Quiz: Chapter 15 Critical Thinking in Nursing Practice

A nurse is working with the nursing assistive personnel (NAP) on a busy oncology unit. The nurse has instructed the NAP on the tasks that need to be performed, including getting client A out of bed, collecting a urine specimen from client B, and checking vital signs on client C, who is scheduled to go home. Which of the following represent(s) successful delegation? Select all that apply. 1 A nurse explains to the NAP the approach to use in getting the client up and why the client has activity limitations. 2 A nurse is asked by a client to help her to the bathroom; the nurse leaves the room and directs the NAP to assist the client instead. 3 The nurse sees the NAP preparing to help a client out of bed, goes to assist, and thanks the NAP for her efforts to get the client up early. 4 The nurse is in client B's room to check an intravenous (IV) line and collects the urine specimen while in the room. 5 The nurse offers support to the NAP when needed but allows her to complete client care tasks without constant oversight

1 A nurse explains to the NAP the approach to use in getting the client up and why the client has activity limitations. 3 The nurse sees the NAP preparing to help a client out of bed, goes to assist, and thanks the NAP for her efforts to get the client up early. 4 The nurse is in client B's room to check an intravenous (IV) line and collects the urine specimen while in the room. Successful delegation is represented by good communication, showing respect, and showing initiative. By directing the NAP to assist the client after the client asked the nurse for help getting to the bathroom, the nurse shows a lack of initiative. Delegation is ineffective if RNs fail to carry out proper supervision and evaluation of care. Test-Taking Tip: Be sure to note whether a question is a single-answer, multiple choice question versus a multiple response "select-all-that-apply" question! If you think there is just one answer, and it is really a multiple response question, you may submit just the first answer you know to be true, and miss the additional correct responses. Text Reference - p. 197

The nurse finds that a patient who had radical prostatectomy 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 is applied by the nurse? 1 Analysis 2 Inference 3 Evaluation 4 Interpretation

1 Analysis 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, which is true and supports the conclusion. Therefore, it indicates the application of analysis in nursing practice. Inference is a skill applied by the nurse to look at the meaning and significance of the nurse's findings. Evaluation is a skill used by the nurse to look at all patients' situations objectively. Interpretation is organizing or orderly collection of a patient's data during assessment. Text Reference - p. 193

A nurse in the postoperative ward has two tasks at hand. A urine sample has to be dispatched, and a client needs to ambulate down the hallway. Meanwhile another client experiences a sudden drop in blood pressure associated with altered consciousness. Which nursing action is appropriate? 1 Directing care to the client who is experiencing falling blood pressure 2 Seeking help of the assistive personnel to dispatch the urine sample 3 Delegating the task of urine collection and assisting with ambulation 4 Providing care to the primary clients and then attending to the client with failing blood pressure

1 Directing care to the client who is experiencing falling blood pressure The nurse should prioritize care to the client who requires immediate care. The client with hypotension requires immediate attention, as the condition may be life-threatening. The nurse may delegate nontechnical interventions like collecting urine and assisting a client to walk, but the client with falling blood pressure must be handled first. The nurse should first attend to the client whose blood pressure is low and then care for the primary clients. Test-Taking Tip: Remember that for multiple choice (single-answer) questions, you are being asked to choose the highest priority or best response because the question only has one answer. More than one choice may be correct, but you need to choose the best answer or highest priority. So be sure to read every choice before submitting your answer. In this case, you have to make the choice about which client requires immediate care. Text Reference - p. 197

Which of the following will help the nurse apply critical thinking skills in her day-to-day routine in an acute care setting? Select all that apply. 1 Discipline 2 Punctuality 3 Responsibility 4 Perseverance 5 Privacy to the client

1 Discipline 3 Responsibility 4 Perseverance It is important for the nurse to have discipline, responsibility, and perseverance in order to have critical thinking. Being exactly on time (punctual) is not essential for critical thinking. The nurse should be available regularly and whenever the client needs him or her. Privacy to the client is not a component of critical thinking. Text Reference - p. 200

The nurse is assessing a client with bowel infection secondary to a colostomy. During the assessment, the nurse learns that the client has not followed the care recommendations she received when she was discharged from the hospital. Which critical thinking attitudes are appropriate for the nurse to exhibit when dealing with this client? Select all that apply. 1 Fairness 2 Hostility 3 Integrity 4 Confidence 5 Punctuality

