EAQ : Chapter 04 : Critical Thinking in Nursing

Critical thinking characteristics, theoretical and experiential knowledge, interpersonal skills, and technical competencies

The Critical Thinking Model includes four concepts:

Theoretical and experiential knowledge help in:

proper assessment and effective care plan development; however, they do not help in conflict management.

According to Paul, which intellectual standards should a nurse possess for critical thinking? Select all that apply.

A. Clear B. Intuitive C. Plausible D. General E. Complete Answer: (A, C, E) Rationale According to Paul, there are 14 intellectual standards that are universal for critical thinking: clear, precise, specific, accurate, relevant, plausible, consistent, logical, deep, broad, complete, significant, adequate (for purpose), and fair. These are guidelines or principles to enhance rational thinking that can be used in daily nursing practice. Intuition is an example of inference, and general is not an intellectual standard. (pp. 56-57)

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 patient 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 patients. Critical thinking does not depend on only the diagnostic reports and analysis. (pp.59)

Maintaining high standards is key to:

critical-thinking character and helps ensure the delivery of quality care, but it does not specifically relate to teamwork and conflict management.

Technical competencies:

indicate the skill and expertise of the nurses attained during nursing practice.

Which techniques would the student nurse use to develop critical thinking skills and bring theory into practice? Select all that apply.

A. Concept mapping B. Reflective journaling C. Meeting with patients D. Discussion with colleagues E. Memorizing clinically relevant facts Answer: (A, B, D) Rationale Reflective journaling involves recollecting the daily incidences and writing them down for further reference. This helps improve critical thinking skills and clarifies concepts for further reference. Concept mapping is a teaching-learning strategy that has been linked with improved critical-thinking skills in nurses. Whether in an academic setting or in the clinical area, discussion of a problem, issue, or situation with colleagues may improve critical thinking. Through dialogue with others who have expertise or experience with the issue being faced, knowledge gaps can be filled, erroneous assumptions exposed, and unconscious biases addressed. Meeting with patients and memorizing clinically relevant facts helps develop knowledge, not critical thinking. (pp. 43-45)

Which attitudes are essential for critical thinking? Select all that apply.

A. Confidence B. Fairness C. Discipline D. Curiosity E. Risk avoidance Answer: (A, B, C, D) Rationale Certain attitudes are essential in the nurse for critical thinking. The nurse should have confidence in her knowledge and abilities. The nurse should be fair in the care she performs. Discipline helps in thorough and critical assessment of any problem. Curiosity helps the nurse question the existing practices and improves the standard of care. Risk-taking abilities help a nurse implement new standards of care, but the risks should always be calculated. (p. 59)

Which processes require critical thinking skills? Select all that apply.

A. Creativity B. Judgment C. Risk taking D. Problem solving E. Decision making Answer: (B, D, E) Rationale Judgment, problem solving, and decision making are processes that require critical thinking because they all require proper evaluation and validation of the gathered information. Creativity and risk taking are traits required by a nurse to become an effective critical thinker. (pp. 55, 59)

Which behaviors are obstacles to the development of critical thinking? Select all that apply.

A. Curiosity B. Biased views C. Self-confidence D. Overconfidence E. Failure to accept mistakes Answer: (B, D, E) Rationale Critical thinking requires certain attitudes. A nurse should be confident but not overconfident. An overconfident nurse may not be open to suggestions and modifications. A nurse who has biased views may not be open to ideas and may have an inclination toward a particular goal or outcome. This is a major obstacle to critical thinking. The nurse should accept his or her mistakes; failure to do so may hinder the process of critical thinking. Curiosity and self-confidence are helpful attitudes in critical thinking. (pp. 60-61)

Which critical thinking attitude would the nurse possess to develop new solutions to patient-related problems?

A. Curiosity B. Creativity C. Integrity D. Humility Answer: (B) Rationale 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 a technique by which the nurse can explore the patient's conditions and emotions. Integrity tests the knowledge and beliefs of the nurse. A nurse can feel humility, but it is not an attitude that leads to new solutions. (p. 59)

The nurse instructs the parents of a malnourished child to make the child's food colorful and attractive. Which trait of critical thinking is the nurse exhibiting?

