Chapter 15: Critical Thinking in Nursing Practice

1. A nurse is caring for a patient in a long-term care facility who has not been sleeping well. She notes that the patient is new to the facility, has been refusing therapy, and is also not eating well. The nurse interprets this to mean that the patient has been having trouble adjusting. The nurse decides to meet with the patient's care team. The team decides to assess the patient's willingness to participate in group recreational activities, The patient agrees to participate. After 1 week, the nurse reevaluates the plan of care and notes that the patient has been sleeping much better. Which of the following terms best describe processes used in the nurse's plan? (Select all that apply.) a. Clinical judgment b. Evidence-based practice c. The nursing process d. Collaborative care planning e. Positive reward process

A, C, D Clinical judgment is a reflective process by which the nurse notices, interprets, responds, and reflects in action. The nursing process is a process by which the nurse assesses, diagnoses, implements, and evaluates the nursing care plan. Consulting and gaining input from the healthcare team is collaborative care planning. Evidence-based practice refers to using interventions found in research studies. The positive reward process is not a term used in care planning.

Which of the following items could be the responsibility of the LPN/LVN for a patient's plan of care? A. Collect data B. Perform nursing interventions C. Initiate the plan of care D. Assist the RN with evaluation of the patient's response to nursing interventions E. Document nursing care

A. Collect data B. Perform nursing D. Assist the RN with evaluation of the patient's response to nursing interventions

In the collaborative process of delivering care based on the nursing process, the responsibility of the LPN/LVN is to: A. Collect data of health status B. Select a nursing diagnosis C. Organize data to help the RN evaluate patient progress D. Prioritize nursing diagnosis for more effective care

A. Collect data of health status

Descriptions of the activities involved in the nursing diagnosis step of the nursing process are: (select all that apply) A. Determination of potential health problems B. Clustering of related assessments C. Sharing of information with the patient and physician D. Determination of desired outcomes E. Evaluation of probable outcomes

A. Determination of potential health problems B. Clustering of related assessments

Activities considered to be aspects of implementation step of the nursing process are: (select all that apply) A. Documentation of care given B. Assembly if supplies C. Analysis of data gathered D. Modification of aspects of the plan. E. Evaluation of the patient response

A. Documentation of care given B. Assembly if supplies

Constant nursing assessments and evaluations of the patient will most likely result in: A. The nursing care plan changing to reflect appropriate priorities B. Small changes in the patient condition being overlooked C. Cluttered and confusing documentation D. Impeded problem solving

A. The nursing care plan changing to reflect appropriate priorities

6. 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

ANS: A Concept mapping challenges the student to synthesize data and identify relationships between nursing diagnoses. The primary 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 the ability to evaluate students' abilities to synthesize data.

20. In which order will the nurse use the nursing process steps during the clinical 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

ANS: A The American Nurses Association developed standards that set forth the framework necessary for critical thinking in the application of the five-step nursing process: assessment, diagnosis, planning, implementation, and evaluation.

11. 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.

ANS: A The critically thinking nurse should explore all options for pain relief first. The nurse should use critical thinking to determine the cause of the pain and determine various options for pain, not just ordered pain medications. The nurse can act independently to determine all options for pain relief and does not have to wait until after the health care provider rounds are completed. Explaining the cause of the pain does not address options for pain relief.

A nursing instructor assigns their clinical group the task of writing a journal depicting the student's clinical day. What is the most likely rationale for this assignment? a. Journaling allows reflection, an important critical thinking skill. b. Journaling gives you time to review what happened in your clinical. c. Journaling is a way to organize your thoughts about your experiences. d. Journaling teaches open-mindedness, a critical thinking disposition.

ANS: A Critical thinking requires reflection on what occurred, how data were processed, and how decisions were made. Journaling is one method of developing critical thinking skills. Journaling does give nurses time to review what happened in their clinical, but this statement does not go far enough in explaining the importance of the journal-writing process. Journaling may be a way to organize thoughts about one's experiences, but this statement is too narrow an explanation and does not account for the critical aspect of reflection. Open-mindedness is a critical thinking disposition that allows one to be tolerant of divergent views. Journaling can assist with developing this disposition, but only if what is written reflects that specific topic.