1 Fairness 3 Integrity 4 Confidence The nurse must always treat the client with fairness, integrity, and confidence to promote positive outcomes for him or her. The nurse should never be hostile to the client. Punctuality is an important factor for a nurse but does not affect the client's compliance. TEST-TAKING TIP: Do not select answers that contain exceptions to the general rule, controversial material, or degrading responses. In this question, you know that a nurse exhibiting hostility is never appropriate--so that choice is easily eliminated. Text Reference - p. 199

A client complains of lower abdominal pain, which is a dull ache and does not radiate. The client expresses that he might be suffering from a heart attack. However, the nurse is convinced that the client is not having a heart attack. How should the nurse act in this situation? Select all that apply. 1 Look at this situation objectively. 2 Use criteria to educate the client. 3 Look at this from the client's point of view. 4 Support the findings and conclusion. 5 Start preliminary treatment for managing a heart attack

1 Look at this situation objectively. 2 Use criteria to educate the client. 4 Support the findings and conclusion. In a healthcare setting, the nurse should analyze the client's situation in an objective manner to prevent any bias or misdiagnosis. The nurse should educate the client by using the criteria (site and nature of the pain) in a polite manner. The nurse should support the findings and conclusions to convince the client. While considering the client's view is important, the nurse must use objective medical judgment when evaluating the client. Since the client has not had a heart attack, the treatment need not be started. Test-Taking Tip: Do not read anything into the question or apply what you did in a similar situation during one of your clinical experiences. If you have nursing experience, ask yourself how a classmate who is inexperienced would answer this question from only the information provided in the textbooks or given in the lectures. Text Reference - p. 193

A nurse tries to apply the concept of critical thinking in clinical practice. What are the characteristics of critical thinking? Select all that apply. 1 Open-mindedness, continual inquiry, and perseverance. 2 Reliance on lab reports and diagnostic results to assess clients. 3 Recognition of an issue, analysis of related information, and formation of conclusions. 4 Imagination and exploration of alternatives, consideration of ethical principles, and informed decision making. 5 Low consideration of what the client says; preference to diagnostic tests and scientific data.

1 Open-mindedness, continual inquiry, and perseverance. 3 Recognition of an issue, analysis of related information, and formation of conclusions. 4 Imagination and exploration of alternatives, consideration of ethical principles, and informed decision making. Critical thinking is a continuous process characterized by open-mindedness, continual inquiry, and perseverance. It may help the nurse to be open to new ideas and incorporate modifications. Critical thinking involves recognizing that an issue exists, analyzing information about the issue, evaluating information, and making conclusions. It is a step-by-step process to come to a logical solution for a client health problem. A critical thinker considers what is important in each clinical situation, imagines and explores alternatives, considers ethical principles, and makes informed decisions about the care of clients. Critical thinking does not depend on only the diagnostic reports and analysis. Text Reference - p. 193

The nurse works in a long-term care facility and understands that integrity is an essential attitude in critical thinking. Which of the following behaviors indicate the nurse's understanding of the "Integrity" aspect of critical thinking? Select all that apply. 1 The nurse follows the highest standards of practice. 2 The nurse questions his or her own knowledge and beliefs. 3 The nurse always has a sense of curiosity about the client's condition. 4 The nurse is honest about and willing to accept his or her mistakes or inadequacies. 5 The nurse keeps looking for more resources until he or she finds a successful approach.

1 The nurse follows the highest standards of practice. 2 The nurse questions his or her own knowledge and beliefs. 4 The nurse is honest about and willing to accept his or her mistakes or inadequacies. In critical thinking, integrity means the nurse should follow the highest standards of practice. The nurse should be honest and accept his mistakes or inadequacies. The nurse should be open-minded and if need arises she should question herself. Having curiosity about the client's condition is included in the "Curiosity" aspect of critical thinking. Looking for more resources until she finds a successful approach is part of the "Perseverance" aspect of critical thinking. Text Reference - p. 201

A nurse assessing a client with genital lesions suspects the client has multiple sexual partners. How should the nurse get more information from the client? Select all that apply. 1 The nurse should be honest. 2 The nurse should be manipulative. 3 The nurse should be tactical. 4 The nurse should ask objective questions. 5 The nurse should ask subjective questions.