A. Fairness B. Curiosity C. Discipline D. Creaivity Answer: (D) Nurses require various traits such as fairness, risk taking, creativity, curiosity, discipline, and perseverance. In this case, the nurse is trying to stimulate the appetite of the child by instructing the parents to make the food colorful and attractive. This shows that the nurse is using the trait of creativity. Fairness is the trait of a nurse who avoids personal bias while caring for a patient. Curiosity is the trait of a critical thinking nurse who always tries to ask "why?" A disciplined nurse follows a systematic approach to plan and achieve goals. (p. 59)

Which character traits are needed by a nurse to develop the ability to think critically? Select all that apply.

A. Honesty B. Creativity C. Validation D. Confidence E. Clarification Answer: (A, B, D) Rationale Critical thinking is an art that helps make the process of thinking more clear, precise, and accurate. Character traits such as fair-mindedness, honesty, creativity, and confidence help nurses to develop critical thinking. Nurses have to validate and clarify the information obtained after assessing patients. Validation and clarification are components of critical thinking. (p. 59)

Which concept in the Critical Thinking Model focuses on teamwork and conflict management?

A. Interpersonal skills B. Technical competencies C. Maintaining high standards D. Theoretical & experiential knowledge (A)

Which process helps in linking thoughts and ideas to develop a solution?

A. Judgment B. Reasoning C. Problem solving D. Decision making Answer: (B) Rationale Reasoning is the process of thinking logically to connect ideas in a meaningful way. Therefore reasoning is helpful in scientific inquiry and solving problems. Judgment is a decision made after systematic analysis of the problem. Problem solving is the process of using a scientific and analytical approach for finding solutions to a problem. Decision making refers to the process of making a choice from the various available options after making proper assumptions. (p. 55)

Which process helps analyze an issue using a systematic approach?

A. Judgment B. Reasoning C. Problem solving D. Decision making Answer: (C) Rationale Problem solving is the process of analyzing the problem in a systematic way. Judgment involves deriving a solution after critically analyzing the problem. Reasoning is the process that helps in linking thoughts and ideas together to derive a solution. Decision making is the process of choosing a solution from the findings or gathered information. (p. 55)

A patient with depression says, "I've really been struggling with insomnia this week." The nurse replies, "Am I correct that you're saying you've been having difficulty sleeping this week?" Which intellectual standard of critical thinking is the nurse demonstrating?

A. Logic B. Depth C. Clarity D. Accuracy Answer: (C) Rationale The nurse is rechecking the patient's concern by rephrasing and restating what the patient said. This helps ensure clarity regarding the problem. Logic is an intellectual standard of critical thinking that helps in finding the relationship between the problem and the conclusion made. Depth refers to the critical thinking standard that involves the assessment of the factors that led to the problem. Accuracy is the intellectual standard that involves the method of verifying and validating the data collected from the patient. (p. 57)

Which concepts are included in the intellectual standards of critical thinking? Select all that apply.

A. Logic B. Humility C. Relevance D. Risk taking E. Significance Answer: (A, C, E) Rationale The nurse uses the intellectual standards of critical thinking while addressing an issue. The intellectual standards of critical thinking include logic, relevance, significance, breadth, depth, and accuracy. The nurse uses logic to combine the thoughts of an issue and draws a conclusion from the combination of thoughts. The nurse focuses on the facts that are directly related to the problem under consideration. This indicates relevance. The nurse focuses on points of significance and concentrates on the most important points of the available information to draw a conclusion. Humility and risk taking are traits that a nurse possesses to become a critical thinker. (pp. 56-57)

Which method would a student nurse use to reflect on and analyze thoughts, actions, and knowledge?