A home care nurse receives a physician order for a medication that the patient does not want to take because the patient has a history of side effects from this medication. The nurse carefully listens to the patient, considers it in light of the patient's condition, questions its appropriateness, and examines alternative treatments. This nurse would most likely a. call the physician, explain rationale, and suggest a different medication. b. consult an experienced nurse on whether there are other similar treatments. c. hold the drug until the physician returns to the unit and can be questioned. d. question other staff as to the physician's acceptance of nursing input.

ANS: A Determining how best to proceed on behalf of a patient's best health care outcomes may require clinical judgment. At the committed level of critical thinking, the nurse chooses an action after all possibilities have been examined. A home care nurse who is using good clinical judgment techniques should have confidence in their decision and may not have another nurse available as this is an autonomous setting. Holding the drug might jeopardize the patient's health, so this is not the best solution. The nurse working at this level of critical thinking makes choices based on careful examination of situations and alternatives; whether or not the physician is open to nursing input is not relevant.

A new graduate nurse (GN) is working with an experienced nurse to chart assessment findings. The GN notes that the physical therapist wrote on the chart that the patient is lazy and did not want to participate in assigned therapies this AM. The experienced nurse asks the GN what may be going on here. What is the best explanation for this statement? a. Data on the chart can sometimes be documented in a biased manner. b. Data on the chart changes as the patient's condition changes. c. Data on the chart is usually accurate and can be verified from the patient. d. Reading the chart is not a wise use of time as this can be time consuming and tedious.

ANS: A It is important that the nurse records only what is assessed, without adding judgments or interpretations to the record. Data do indeed change (and need to be charted) as the patient's condition changes, but this would not be the best answer to this question. Assessment data may at times be difficult to obtain, but that would not occur often enough to warrant a warning about the difficulty in charting it. Also, obtaining data is clearly a different activity from charting it. Charting can be time consuming and tedious, but this is not the most complete answer to this question.

A student nurse is studying clinical judgment theories and is working with Tanner's Model of Clinical Judgment. The student nurse can generalize the process as a. a reflective process where the nurse notices, interprets, responds, and reflects in action. b. one conceptual mechanism for critiquing ideas and establishing goal-oriented care. c. researching best practice literature to create care pathways for certain populations. d. assessing, diagnosing, implementing, and evaluating the nursing care plans.

ANS: A Looking across theories and definitions of clinical judgment, they all have in common the ability to reflect on data and choose actions. Reflection also considers evaluating the result of the actions to determine whether they were effective. Although critiquing ideas and establishing goal-oriented care could be considered part of a generalized statement of critical thinking, this is not broad enough without the reflection and evaluation. Clinical judgment would most likely be used to create care paths derived from the evidence; however, this is not the cornerstone of the Tanner Model. Clinical judgment is used when engaging in the nursing process, but this is too narrow in focus to capture the essence of critical thinking definitions and theories. Critical thinking is not synonymous with the nursing process.

A nurse has committed a serious medication error and has reported their error to the hospital's adverse medication error hotline as well as to the unit manager. The manager is a firm believer in developing critical thinking skills. From this standpoint, what action by the manager would best nurture this ability in the nurse who made the error? a. Have the nurse present an in-service related to the cause of the error. b. Instruct the nurse to write a paper on how to avoid this type of error. c. Let the nurse work with more experienced nurses when giving medications. d. Send the nurse to refresher courses on medication administration.

ANS: A Nurturing critical thinking skills is done in part by turning errors into learning opportunities. If the nurse presents an in-service on the cause and prevention of the type of error committed, not only will the nurse learn something but many others nurses on the unit will learn from it to. This is the best example of developing critical thinking skills. This option would allow the nurse to learn from the mistake, which is a method of developing critical thinking skills, but the paper would benefit only the nurse, so this option is not the best choice. Letting the nurse work with more experienced nurses might be a good option in a very limited setting, for example, if the nurse is relatively new and the manager discovers a deficiency in the nurse's orientation or training on giving medications in that system. Otherwise, this option would not really be beneficial. Sending the nurse to refresher courses might be a solution, but it is directed at the nurse's learning, not critical thinking. The nurse might feel resentful at having to attend such classes, but even if they were helpful, only this one nurse is learning. Going to generic classes also does not address the specific reason this error occurred, and thus might be irrelevant. Critical thinking and learning can be enhanced by a presentation to the staff on the causes of the error.