1 The nurse should be honest. 3 The nurse should be tactical. 4 The nurse should ask objective questions. The right way of seeking truth from the client is to be honest, tactical, and to ask objective questions. This may prompt the client to provide more information. If the nurse exhibits a manipulative attitude, the client may hesitate to share information. The nurse should not be subjective, as it can embarrass the client. STUDY TIP: A helpful method for decreasing test stress is to practice self-affirmation. After you have adequately studied and really know the material, start looking in the mirror each time you pass one and say to yourself—preferably out loud—"I know this material, and I will do well on the test." After several times of watching and hearing yourself reaffirm your knowledge, you will gain inner confidence and be able to perform much better during the test period. This technique really works for students who are adventurous enough to use it. Text Reference - p. 194

A client complains of epigastric pain. The nurse assumes the problem is gastritis and educates the client about the condition. The client is later diagnosed with mild myocardial infarction. Which statements indicate appropriate management of the situation? Select all that apply. 1 The nurse should provide a straightforward explanation to the client for why the confusion occurred. 2 The nurse should remember the need to be open-minded while looking at the client's information during the initial diagnosis. 3 The nurse should retroactively correlate the client's data to see what was missed. 4 The nurse should try to avoid the situation without further clarification to the client. 5 The nurse should defend her assumptions.

1 The nurse should provide a straightforward explanation to the client for why the confusion occurred. 2 The nurse should remember the need to be open-minded while looking at the client's information during the initial diagnosis. 3 The nurse should retroactively correlate the client's data to see what was missed. The nurse should have performed a proper analysis by being open minded while looking at the client's information. The incorrect diagnosis of gastritis might have been avoided by correlating the client's data, so the nurse should review the data to see what was missed. The nurse should explain care clearly and in a straightforward manner to the client. The nurse should not avoid the situation. Instead of defending the diagnosis, the nurse should accept the mistake. Test-Taking Tip: Do not choose responses that do not support the nurse's accountability for her or his actions. Text Reference - p. 193

On assessment of a chronically bed-ridden client, the nurse suspects the client is at risk for pressure ulcers. What assessment findings help the nurse determine if the client has pressure ulcers? Select all that apply. 1 Warm skin 2 Red lesions 3 Blanching skin 4 Punched out margins 5 Absence of tenderness

1 Warm skin 2 Red lesions Ulcers that are warm on palpation and red in color may be pressure ulcers. Pressure ulcers do not blanch after the pressure from the palpating finger is released. Gastric ulcers are punched out, not pressure ulcers. Usually pressure ulcers are tender to the touch. Text Reference - p. 196

A second-year nursing student works in a surgical unit. A 56-year-old male client admitted to the unit underwent a prostatectomy. The client expresses to the nursing student that he is experiencing some pain and discomfort. The nursing student examines the client's wound. The nursing student decides to use the scientific method of critical thinking while assessing the client. Arrange the steps of the scientific method of critical thinking in the correct order. 1. Collecting essential data 2. Formulating questions 3. Identifying the problem 4. Requesting diagnostic tests 5. Diagnosing the problem

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 client and solving problems. A 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. Establishing nursing diagnosis is a component of the nursing process. Diagnostic tests required for establishing diagnosis are ordered by the primary health care practitioner. Text Reference - p. 195

The nurse understands that critical thinking is important in making clinical decisions. The scientific method is one approach to critical thinking and consists of five important steps. Arrange the steps of the scientific method of critical thinking in the correct sequence. 1. Collecting data 2. Identifying the problem 3. Formulating a question or hypothesis 4. Evaluating results of the study 5. Testing the question or hypothesis

1. Identifying the problem 2. Collecting data 3. Formulating a question or hypothesis 4. Testing the question or hypothesis 5. Evaluating results of the study The scientific method is a general critical thinking approach. It is not specific to clinical nursing and can be applied to other practices as well, especially nursing research. The scientific method consists of five steps. The first steps are to identify the problem that exists and collect relevant data. The data are helpful to formulate a question or a hypothesis that can be tested, which is the next step. The final steps are to test the hypothesis and evaluate the results. Text Reference - p. 195