A. Meditation B. Mindfulness C. Thoughtfulness D. Reflective journaling Answer: (D) Rationale Reflective journaling is a method by which the nurse can find the reasons for a particular behavior and analyze her thought process, actions, and knowledge. It helps the nurse make quality decisions for patient care. Meditation helps increase concentration and relieves stress. Thoughtfulness is a part of critical thinking and refers to considering the feelings of others. Mindfulness helps one focus and concentrate on present situations. (p. 55)

Which actions by a nurse indicate an attitude of open-mindedness? Select all that apply.

A. Respecting the patient's views on treatment options B. Insisting that a patient choose typical treatment modalities C. Ignoring his or her own prejudices when working with a patient D. Developing a tolerance for differences of opinion E. Discouraging a patient against follow-up visits Answer: (A, D) Rationale Being open-minded means the nurse respects the patient's views and develops tolerance to differences of opinion. Respecting the patient's beliefs helps the nurse gain the patient's trust and establishes a therapeutic relationship. The nurse should not insist on typical treatment modalities in case the patient is against those methods. In nursing practice, the nurse should be sensitive to his or her own prejudices. Further visits by the patient should be encouraged. (p. 61)

Which data collected on a patient by the nurse can be considered objective data? Select all that apply.

A. Rolling of eyes B. Grimace on face C. Presence of lesions on leg D. Decrease in hemoglobin level E. Increase in body temperature Answer: (C, D, E) Rationale The nurse interprets and validates both subjective and objective data. Objective data include laboratory findings, clinical manifestations, and the results of diagnostic tests. The presence of lesions on the patient's leg is objective data as it is a clinical manifestation. A decrease in the hemoglobin level and an increase in body temperature are objective data as they are laboratory findings. Rolling of the eyes and a grimace on the face are subjective data because different people can interpret them differently. STUDY TIP: Objective data is observable by another individual. It is not subject to your or the patient's interpretation. Practice distinguishing objective data from subjective data in your study group. p. 58

Which measures can be taken by a nurse who is working on a new unit in order to best care for the needs of the patients? Select all that apply.

A. Spend more time on initial assessment. B. Request an assignment to another unit. C. Provide nonspecific interventions to the patient. D. Constantly assess and monitor patients for health needs. E. Observe the patient's behavior and measure physical findings. Answer: (A, D, E) Rationale The nurse should improve his clinical decision-making skills by spending more time in initial assessment; this helps better assess the patient's needs. Observing the patient's behavior and measuring physical findings promotes better assessment and formulation of nursing diagnoses. The nurse should constantly assess and monitor the patients so that the care plan can be modified as needed. The nurse's learning may come to a halt if he is transferred to a less demanding position. Providing nonspecific interventions is not ethically acceptable. (pp. 55-56)

The health care team works to resuscitate a child with renal failure without success. When the nurse attempts to speak with family, the mother says, "You can't make me feel better; you don't know what it's like to lose a child." Which journal entries would help the nurse reflect on this clinical experience? Select all that apply.

A. The history of the child's illness B. Data entry of time of day, who was present, and condition of the child C. The meaning the experience had for the nurse with respect to her understanding of dealing with a patient's death D. Description of the efforts to resuscitate the child, what was used, and questions about the child's response E. 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 Answer: (C, D, E) Rationale 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. Reflecting is thinking that examines actions and beliefs. The history of the child's illness and data concerning dates, attendees, and the condition of the child do not contribute to this reflection. (p. 55)

Which action should the nurse take when responding to a patient who asks why a rash developed following antibiotic administration?

A. Use previous knowledge. B. Create an independent explanation. C. Inquire why the patient is concerned. D. Determine which primary health care provider prescribed the drug. Answer: (A) Rationale A nurse has to use previous knowledge before answering the patient's queries. A nurse should not create an independent explanation, as it could be wrong and misleading. If the nurse is unable to give any explanation, a senior staff member should be consulted for guidance. A nurse should not ask "why" to the patient; it could lead to patient distrust and withholding information. Knowing the primary health care provider will not help determine the reason for the reaction. (p. 56)

A student nurse is assigned to care for a patient admitted with severe abdominal pain. Initial interventions are unsuccessful in reducing the pain, so the student looks for different approaches to the patient's pain relief. Which attitude for critical thinking is displayed by the student nurse?