A GN appears to be second-guessing herself and is constantly calling on the other nurses to double-check their plan of care or rehearse what they will say to the doctor before she call on the patient's behalf. This seems to be annoying some of the nurse's coworkers. The nurse manager's best response to this situation is to a. explain to coworkers that this is a characteristic of critical thinking and is important for the GN to improve reasoning skills. b. agree with the staff and have someone follow and work more closely with a preceptor. c. have a talk with the nurse and suggest asking fewer questions. d. tell the staff that all new nurses go through this phase, and ignore their behavior.

ANS: A Reflection-on-action is critical for development of knowledge and improvement in reasoning. It is where learning from practice is incorporated into experience. Inquisitiveness is a characteristic of critical thinking and reflects a desire to learn even when the knowledge may not appear readily useful. The manager should promote this. Suggesting the nurse work more closely with a preceptor implies that the manager thinks the nurse needs to learn more and increase confidence. In reality, this nurse is demonstrating a characteristic of critical thinking. Suggesting that the nurse ask fewer questions would hamper the development of the nurse as a critical thinker. All new nurses do go through a phase of asking more questions at one time, but dismissing the nurse's behavior with this explanation is simplistic and will discourage critical thinking.

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

ANS: 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.

16. 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

ANS: B Humility and responsibility are displayed when the nurse realizes lack of knowledge and requests an orientation to the unit. The other answer choices represent inappropriate actions in this situation and are not examples of humility and responsibility. The nurse should explore all options before refusing an assignment. The nurse 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.

3. 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

ANS: B 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.

13. 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.

ANS: B 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 the catheter is not an appropriate action.

19. 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

ANS: B 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. The purpose of the nursing process is to diagnose and treat human responses (e.g., patient symptoms, need for knowledge) to actual or potential health problems. Use of the process allows nurses to help patients meet agreed-on outcomes for better health. The patient's outcomes, having several actual health problems, and a description of the patient's abilities to meet the goal are all appropriate to document in the nursing plan of care.

15. 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

ANS: B The nurse uses creativity in this situation to figure out how the patient 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 the attitude of creativity. Risk taking is demonstrating the courage to speak out or to question orders based on the nurse's own knowledge base.

A nurse has designed an individualized nursing care plan for a patient, but the patient is not meeting goals. Further assessment reveals that the patient is not following through on many items. Which action by the nurse would be best for determining the cause of the problem? a. Assess whether the actions were too hard for the patient. b. Determine whether the patient agrees with the care plan. c. Question the patient's reasons for not following through. d. Reevaluate data to ensure the diagnoses are sound.

ANS: B Having patient and/or family provide input to the care plan is vital in order to gain support for the plan of action. The actions may have been too difficult for the patient, but this is a very narrow item to focus on. The nurse might want to find out the rationale for the patient not following through, but instead of directly questioning the patient, which can sound accusatory, it would be best to offer some possible motives. Reevaluation should be an ongoing process, but the more likely cause of the patient's failure to follow through is that the patient did not participate in making the plan of care.

A patient has been admitted for a skin graft following third degree burns to the bilateral calves. The plan of care involves 3 days inpatient and 6 months outpatient treatment, to include home care and dressing changes. When should the nurse initiate the educational plan? a. After the operation and the patient is awake b. On admission, along with the initial assessment c. The day before the patient is to be discharged d. When narcotics are no longer needed routinely

ANS: B Initial discharge planning begins upon admission. After the operation has been completed is too late to begin the discharge planning process. The day before discharge is too late for the nurse to gather all pertinent information and begin teaching and coordinating resources. After a complicated operation, the patient may well be discharged on narcotic analgesics. Waiting for the patient to not need them anymore might mean the patient gets discharged without teaching being done.

1. 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.

ANS: C 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 patients. Patient care can be provided in many ways. The use 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.

2. 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

ANS: C Asking the patient what pain-relief methods have worked in the past 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. The nurse is to conduct an assessment each shift on assigned patients and intervene accordingly. Pain is subjective. The nurse should offer pain-relief methods based on the patient's reports without being judgmental.

