Critical Thinking (Chapters 17 and 18)

15. A nurse is interested in improving patient care on the unit through performance improvement. What is the first step in this process? A) Discover the problem. B) Plan a strategy. C) Implement a change. D) Assess the change.

A) Discover the problem.

18. Why are quality-assurance programs important in nursing? A) They enable nursing to be accountable for the quality of care. B) They facilitate increased enrollment in educational programs. C) They specify how resources are used or not used. D) They allow increased retention of qualified nurses.

A) They enable nursing to be accountable for the quality of care.

6. What phrase best describes nurse-initiated interventions? A) nurse-prescribed interventions B) physician-prescribed interventions C) healthcare team interventions D) interventions based on medical orders

A) nurse-prescribed interventions

20. According to the American Nurses Association, who determines the scope of nursing practice? A) nurses B) lawyers C) physicians D) consumers

A) nurses

12. A nurse in a community health center has been having regular meetings with a woman who wants to stop smoking. Which of the following outcome decision options would the nurse document if the woman has not smoked for 3 months? A) outcome met B) outcome partially met C) outcome not met D) outcome inappropriate

A) outcome met

1. What is the unique focus of nursing implementation? A) patient response to health and illness B) patient response to nursing diagnosis C) patient compliance with treatment regimen D) patient interview and physical assessment

A) patient response to health and illness

15. Each time a nurse administers an insulin injection to a patient with diabetes, she tells the patient what she is doing and demonstrates each step of preparing and giving the injection. What is the nurse promoting? A) self-care B) dependence C) coping with disability D) nursepatient relationship

A) self-care

2. What is the purpose of evaluation in the nursing process? A) to direct future nursing interventions B) to formulate a database of nursing diagnoses C) to complete an initial plan of care D) to transfer medical orders to the plan of care

A) to direct future nursing interventions

2. What is one advantage of having a standard classification of nursing interventions? A) to standardize nomenclature (names or terms) B) to legitimize the use of the nursing process C) to classify indicators of patient outcomes D) to facilitate documentation of expected goals

A) to standardize nomenclature (names or terms)

7. Which of the following examples of nursing actions involve direct care of the patient? A) A nurse counsels a young family who is interested in natural family planning B) A nurse massages the back of a patient while performing a skin assessment C) A nurse arranges for a consultation for a patient who has no health insurance D) A nurse helps a patient in hospice fill out a living will form E) A nurse arranges for physical therapy for a patient who had a stroke. F) A nurse comforts a distraught patient whose baby was stillborn

A, B, D, E

16. A nurse working in a hospital setting discovers problems with the delivery of nursing care on the pediatric unit. Which of the following suggestions from the Institute of Medicines Committee on Quality of Health Care in America (Kohn, Corrigan, & Donaldson, 2000) could help redesign and improve care? Select all that apply. A) Base care on continuous healing relationships. B) Customize care based on available resources. C) Keep the nurse as the source of control. D) Share knowledge and allow for free flow of information E) Practice evidence-based decision making F) Emphasize safety as a system property.

A, D, E, F

12. A nurse is preparing to insert an intravenous line and begin administering intravenous fluids. The patient has visitors in the room. What should the nurse do? A) Ask the visitors to leave the room. B) Ask the patient if visitors should remain in the room. C) Tell the patient to ask the visitors to leave the room. D) Wait until the visitors leave to begin the procedure.

B) Ask the patient if visitors should remain in the room.

14. A nurse has developed a plan of care for the nursing diagnosis Risk for Loneliness for a recently widowed man. When evaluating the plan, the man tells the nurse new information about his active social life. What would the nurse do next? A) Continue with the plan. B) Delete the nursing diagnosis. C) Tell the patient he is lonely. D) Adjust the time criteria.

B) Delete the nursing diagnosis.

23. A nurse forgets to raise the railings of the bed of a patient who is confused after taking pain medications. The patient attempts to get out of bed, and suffers a minor fall. The nurse asks a colleague who witnessed the fall not to mention it to anyone because the patient only had minor bruises. What would be the appropriate action of the colleague? A) No other steps need to be taken, since the patient was not seriously injured. B) The colleague should inform the nurse that a full report of the incident needs to be made. C) The colleague should monitor the patient closely for any adverse effects of the fall. D) The colleague should report the incident in a peer review of the nurse.

B) The colleague should inform the nurse that a full report of the incident needs to be made.