Answer: Creativity. Rationale Creativity is an attitude of critical thinking that involves exploring different approaches if the interventions are not working for the patient. Fairness is making decisions without prejudice. Discipline is being thorough in work and managing time effectively. Risk taking is being courageous and questioning interventions if needed. (p. 59)

Interpersonal skills such as:

teamwork, conflict management, and advocacy are important in critical thinking.

Which action by the nurse demonstrates humility?

A. A willingness to try new ideas. B. Admission of mistakes. C. Upholding high standards of care. D. Always taking the suggestions of others. Answer: (B) A nurse who can admit his or her mistakes and is aware of his or her own limitations reflects humility. A nurse who is willing to try new ideas is a risk taker. A nurse always follows the highest standards for patient care even in the face of adversity; this is integrity. Nurses must be open-minded and listen to others' opinions but also must be able to think independently before coming to a final conclusion. (p. 59)

A pregnant patient with epilepsy is prescribed phenytoin, which is teratogenic. Which clinical action by the nurse is appropriate?

A. Administer as ordered. B. Question the order. C. Discontinue the medication. D. Replace phenytoin with carbamazepine. Answer: (B) Rationale The nurse should use knowledge of the drug and patient status to be able to question the prescription. A nurse should not follow the prescription blindly, as it could cause potential adverse effects. A nurse cannot change the drug without the primary health care provider's approval. A nurse should not stop giving the medication without notifying the provider, as doing so could make the disease worse. (p. 44)

While caring for a patient with cancer, the nurse finds that the patient is anemic. Which reflective question by the nurse indicates effective critical thinking?

A. "What should be included in the diet of the patient?" B. "How does anemia develop in a cancer patient?" C. "Which medication can be prescribed to the patient? D. "What are the side effects of the medication prescribed?" Answer: (B) Rationale The nurse is able to pose a question whenever he or she finds an issue or complication in the patient. As a part of critical thinking, the nurse has to think about how and why the complication has happened. The nurse thinks about the cause of the complication before planning an intervention such as a diet plan. This allows the nurse to deliver effective care. It is not a correct practice to consider the medication before determining the cause of the complication. The nurse can think about the side effects of the medication after finding the cause because sometimes medications may have side effects that result in serious complications. (p. 55)

A postoperative patient complains of pain 1 hour after receiving an opiate analgesic. On re-assessment, the nurse finds that the patient is anxious and determines this condition may be increasing the pain perception. Which nursing intervention is most appropriate in this situation?

A. Administer another opioid analgesic per standing orders. B. Administer drugs that relieve anxiety per standing orders. C. Promote meditation to relieve anxiety. D. Administer an analgesic that is not an opiate per standing orders. Answer: (B) Rationale The patient has pain that may be perceived by the patient as worse due to anxiety. Therefore appropriate measures should be taken to relieve the anxiety, such as administering antianxiety drugs. If there is no relief after the antianxiety drug, further assessment is needed. Opioid analgesics are not a primary intervention in this patient. Meditation reduces anxiety, but it is not an appropriate measure for a postoperative patient. Analgesics that are not opiates in nature are less effective than opiate analgesics; in any case pain medications are not a primary intervention in the patient. STUDY TIP: If you find you are anxious, try exercising to reduce stress. Three 10-minute bursts of exercise are as valuable as one 30-minute session, so don't be concerned if you can't fit 30 minutes into your day at one time. pp. 59-60

Which characteristics would the nursing student adopt to become a good critical thinker? Select all that apply.

A. Analysis B. Inquisitiveness C. Diagnostic ability D. Systematic thinking E. Overconfidence Answer: (A, B, D) Rationale To be a critical thinker, it is essential to be analytical. The nursing student should analyze a problem and estimate the possible results. The nurse should also be systematic in order to stay organized and focused on the work. Inquisitiveness—to always ask "why?"—is necessary to learn more and acquire knowledge and understanding. Establishing a nursing diagnosis is a part of the nursing process and not a concept for critical thinking. The nurse should have self-confidence but should not be overconfident. The nurse should be open-minded and mature enough to accept mistakes for the betterment of the patient if required. (pp. 55-56)

Which nursing actions improve the quality of nursing care? Select all that apply.