10. 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

ANS: C Interpretation involves being orderly in data collection, looking for patterns to categorize data, and clarifying uncertain data. This nurse is clarifying the data in this situation. Evaluation involves determining the effectiveness of interventions or care provided. The nurse in this scenario is assessing the patient, not evaluating interventions. Self-regulation is reflecting on experiences. Explanation is supporting findings and conclusions. The nurse in this question is clarifying uncertain data (determining cause of the low pulse), not supporting the finding of a low pulse.

12. 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.

ANS: C 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.

5. 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

ANS: C Reflection utilizes critical thinking when thinking back on the effectiveness of interventions and how they were performed. It involves purposeful thinking back or recalling a situation to discover its purpose or meaning. The other 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 the meaning or purpose of a situation. Providing evidence-based explanations for nursing interventions does not always involve thinking back to discover the meaning of a situation.

9. 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.

ANS: C Reviewing the effectiveness of interventions best describes evaluation. Examining the meaning of data is inference. Supporting findings and conclusions provides explanations. Searching for links between the data and the nurse's assumptions describes analysis.

14. 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.

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

17. 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

ANS: D Professional standards promote the highest level of quality nursing care. Application of professional standards requires you to use critical thinking for the good of individuals or groups. Bypassing the patient's feelings is not practicing according to professional standards. The primary 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.

4. 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

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

7. 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

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

8. 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

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

18. 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

ANS: D The standards of professional responsibility that a nurse tries to achieve are the standards cited in Nurse Practice Acts, institutional practice guidelines (hospital/facility policy), and professional organizations' standards of practice (e.g., The American 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.

The nurse is implementing a plan of care for a patient newly diagnosed with type 2 diabetes mellitus. The plan includes educating the patient about diet choices. The patient states that they enjoy exercising and understand the need to diet; however, they can't see living without chocolate on a daily basis. Using the principles of responding in the Model of Clinical Judgment, how would the nurse proceed with the teaching? a. The nurse explains to the patient that chocolate has a high glycemic index. The nurse then focuses on foods that have low glycemic indexes and provides a list for the patient to choose from. b. The nurse explains that the patient may eat whatever they would like as long as the patient's glucose reading and A1c remain stable. c. The nurse derives a new nursing diagnosis of Knowledge Deficit and readjusts the plan of care to include additional sessions with the registered dietician. d. The nurse examines the patient's daily glucose log and incorporates the snack into the time of day that has the lowest readings. The nurse then follows up and evaluates the response in 1 week.

ANS: D Responding entails adjusting the plan of care to the particular patient issue through one or more nursing interventions. In this case, the nurse is working with the patient's wishes, knowing that the patient will most likely cheat. The patient will be allowed to "cheat." The plan will be evaluated to be sure the snack does not elevate the glucose excessively and be readjusted if warranted. While it is true that most chocolate has a high glycemic index, providing a list of foods that do not include the one thing the patient enjoys will most likely lead to nonadherence to the diet. Advising the patient that they can have whatever they want to eat may lead to further dietary indiscretions and cause side effects such as obesity or high glucose readings. Knowledge Deficit is an inaccurate diagnosis for this patient as evidenced by the patient stating they understand the need to exercise and the need to diet.

Once the nursing plan has been initiated, the nursing care plan will: A. stay in place until all nursing goals have been met. B. Change as the patient's condition changes C. remain on the patient record to show progress D. be given to the patient for final approval

B. Change as the patient's condition changes

The activity that is implementation in nursing care is: A. Checking the assigned patient's blood pressure, pulse, and respiration B. Changing the patient's surgical dressing C. Asking the patient to demonstrate how to give himself medication after teaching him D. Discussing the patient with other team members to establish a care plan

B. Changing the patient's surgical dressing

When a nurse prioritized the patient care, consideration is given to: A. Completing assessments before mid-shift B. Considering situations that may result in an alteration of health C. Assuming all health care activities for a group of patients D. Identifying who can assist with the aspect of care