22. A nurse evaluates nursing care and outcomes for a current patient by using direct observation of nursing care, patient interviews, and chart review to determine whether the specified evaluative criteria are met. This practice is known as: A) a nursing audit B) a concurrent evaluation C) a retrospective evaluation D) an evaluation of patient satisfaction

B) a concurrent evaluation

9. A nurse is teaching a patient how to administer insulin, with the expected outcome that the patient will be able to self-administer the insulin injection. How would this outcome be evaluated? A) asking the patient to verbally repeat the steps of the injection B) asking the patient to demonstrate self-injection of insulin C) asking family members how much trouble the patient is having with injections D) asking the patient how comfortable he or she is with injections

B) asking the patient to demonstrate self-injection of insulin

5. What cognitive processes must the nurse use to measure patient achievement of outcomes during evaluation? A) intuitive thinking B) critical thinking C) traditional knowing D) rote memory

B) critical thinking

17. The nursing staff on a hospital unit are using peer review to improve professional performance. Who performs the review? A) unit manager B) nurses C) patients D) visitors

B) nurses

3. The researchers developing classifications for interventions are also committed to developing a classification of which of the following? A) diagnoses B) outcomes C) goals D) data clusters

B) outcomes

8. A nurse documents the following diagnosis for a hospitalized patient: Risk for Imbalanced Nutrition: More Than Body Requirements. What is the major goal of interventions for a risk diagnosis? A) reduce or eliminate contributing factors B) prevent the problem C) collect additional data D) promote higher-level wellness

B) prevent the problem

4. Nurses evaluate many aspects of the healthcare delivery system. Which of the following is always the primary concern when performing the evaluating step of the nursing process? A) the nurse B) the patient C) the healthcare system D) outcome achievement

B) the patient

10. A nurse is counseling a novice nurse who gives 150% effort at all times and is becoming frustrated with a healthcare system that provides substandard care to patients. Which of the following advice would be appropriate in this situation? Select all that apply. A) Tell the new nurse to help other nurses perform their jobs to ensure quality patient care is being delivered. B) Encourage the new nurse to leave her problems at work behind, instead of rehashing them at home. C) After establishing a reputation for delivering quality nursing care, have her seek creative solutions for nursing problems. D) Tell her to view nursing care concerns as challenges rather than overwhelming obstacles and seek help for solutions. E) State that if resources do not permit quality care, it is not the role of the new nurse to explore change strategies within the institution. F) Tell the nurse that if administration is not supportive, moving to another practice setting might be more appropriate.

B, C, D, F

16. Which of the following statements accurately describe a recommended guideline for implementation? Select all that apply. A) When implementing nursing care, remember to act independently, regardless of the wishes of the patient/family. B) Before implementing any nursing action, reassess the patient to determine whether the action is still needed. C) Assume that the nursing intervention selected is the best of all possible alternatives. D) Consult colleagues and the nursing and related literature to see if other approaches might be more successful. E) Reduce your repertoire of skilled nursing interventions to ensure a greater likelihood of success. F) Check to make sure that the nursing interventions selected are consistent with standards of care.

B, D, F

6. A nurse is evaluating an established plan of care. After identifying the evaluative criteria and standards (expected patient outcomes), what must the nurse do next? A) Interpret and summarize findings. B) Document his or her judgment. C) Collect data about patient responses. D) Formulate a new plan of care.

C) Collect data about patient responses.

19. Which of the following are major premises of a quality-improvement program? Select all that apply. A) It focuses on organizational structure. B) It is driven by external factors. C) It focuses on processes rather than individuals. D) It has no end points. E) Its outcome is focused on assuring quality. F) It focuses on data and statistical thinking.

C) It focuses on processes rather than individuals. D) It has no end points. F) It focuses on data and statistical thinking.

4. What activity is carried out during the implementing step of the nursing process? A) Assessments are made to identify human responses to health problems. B) Mutual goals are established and desired patient outcomes are determined. C) Planned nursing actions (interventions) are carried out. D) Desired outcomes are evaluated and, if necessary, the plan is modified.

C) Planned nursing actions (interventions) are carried out.

19. A nurse delegates a specific intervention to a UAP. What implications does this have for the nurse? A) The UAP is responsible and accountable for his or her own actions. B) Nurses do not have authority to delegate interventions. C) The nurse transfers responsibility but is accountable for the outcome. D) The UAP can function in an independent role for all interventions.

C) The nurse transfers responsibility but is accountable for the outcome.