A. Appeal to tradition. B. Ask questions. C. Be open to changes. D. Make sound decisions. E. Seek new knowledge. Answer: (B, C, D, E) Rationale Nurses maintain certain characteristics to improve the quality of their professional practice. They ask questions to clarify problems. They are open to changes and make accurate decisions to improve the health of the patient. Inquisitive nurses or nurses who seek new knowledge can have good critical thinking skills. Critical thinking plays a vital role in delivering effective nursing care. Nurses avoid an overreliance on traditional practices, as it can stifle innovation and creativity. (p. 55)

Which stages of patient care are included in the nursing process? Select all that apply.

A. Assessment B. Intervention C. Nursing diagnosis D. Rehabilitation E. Pathological reports and screening Answer: (A, B, C) Rationale A nursing process consists of five phases of patient care. The first phase is assessment, in which the nurse collects data from the patient by interviewing the patient and by performing a physical examination. Diagnosis is the second step, in which the nurse formulates the specific need statement of the patient based on the assessment data. Intervention is the third step and includes nursing care to meet the patient needs identified during assessment and diagnosis. Rehabilitation and pathological reports and screening are not stages of patient care. (p. 60)

A nurse attempting to decrease the patient's adverse reactions to prescribed medications is unable to find information about the medication in any of the hospital databases or electronic health records. Which action should the nurse take in this situation?

A. Avoid administering the medication. B. Contact the hospital pharmacist. C. Contact the primary health care provider. D. Ask the pt for written consent before administering. Answer: (B) When a primary health care provider prescribes a medication, the nurse is knowledgeable of its use, the expected outcome, and any adverse effects and drug interactions. The nurse requests the information from the pharmacist when the information is not available in any of the resources available. The nurse cannot avoid administering the medication if the information is unavailable. Instead, the nurse obtains the information from another resource. The nurse contacts the pharmacist rather than informing the primary health care provider. The patient's written consent is required only if the drug is still under trial or if it has potentially harmful adverse reactions. (p. 61)

A patient has come to the hospital for a checkup after taking insulin injections for 1 month. Which assumptions about the patient, made by the nurse before assessment, would be considered erroneous? Select all that apply.

A. Body language conveys an energized nature. B. Medication is taken as scheduled. C. There is a relaxed body posture while sitting. D. Good control over blood glucose levels has been achieved. E. Interventions taught by the nurse are followed. Answer: (B, D, E) Rationale Erroneous assumptions are the assumptions taken for granted by the nurse without proper assessment and evaluation. The assessments made regarding the patient's compliance with medication, maintenance of blood glucose levels, and adherence with the suggested nursing interventions before assessing the patient would be erroneous, because those assumptions are possible only after proper assessment of the patient. The nurse can directly draw conclusions from the patient's body language by carefully observing the patient's behavior during the visit to hospital. The nurse can conclude that the patient has relaxed body posture by directly observing the patient. This does not require any assessment. (p. 61)

The nurse reads the institution's procedure manual to review how to insert a urinary catheter for a patient. Which level of critical thinking is the nurse using?

A. Commitment B. Scientific method C. Basic critical thinking D. Complex critical thinking Answer: (C) Rationale This is an example of basic critical thinking, in which the nurse trusts that experts have the right answers for how to insert the catheter and thus goes to the procedure manual. Thinking is concrete and based on a set of rules or principles. Commitment is not a level of critical thinking. The scientific method and complex critical thinking are not required for this level of critical thinking and are used for more complex situations. (p. 59)

In which way is critical thinking in professional nursing practice advantageous? Select all that apply.

