Unit 2 - CHAPTER 15 - Critical thinking

A nurse is preparing medication for a patient. The nurse checks the name of the medication on the lab with the name of the medication on the doctor's order. At the bedside the nurse checks the patients name against the medication order as well. The nurse is following which critical thinking attitude: 1. Responsible 2. Complete 3. Accurate 4. Broad

1

A nurse just started working at a well-baby clinic. One of her recent experiences was to help a mother learn the steps of breastfeeding. During the first clinic visit the mother had difficulty positioning the baby during feeding. After the visit the nurse considers what affected the inability of the mother to breastfeed, including the mother's obesity and inexperience. The nurse's review of the situation is called: A. Reflection. B. Perseverance. C. Intuition. D. Problem solving.

1

While preparing medications for a patient, the nurse compares the name of the medication on the label with the name of the medication on the physician's order. At the bedside, the nurse checks the patient's name against the order as well. The nurse is following which critical thinking attitude? 1. Responsible 2. Complete 3. Accurate 4. Broad

1

A nurse on a busy medicine unit is assigned to four patients. It is 10 AM. Two patients have medications due and one of those has a specimen of urine to be collected. One patient is having complications from surgery and is being prepared to return to the operating room. The fourth patient requires instructions about activity restrictions before going home this afternoon. Which of the following should the nurse use in making clinical decisions appropriate for the patient group? (Select all that apply.) 1. Consider availability of assistive personnel to obtain the specimen 2. Combine activities to resolve more than one patient problem 3. Analyze the diagnoses/problems and decide which are most urgent based on patients' needs 4. Plan a family conference for tomorrow to make decisions about resources the patient will need to go home 5. Identify the nursing diagnoses for the patient going home

1, 2, 3

Which of the following describes a nurse's application of a specific knowledge base during critical thinking? (select all that apply) 1. Initiative in reading current evidence from the literature 2. application of nursing theory 3. Reviewing policy and procedure manual 4. Considering holistic view of patient needs 5. Previous time caring for specific group of patients.

1, 2, 4

One element of clinical decision making is knowing the patient. Which of the following activities affect a nurse's ability to know patients better? (Select all that apply.) 1. Caring for similar groups of patients over time 2. Reading the evidence-based practices appropriate to patients 3. Learning how patients typically respond to a particular clinical situation 4. Observing patients 5. Engaging with patients experiencing illness

1,3,4,5

A nurse enters a heated discussion with a colleague over a work schedule change. The nurse has a patient who asked for a pain medication 20 minutes earlier. Another patient calls the nurse to request assistance. The nurse feels tension in her neck and around her eyes, and she takes a 10-second time out. This shows the nurse is aware of which of the following? (Select all that apply.) 1. Stress affects accuracy of problem solving. 2. During stressful events, it is easier to communicate concise information. 3. The level of stress can affect the nurse's ability to speak clearly. 4. Stress improves recall of information. 5. Managing emotions is difficult during stress.

1,3,5

A nurse asks a student nurse to irrigate a patient's feeding tube. The student has not performed the procedure other than in simulation laboratory. The student approaches her clinical instructor and asks a clarifying question about the amount of saline to use in the procedure. This is an example of which critical thinking attitude? 1. Risk taking 2. Confidence 3. Consistency 4. Curiosity

2

Two patient deaths have occurred on a medical unit in the last month. The staff notices that everyone feels pressured and team members are getting into more arguments. As a nurse on the unit, what will best help you manage this stress? 1. Keep a journal 2. Participate in a unit meeting to discuss feelings about the patient deaths 3. Ask the nurse manager to assign you to less difficult patients 4. Review the policy and procedure manual on proper care of patients after death

2

A patient diagnosed with stage 4 breast cancer has undergone three different chemotherapy trials. The patient has severe hip pain as a result of the cancer spreading to the bones. The nurse and patient discuss the patient's expectations for pain management and the approach she prefers for treatment while meeting the Oncology Nurses Society (ONS) standards for pain management. The nurse has applied which critical thinking standards? (Select all that apply.) 1. Specific critical thinking 2. Evidence-based criteria 3. Standards of practice 4. Intellectual standards 5. Ethical standards

2,5

A patient has regularly visited the outpatient wound clinic over the last 2 months for treatment of a foot ulcer. The nurses have tried two types of dressings, but the wound shows little improvement. During the patient's next visit, a nurse recommends a hydrocolloid dressing and use of a foot boot to reduce pressure on the ulcer when the patient walks. This approach to selecting an intervention employs which critical thinking attitude? 1. Significance 2. Curiosity 3. Perseverance 4. Logic

