the criterion used to evaluate efficacy of interventions. Expected outcomes include physiological, developmental, psychological, social, or spiritual responses that are desirable to the patient. These responses indicate a resolution of the patient's health problems. Consultation, critical thinking, and communication are not criteria used to evaluate efficacy of interventions.

Which activity performed by the nurse is related to maintaining competency in nursing practice? 1. Asking another nurse about how to change the settings on a medication pump 2. Regularly attending unit staff meetings 3. Participating as a member of the community council 4. Earning certification in a specialty area

4 Earning certification in a specialty area is one mechanism that demonstrates competency. Maintaining ongoing competency is the nurse's responsibility. Asking another nurse about how to change the settings on a medication pump is safe practice, but it does not maintain competency. The nurse would read procedures and protocols about the medication pump to maintain competency. Regularly attending unit staff meetings is a professional activity, but it does not maintain competency in nursing care. Knowing and following the standards of nursing care is competency. Participating as a member of the community council is a civic responsibility, not competency in nursing practice.

Which action does not exemplify critical thinking skills by the nurse? 1. Considering personal experience in performing intravenous (IV) line insertion and ways to improve performance 2. Using a fall risk inventory scale to determine a patient's fall risk 3. Observing a change in a patient's behavior and considering which problem is likely developing 4. Explaining the procedure for giving a tube feeding to a second nurse who has floated to the unit to assist with care

4 The nurse is explaining how to provide care on the basis of knowledge, which is not using critical thinking skills. Considering personal experience is an example of self-regulation through reflection. Using a fall risk inventory scale illustrates the process of evaluation, using a criteria-based screening scale. Observing a change and considering the problem that is likely developing involves inference, in which the nurse looks for a relationship in findings.

Which critical thinking skill does the nurse use when considering how the patient's cultural perspectives affect the meaning of loss or death? 1. Attitudes 2. Standards 3. Experience 4. Knowledge

4 The nurse uses knowledge as the critical thinking skill to understand the patient's cultural perspectives on the meaning of loss or death. Attitudes is the critical thinking skill that involves taking risks if necessary to develop a close relationship with the patient to understand loss; it does not focus on cultural perspectives affecting the meaning of loss/death in a patient. Standards is the critical thinking approach used for applying principles outlined in professional and clinical standards, not considering how cultural perspectives affect the meaning of loss/death. Experience is the critical thinking approach used to care for a patient who experienced a physical or emotional loss or death and personal experience with loss/death, not the effect of culture on loss/death.

A patient is admitted with severe pain in the lower abdomen and is very uncomfortable. Which attitude of critical thinking would the student nurse adopt when approaching the patient? 1. Integrity 2. Curiosity 3. Risk taking 4. Confidence

4 The student nurse needs to be confident when meeting the patient. The nurse should speak with conviction and must never give the patient the impression that the nurse is unable to perform assigned tasks. Integrity is reviewing one's own position and recognizing when interests conflict with those of the patient. Curiosity is the desire to explore more. Risk taking involves being courageous and questioning interventions if needed.