A. Confidence in nurses is increased. B. Positive patient outcomes are increased. C. Effective care planning for the patient can be mapped. D. The risk of adverse effects on the patient is reduced. E. The need for interaction with colleagues is decreased. Answer: (A, B, C, D) Rationale Critical thinking skills help increase nurses' confidence by ensuring that nursing practices are supported by reason and established standards. Critical thinking helps in making accurate decisions, thus increasing positive outcomes. The skill of concept mapping using critical thinking skills helps organize data and information and map care plans for patients through visual representation. Applying theoretical and experiential knowledge helps nurses improve the safety of patient care by reducing adverse effects of medications and other interventions. The effective use of critical thinking requires good interaction with colleagues and other health care providers; hence critical thinking should increase interaction and teamwork among nurses and other health care professionals. (pp. 61-62)

A patient tells the day shift nurse that the night shift nurse was rude and did not pay any attention to him. The day shift nurse apologizes, ensures that the patient's needs are fulfilled, and then speaks to the co-worker to understand the situation. Which attitude for critical thinking did the day shift nurse demonstrate?

A. Curiosity B. Fairness C. Creativity D. Confidence Answer: (B) Rationale 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 patient's needs. Confidence is presenting oneself with conviction and being well prepared. (p. 59)

In which way does a concept map improve critical thinking skills? Select all that apply.

A. Data in a plan of care can be visualized. B. Learning can be summarized when preparing for exams. C. Understanding of subject matter can be enhanced. D. Practical application of learned skills is achieved. E. Assessment data can be organized in a meaningful way. Answer: (A, B, C, E) Rationale Concept mapping is a teaching-learning strategy used in nursing to enhance nurses' critical thinking skills. A concept map can help create care plans by organizing and visualizing data. Nurses can use a concept map as a method to summarize learning while preparing for examinations. Concept maps also help in better understanding of a subject. Concept maps also help in organizing and collecting data for further assessment and evaluation to solve problems. While concept maps are useful for organizing information, they do not provide a means of practically applying skills. Simulation and role-playing are effective techniques for practical application. (pp. 62-64)

Use of a pain-rating scale on a postoperative unit to uniformly assess patients' pain severity is an example of which intellectual standard?

A. Depth B. Precision C. Relevance D. Significance Answer: (B) Rationale Use of the same pain scale for assessing pain acuity is an example of precision. Depth is getting beneath the surface of a topic or problem to identify and manage related complexities. Relevance is focusing on facts and ideas directly related and pertinent to a topic. Significance is concentrating on the most important information. (p. 57)

The nurse is caring for a patient with a negative urine pregnancy test, but believes the test may not be reliable due to increased fluid intake by the patient. Which critical thinking skill is the nurse using to assess the reliability of the test?

A. Evaluation B. Explanation C. Interpretation D. Self-regulation Answer: (A) Rationale The different skills of critical thinking include interpretation, analysis, evaluation, inference, explanation, self-regulation, and clinical decision making. Evaluation involves the nurse's ability to assess the reliability and credibility of the information. Here the nurse suspects that the patient had a false-negative pregnancy test due to dilution of urine caused by high fluid intake. Explanation is the skill with which the nurse can provide a rationale for the conclusions and decisions made. Interpretation is the skill of understanding the findings in the patient. The skill of self-regulation evaluates the nurse's own thoughts and performance while collecting the data and making conclusions. (p. 60)

Which component of critical thinking is being used when the nurse reviews relevant clinical principles in a textbook prior to caring for a patient?

A. Experience B. Problem solving C. Knowledge application D. Clinical decision making Answer: (C) Rationale When the nurse reviews knowledge that pertains to a patient's clinical situation, this facilitates critical thinking and enhances application of cognitive learning to clinical practice. Experience is what the nurse already knows about a given situation. The knowledge gained from the review of the textbook can be applied to problem solving or clinical decision making, but neither concept reflects actively using resources to gain specific knowledge. (p. 56)

In which way would the nurse confirm the effectiveness of a previously untried intervention in an ethical manner? Select all that apply.