9. A nurse is changing a sterile pressure ulcer dressing based on an established protocol. What does this mean? A) The nurse is using critical thinking to implement the dressing change. B) The patient has specified how the dressing should be changed. C) Written plans are developed that specify nursing activities for this skill. D) The physician verbally requested specific steps of the dressing change.

C) Written plans are developed that specify nursing activities for this skill.

7. Which of the following is a descriptor that helps to define the term criteria? A) immeasurable qualities B) established by authority C) acceptable level of performance D) evidence-based practice

C) acceptable level of performance

13. A nurse is catheterizing a patient. What action illustrates respect for the patients privacy? A) explaining the procedure to the family B) leaving the patients pajamas on C) closing the door to the room D) asking another nurse if he wants to watch

C) closing the door to the room

5. What role of the nurse is crucial to the prevention of fragmentation of care? A) advocate B) teacher C) counselor D) coordinator

C) counselor

17. The staff in a long-term care facility often plays loud rock music on the radio and designs childrens games as exercise. What is the staff doing in this situation? A) considering the hearing level of older adults B) failing to consider visual deficits that occur with aging C) ignoring the developmental needs of older adults D) meeting needs for sensory input and exercise

C) ignoring the developmental needs of older adults

11. A plan of care for a patient with a low potassium level includes providing information about the effect of medications and dietary intake of foods high in potassium. How would a nurse measure achievement of an outcome for this plan? A) physical assessment B) health history C) laboratory data D) patient statements

C) laboratory data

22. What core value of nursing care is missing when a nursing intervention is delegated to a UAP? A) communication B) patient teaching C) nurse/patient dynamic D) competent care

C) nurse/patient dynamic

21. What is evaluated when conducting a nursing audit? A) physical environment B) policies and procedures C) patient records D) patient satisfaction

C) patient records

14. A student is ambulating a patient for the first time after surgery. What would the student do to anticipate and plan for an unexpected outcome? A) Take the patients vital signs after ambulation. B) Ask the patients wife to assist with ambulation. C) Delay ambulation until the following shift. D) Ask another student to help with ambulation.

D) Ask another student to help with ambulation.

18. A nurse administers a medication for pain but forgets to document it in the patients medical record. Legally, what does this mean? A) Nothing, the nurses honesty will not be questioned. B) The nurse can add the documentation after the patient goes home. C) The physician will verify that the nurse carried out the order. D) In the eyes of the law, if it is not documented, it was not done.

D) In the eyes of the law, if it is not documented, it was not done.

1. Which of the following best summarizes the evaluating step of the nursing process? A) The nurse completes a health assessment to establish a database. B) The patient and family have met healthcare goals and no longer need care. C) The nurse and patient identify nursing diagnoses and appropriate interventions. D) The nurse and patient measure achievement of planned outcomes of care.

D) The nurse and patient measure achievement of planned outcomes of care.

13. Patient lost 2 of the 5 pound/month goal. How should the nurse alter the plan of care in response to this new data? A) The nurse should not alter the plan of care. B) The nurse should change the diet. C) The nurse should delete the nursing diagnosis. D) The nurse should modify the time criteria.

D) The nurse should modify the time criteria.

10. What must occur before physician-initiated interventions can be carried out? A) They must be written on the nursing plan of care. B) The nurse relinquishes all responsibility for them. C) Any healthcare provider may order them. D) The physician gives a verbal or written order.

D) The physician gives a verbal or written order.

3. Which of the following would not be part of the nurses decision about care after evaluating the patients responses to the plan of care? A) terminate the plan of care B) modify the plan of care C) continue the plan of care D) begin the plan of care

D) begin the plan of care

8. A nurse is evaluating the outcomes of a plan of care to teach an obese patient about the calorie content of foods. What type of outcome is this? A) psychomotor B) affective C) physiologic D) cognitive

D) cognitive

21. What characteristic of a competent nurse practitioner enables nurses to be role models for patients? A) sense of humor B) writing ability C) organizational skills D) good personal health

D) good personal health

20. A hospital is evaluating its policies and procedures. What type of evaluation is the hospital conducting? A) outcome B) process C) quality D) structure

D) structure

11. A patient who was previously awake and alert suddenly becomes unconscious. The nursing plan of care includes an order to increase oral intake. Why would the nurse review the plan of care? A) to implement evidence-based practice B) to ensure the order follows hospital policy C) to be sure interventions are individualized D) to be sure the intervention is safe

D) to be sure the intervention is safe