3

An aspect of clinical decision making is knowing the patient. Which of the following is the most critical aspect of developing the ability to know the patient? 1. Working in multiple health care settings 2. Learning good communication skills 3. Spending time establishing relationships with patients 4. Relying on evidence in practice

3

By using known criteria in conducting an assessment such as reviewing with a patient the typical characteristics of pain, a nurse is demonstrating which critical thinking attitude? 1. Curiosity 2. Adequacy 3. Discipline 4. Thinking independently

3

You can use the REFLECT model to improve learning after providing patient care. Place the steps of this model in the correct order. 1. Think about your thoughts and actions at the time of the situation. 2. Review the knowledge you gained from the experience. 3. Review the facts of the situation. 4. Set a schedule for completing your plan of action. 5. Consider options for handling a similar situation in the future. 6. Recall any feelings you had at the time of the situation. 7. Create a plan for future situations.

3,1,6,2,5,7,4

A nurse has seen many cancer patients struggle with pain management because they are afraid of becoming addicted to the medicine. Pain control is a priority for cancer care. By helping patients focus on their values and beliefs about pain control, a nurse can best make clinical decisions. This is an example of: 1. Creativity. 2. Fairness. 3. Clinical reasoning. 4. Applying ethical criteria.

4

A nurse prepares to insert a Foley catheter. The procedure manual calls for the patient to lie in the dorsal recumbent position. The patient complains of having back pain when lying on her back. Despite this, the nurse positions the patient supine with knees flexed as the manual recommends and begins to insert the catheter. This is an example of: 1. Accuracy 2. Reflection 3. Risk taking 4. Basic critical thinking

4

When a nurse tries to understand a patient's and family caregiver's perspective of why a patient is falling at home, the nurse applies the intellectual standard of _________________________ to understand all viewpoints.

Broad

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.

a

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

a

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

a

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

a,b,c,d

Anticipate how a patient might respond to a treatment

analyticity

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

b

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

b

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

b

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

b

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

b

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.

c

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

c

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.

c

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 d. Explaining to the patient that self-reporting of severe pain is not consistent with the minor procedure that performed

c

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

c

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.

c

A nurse changed a patient's surgical wound dressing the day before and now prepares for another dressing change. The nurse had difficulty removing the gauze from the wound bed yesterday, causing the patient discomfort. Today he gives the patient an analgesic 30 minutes before the dressing change. Then he adds some sterile saline to loosen the gauze for a few minutes before removing it. The patient reports that the procedure was much more comfortable. Which of the following describes the nurse's approach to the dressing change? (Select all that apply.) A. Clinical inference B. Basic critical thinking C. Complex critical thinking D. Experience E. Reflection

c, d

Match the concepts for a critical thinker with the application of the term Term Application ___1. Be competent in performing a nursing intervention ___2. Organize assessment d. Systematic on the basis of patient priorities ___3. Be objective in asking questions of a patient ___4. Be tolerant of the patient's views and beliefs a. Truth seeking b. Open mindedness c. Responsibility d. Systematic

c, d, a, b

Fill in the blank. A nurse who has been asked to float to the women and infants unit to work the evening shift knows that clinical judgments are influenced by the ______________ of the clinical situation.

context

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.

d

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

d

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

d

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

d

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

d

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

d

A nurse enters a 72-year-old patient's home and begins to observe her behaviors and examine her physical condition. The nurse learns that the patient lives alone and notices bruising on the patient's leg. When watching the patient walk, the nurse notes that she has an unsteady gait and leans to one side. The patient admits to having fallen in the past. The nurse identifies the patient as having the nursing diagnosis of Risk for Falls. This scenario is an example of: A. Inference. B. Basic critical thinking. C. Evaluation. D. Diagnostic reasoning.

d

Match the critical thinking skill on the left with the correct nursing practice application on the right. Critical Thinking Skill Nursing Practice Application ___1. Interpretation ___2. Self-regulation ___3. Analysis ___4. Inference a. Look at the meaning of data to determine whether there is a relationship between findings that helps you reach a conclusion. b. Be open minded as you look at data about patients, and avoid making careless assumptions. c. Reflect on your experiences, and identify ways to improve. d. Be orderly in data collection and then look for patterns to categorize the data.

d, c, b, a

Be tolerant of the patient's views and belief

open-mindedness

Organize assessment on the basis of patient priorities.

systematicity

Be objective in asking questions of a patient.

truth seeking