A. Follow evidence-based practice. B. Perform intervention without informing the patient. C. Try interventions irrespective of their beneficial effects. D. Give priority to scientific knowledge over the patient's beliefs. E. Focus on the patient's values and beliefs related to the new intervention. Answer: (A, E) Rationale While experimenting with newer interventions, the nurse should act ethically and try interventions only if evidence supports their beneficial effects. The nurse should focus on the patient's rights and beliefs so that interventions are faithful and beneficial to the patient. The patient should be informed before the intervention. Priority should be given to patient's rights over scientific knowledge. The nurse should not try interventions that are likely to have no beneficial effects. (pp. 59-60, 62)

Which critical thinking attitudes would the nurse adopt when caring for a patient who has not followed treatment recommendations, which has resulted in a complication? Select all that apply.

A. Hostility B. Integrity C. Fairness D. Punctuality E. Confidence Answer: (B, C, E) Rationale The nurse must always treat the patient with fairness, integrity, and confidence to promote positive outcomes for him or her. The nurse should never be hostile to the patient. While punctuality is an important factor for a nurse, it does not affect the patient's compliance. (p. 59)

A patient with a plaster of Paris casting on the elbow joint prefers to bathe every other day. The nurse insists that the patient take a bath every morning to maintain hygiene. Which error of critical thinking process does this nursing action depict?

A. Illogical thinking B. Lack of information C. Closed-mindedness D. Erroneous assumptions Answer: (C) Rationale A nurse who is closed-minded performs the interventions without adequately considering the preferences of the patient. This may interfere with fulfilling the requirements of the patient. Illogical thinking involves the nurse's inability to follow a systematic approach while addressing an issue. Sometimes the nurse may overlook important information related to the findings in the patient and draw conclusions without obtaining complete information. Erroneous assumptions are false assumptions made by the nurse without proper evaluation and validation. (p. 61)

A student nurse is assigned to care for a patient admitted to the hospital with severe abdominal pain. Which concept of critical thinking would the student nurse adopt when approaching the patient?

A. Integrity B. Curiosity C. Risk taking D. Confidence Answer: (D) Rationale The nursing student needs to be confident when introducing oneself to the patient. The student should speak with conviction and must never give the patient the impression that he or she is unable to perform the 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 is being courageous and questioning interventions if needed. (p. 59)

Which intellectual trait is characterized by staying determined until achieving a goal?

A. Integrity B. Humility C. Risk taking D. Perseverance Answer: (D) The nurse who has the intellectual trait of perseverance stays determined and keeps trying until the goal is achieved. Integrity refers to being honest and willing to adhere to nursing principles in the face of unpleasant situations. Humility refers to having a humble nature without arrogance or overassertiveness while delivering nursing care. The nurse who has the trait of humility can deliver effective nursing care to the patients within the limitations of nursing practice. The nurse who has the intellectual trait of risk taking tries new ideas to improve the quality of the nursing care. (p. 59)

Which strategies focus on improving critical thinking skills through written work? Select all that apply.

A. Noting key facts B. Reviewing study notes C. Simulating realistic scenarios D. Verbalizing thoughts E. Identifying knowledge gaps Answer: (A, B, E) Rationale Written work is one tool that can help improve critical thinking skills. Strategies for written work include identifying gaps in knowledge and maintaining organized study notes of key points while reading. It is then important to target those knowledge gaps while reviewing the study notes to consolidate learning. Simulation provides a way for students to apply knowledge in a realistic, but safe, environment. It is not a strategy for written work. Verbalization of thoughts refers to thinking aloud. (pp. 56, 62, 64)

A diabetic patient has come to the nurse with symptoms suggestive of hypoglycemia. Which action would the nurse take first?

A. Offer foods rich in glucose. B.Obtain an electrocardiogram. C. Wait and watch for health care provider instructions. D. Confirm the diagnosis by sending a blood sample to the laboratory. Answer: (A) Rationale Since the nurse suspects hypoglycemia in the diabetic patient, the best action is to offer foods rich in glucose. This helps normalize glucose levels and relieve symptoms of hypoglycemia. Obtaining an electrocardiogram is not appropriate in hypoglycemia. Even though confirmation would be appropriate, the nurse should not wait for the laboratory results. Even though waiting for the primary health care provider's instructions is appropriate, there is no harm in giving glucose-rich food first. (p. 61)

A pregnant patient who is worried about having a second caesarean delivery is told by the nurse, "You likely won't require a caesarean delivery this time" in order to reduce the patient's anxiety. Which thought process is the nurse using?