The nurse cared for a 14-year-old with renal failure who died near the end of the work shift. The health care team tried for 45 minutes to resuscitate the child with no success. The family was devastated by the loss, and, when the nurse tried to talk with them, the mother said, "You can't make me feel better; you don't know what it's like to lose a child." Which of the following examples of journal entries might best help the nurse reflect and think about this clinical experience? Select all that apply. 1 Data entry of time of day, who was present, and condition of the child 2 Description of the efforts to restore the child's blood pressure, what was used, and questions about the child's response 3 The meaning the experience had for the nurse with respect to her understanding of dealing with a client's death 4 A description of what the nurse said to the mother, the mother's response, and how the nurse might approach the situation differently in the future 5 The history of the child's illness

2 Description of the efforts to restore the child's blood pressure, what was used, and questions about the child's response 3 The meaning the experience had for the nurse with respect to her understanding of dealing with a client's death 4 A description of what the nurse said to the mother, the mother's response, and how the nurse might approach the situation differently in the future The nurse can reflect on the effects of the treatment and what was difficult or confusing about the outcome. The nurse reviews the meaning of the experience to help improve understanding of personal comfort and competence in dealing with death and how to respond in the future. The nurse reflects on the communication approach used with the mother to consider if it was appropriate. Text Reference - p. 202

A second-year nursing student works in a surgical unit. A 56-year-old male client admitted to the unit underwent a prostatectomy. The client expresses to the nursing student that he is experiencing some pain and discomfort. The nursing student examines the client's wound. The client also tells the nurse that another nurse visited him a while ago but was rude and did not pay any attention to him. The student nurse apologizes to the client and ensures that the client's needs are fulfilled. The student speaks to the co-worker and manages the situation. Which attitude for critical thinking did the nursing student display here? 1 Curiosity 2 Fairness 3 Creativity 4 Confidence

2 Fairness Fairness is listening to both sides of the story and managing the situation without any prejudice. Curiosity is characterized by exploring and desiring to learn more. Creativity is looking for and exploring different approaches for the client's needs. Confidence is presenting oneself with conviction and being well prepared. Text Reference - p. 200

The surgical unit has initiated the use of a pain-rating scale to assess clients' pain severity during their postoperative recovery. The registered nurse (RN) looks at the pain flow sheet to see the pain scores recorded for a client over the last 24 hours. Use of the pain scale is an example of which intellectual standard? 1 Deep 2 Relevant 3 Consistent 4 Significant

3 Consistent Use of the same pain scale for assessing pain acuity is an example of being consistent. Text Reference - p. 199

The nurse received the Employee of the Year award for her knowledge, courage, honesty, and objectivity. Which concept of critical thinking does the nurse possess according to Facione and Facione (1996)? 1. Analyticity 2. Systematicity 3. Truth-seeking 4. Self-confidence

3. Truth-seeking Truth-seeking is characterized by courage, honesty, and being objective about asking questions in a situation. Therefore, the nurse exhibited the truth-seeking concept of critical thinking behavior in practice. Analyticity is characterized by anticipating possible consequences and using evidence-based knowledge. Systematicity is characterized by organization, focus toward work, and working hard in any inquiry. Self-confidence is characterized by trust and executing practice in a refined process. Text Reference - p. 194

Which of the following is unique to the commitment level of critical thinking? 1 Weighs benefits and risks when making a decision. 2 Analyzes and examine choices more independently. 3 Thinks in a concrete manner. 4 Anticipates when to make choices without others' assistance.

4 Anticipates when to make choices without others' assistance. Anticipating when to make choices during decision making is unique to the commitment level of critical thinking. Thinking concretely is basic critical thinking. Analyzing and examining choices and weighing benefits and risks are characteristic of complex critical thinking. Text Reference - p. 194

Which components can restrict a student nurse's ability to move from a basic level to a complex level of critical thinking? Select all that apply. A. Inexperience B. Inflexible attitude C. Weak competency D. Lack of specific knowledge base E. Lack of policy related to procedures

A. Inexperience B. Inflexible attitude C. Weak competency Student nurses mostly apply the basic level of critical thinking in practice because they are still learning and task-oriented. The student's inexperience due to less exposure, inflexible attitude due to less practice, and weak competency due to less exposure can restrict his or her ability to move from a basic level to a complex level of critical thinking in practice. Student nurses work in all domains and 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 advancement of critical thinking skills. Text Reference - p. 194