B. Considering situations that may result in an alteration of health

When a patient states, "I can't walk very well," the first problem-solving step would be to: A. Consider alternatives such as a wheelchair or walker B. Find out what the problem is, such as weakness or poor balance C. Choose the alternative with the best chance of success D. Consider the outcomes of the choices, such as danger of falling with a walker

B. Find out what the problem is, such as weakness or poor balance

The nurse completing morning assessments on a patient who is sitting up in bed is told by the patient, "I'm having trouble breathing-I can't seem to get enough air." The best nursing response is to: A. Notify the doctor as soon as he or she comes in later in the morning B. Further assess the assigned patient and notify the charge nurse C. Reassure the patient, if his BP and pulse are normal D. Notify the charge nurse immediately of the patient's statement

B. Further assess the assigned patient and notify the charge nurse

Which of the following nursing actions is the best example of problem solving? A. Requesting the IV team to start an antibiotic drip on a patient with a history of being a difficult stick B. Offering to call the kitchen to provide an alternate breakfast for a patient who does not like cooked cereal C. Trying several difficult wound dressings to determine which one the patient can apply the most effectively D. Calling for another pain medication order when the current drug results in the patient experiencing nausea

B. Offering to call the kitchen to provide an alternate breakfast for a patient who does not like cooked cereal

Which of the following is an example of a nurse's statement that reflects using the scientific method in the nursing process? A. "I believe that this patient is getting depressed." B. "The patient doesn't look right to me; I think something is wrong." C. "The patient's husband told me that she is feeling very uncomfortable." D. "The patient reports more pain than yesterday and her blood pressure is elevated."

B."The patient doesn't look right to me; I think something is wrong."

The nurse who uses the nursing process will: A. Help reduces the obvious signs of discomfort B. Help the patient adhere to the physician's treatment protocol C. Approach the patient's disorder in a step-by-step method D. Make all significant nursing care decisions involving patient care

C. Approach the patient's disorder in a step-by-step method

When a resident in the nursing home complains of constipation, the nurse performs a digital rectal examination and finds a hard fecal mass. This is an example of: A. Implementation B. Nursing Diagnosis C. Assessment D. Evaluation

C. Assessment

The order in which the nursing process is approached is: A. Planning, assessment, implementation, nursing diagnosis, evaluation B. Nursing diagnosis, evaluation, assessment, Implementation, planning C. Assessment, nursing diagnosis, planning, implementation, evaluation D. Evaluation, nursing diagnosis, planning, implementation, assessment

C. Assessment, nursing diagnosis, planning, implementation, evaluation

The participants of the planning stage of the nursing process during which the health goals are defined included the: A. RN B. Health team led by the RN C. Health team, the patient, and the patient's family D. Health team as directed by the physician

C. Health team, the patient, and the patient's family

The effect of using a scientific problem-solving approach in nursing care will cause decision making to be: A. Slowed down considerably by the multiple steps B. Rigid and non-patient oriented C. Improved nursing care outcomes D. Unrelated to the nursing process

C. Improved nursing care outcomes

Critical thinking is considered to be the keystone and foundation of the development of ______________________.

Clinical Judgment

The tasks of synthesizing data and linking nursing interventions with patient health problems are enhanced by the process of _________________.

Concept Mapping

When the nurse constructs a nursing approach after careful judgment and sound reasoning, the nurse has used a system of _______________.

Critical Thinking

A nurse will arrive at a nursing diagnosis through the nursing process step of: A. Planning B. Evaluation C. Research D. Assessment

D. Assessment

An emergency room nurse will give first priority to the patient with the most critical need, which is the patient who: A. Is bleeding from a chin laceration B. Complains of a productive cough C. Has a fever of 102F D. Complains of severe chest pain

D. Complains of severe chest pain

When the nurse checks to see whether a patient has had relief 45 minutes after administering pain medication, the nurse is performing an: A. Nursing diagnosis B. Implementation C. Assessment D. Evaluation

D. Evaluation

A student nurse can begin to develop critical thinking skills by means of: A. Working with a more experienced nurse. B. Questioning every statement made by instructors to be sure of its correctness C. Memorizing class notes for tests and studying all night for big tests D. Listening attentively and focusing on the speaker's words and meaning

D. Listening attentively and focusing on the speaker's words and meaning