A. Personal bias B. Illogical thinking C. Open-mindedness D. Erroneous assumption Answer: (B) Rationale Illogical thinking is characterized by a failure to follow a systematic approach while addressing a problem or an issue. The nurse who thinks illogically does not consider the evidence and makes quick generalizations. Personal bias refers to an error in which the nurse will have unnecessary preferences. An open-minded nurse sincerely considers suggestions and information given by colleagues and patients. The nurse is open-minded to improve communication with patients. Erroneous assumptions are false suppositions made by the nurse without proper evaluation and validation. (pp. 60-61)

A nursing instructor observes that a student nurse is caring for the American patients on the unit first and then attending to the needs of the European patients. Which error of critical thinking does this nursing action depict?

A. Personal bias B. Illogical thinking C. Lack of information D. Closed-mindedness Answer: (A) The nurse should avoid personal bias in order to deliver effective care to patients. In this case, the nurse is caring for American patients first and then attending to the needs of European patients. This indicates that the nurse is showing personal bias toward the American patients. Illogical thinking is characterized by the nurse's failure to address a problem systematically. Sometimes the nurse may overlook the important data related to the patient's medical condition, which may lead to erroneous assumptions. The nurse is open-minded to improve the quality of nursing practice. Closed-mindedness may cause a nurse to overlook important instruction, advice, or information offered by colleagues or patients and lead to incorrect assumptions and ineffective nursing care. In this case, there is no evidence that the student nurse has demonstrated closed-mindedness by ignoring or overlooking instruction or advice. (pp.60)

The nurse must notify the surgeon if a patient's postoperative wound collection device drains more than 100 mL over 24 hours. Which phase of the nursing process is the nurse acting in when the drainage device is observed and the amount of drainage currently in it is documented?

A. Planning B. Evaluation C. Diagnosis D. Intervention Answer: (B) Rationale In this example the nurse is evaluating the amount of drainage to determine if there is a change in the amount of drainage, which indicates the progress of wound healing or alerts to the need to notify the surgeon. (pp.59-60)

Which statements are true of concept maps? Select all that apply.

A. They are used for patients with a single nursing diagnosis. B. Relevant data about the patient can be better synthesized. C. A more focused view of a patient's health situation will result. D. Meaningful patterns from diverse patient information are generated. E. They are visual presentations of relationships between problems and interventions. Answer: (B, D, E) Rationale A concept map helps connect theory and practice and helps develop critical thinking skills. A concept map is a visual presentation of the interrelationship that exists between problems and interventions. It helps synthesize relevant data. The data may include assessment data, diagnostic data, and other related history. Once the interrelationship between the problems and interventions is established, meaningful patterns are formed that help in clinical reasoning and decision making. The concept map is not suitable for patients with a single nursing diagnosis; it is used for patients with multiple diagnoses and collaborative problems. The concept map does not give a focused view of the patient; instead it gives a holistic view of the patient and his or her health problems. (p. 62)

The nurse finds it difficult to interact with a patient who is unable to speak. In which way would the nurse best manage this situation?

A. Wait until the patient is able to speak. B. Make physical assessments as directed. C. Use message boards to communicate with the patient. D. Consult with the primary health care provider for further actions. Answer: (C) Rationale The nurse should have the perseverance to know the patient's situation and should try all possible interventions to alleviate the patient's problems. In this situation, since the patient is not in a position to speak, the nurse may use a message board or an alarm bell. Waiting until the patient is able to speak deprives the patient of essential nursing care. Just performing physical assessments will not satisfy the patient and will not provide the nurse with important subjective data. Asking the primary health care provider for further actions is not appropriate until the nurse has attempted to intervene and is unable to make progress. (p. 59)