Chapter 15 Critical Thinking in Nursing Practice

The student nurse is assigned to check the blood pressure of a patient. The student refers to the manual before checking the blood pressure. Which level of thinking does this illustrate? 1 Basic 2 Complex 3 Commitment 4 Intermediate

1 A learner has basic critical thinking. A basic critical thinker always has faith in the experts. The learner tends to consult books or experts before making a decision or performing a task. A complex critical thinker analyzes a situation before making a decision. In commitment thinking, the person makes decisions without any assistance and is accountable for the decision made. There is no intermediate level of thinking.

A patient with diabetes has come to the nurse with symptoms suggestive of hypoglycemia. Which would be the first appropriate nursing intervention? 1 Offer foods rich in glucose. 2 Obtain an electrocardiogram. 3 Confirm the diagnosis by sending a blood sample to the laboratory. 4 Wait and watch for instructions from the health care provider.

1 Because the nurse suspects hypoglycemia in the diabetic patient, the best action is to offer foods rich in glucose. This helps normalize glucose levels and relieves 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 instructions from the primary health care provider is appropriate, there is no harm in giving glucose-rich food first.

The nurse talks with a patient who lost a sister 2 weeks ago. The patient is unable to sleep, feels very fatigued during the day, and is having trouble at work. The nurse asks the patient to clarify the type of trouble. The patient explains she can't concentrate or even solve simple problems. The nurse records the results of the assessment, describing the patient as having ineffective coping. Of what is this is an example? 1 Diagnostic reasoning 2 Competency 3 Inference 4 Problem solving

1 In this example the nurse collects information about the patient, sees patterns in the data collected, and makes a nursing diagnosis. This is an example of the diagnostic process. This is not an example of competency, inference, or problem solving.

During a home health visit, the nurse prepares to instruct a patient in how to perform range-of-motion (ROM) exercises for an injured shoulder. The nurse verifies that the patient took an analgesic 30 minutes before the nurse arrived at the patient's home. After discussing the purpose for the exercises and demonstrating each one, the nurse has the patient perform them. After two attempts with only the second of three exercises, the patient stops and says, "This hurts too much. I don't see why I have to do this so many times." Which statement by the nurse illustrates the critical thinking attitude of integrity? 1 "I understand your reluctance, but the exercises are necessary for you to regain function in your shoulder. Let's go a bit more slowly and try to relax." 2 "I see that you're uncomfortable. I'll call your doctor to decide the next step." 3 "Show me exactly where your pain is and rate it for me on a scale of 0 to 10." 4 "Is anything else bothering you? Other than the pain, is there any other reason you might not want to do the exercises?"

1 The nurse reviews the position of requiring exercises to restore function and decides to try a different approach to proceed, which is an example of integrity. By offering to call the patient's doctor, the nurse does not reinforce the importance of exercises, which are likely the standard of care for this type of patient. By evaluating the patient's pain, the nurse is determining whether any other physical problems are developing. By asking if anything else is bothering the patient, the nurse is showing curiosity and attempting to learn if any other underlying problems exist.

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

1 The nurse should prioritize care to the patient who requires immediate care. The patient with hypotension requires immediate attention, because the condition may be life-threatening. The nurse may delegate nontechnical interventions such as collecting urine and assisting a patient to walk, but the patient with falling blood pressure must be handled first. The nurse should first attend to the patient whose blood pressure is low and then care for the primary patients.

Organize assessment on the basis of patient priorities.

Systematicity

The nurse works in a long-term care facility and understands that integrity is an essential attitude in critical thinking. Which behaviors indicate the nurse's understanding of integrity? Select all that apply. 1 Following the highest standards of practice 2 Questioning own knowledge and beliefs 3 Always having a sense of curiosity about the patient's condition 4 Being honest about and willing to accept own mistakes or inadequacies 5 Continually looking for more resources until a successful approach is found

1, 2, 4 In critical thinking, integrity means the nurse should follow the highest standards of practice. Nurses should be honest and accept their own mistakes or inadequacies. Nurses should be open-minded and, if need arises, should question themselves. Having curiosity about the patient's condition is not part of integrity. Perseverance involves looking for more resources until a successful approach is found.

Be objective in asking questions of a patient.

Truth Seeking

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

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

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

1, 3, 4 The nurse must always treat the patient with fairness, integrity, and confidence to promote positive outcomes for the patient. The nurse should never be hostile to the patient. Punctuality is an important factor for the nurse but does not affect the patient's compliance.

Which attitudes are essential for critical thinking? Select all that apply. 1 Confidence 2 Risk avoidance 3 Fairness 4 Discipline 5 Curiosity

1, 3, 4, 5 Certain attitudes are essential for critical thinking. Nurses should have confidence in their knowledge and abilities. Nurses should be fair in the care they provide. Discipline helps in thorough and critical assessment of any problem. Curiosity helps the nurse question existing practices and improves the standard of care. Risk-taking abilities help the nurse implement new standards of care, but the risks should always be calculated.

According to R.W. Paul, which intellectual standards should the nurse have for critical thinking? Select all that apply. 1 Clear 2 Intuitive 3 Plausible 4 General 5 Complete

1, 3, 5 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.

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

1, 3, 5 Nurses demonstrate successful delegation by communicating clearly, showing respect, showing initiative, and having confidence in other staff members. The nurse shows a lack of initiative by directing the NAP to assist the patient after the patient asked the nurse for help getting to the bathroom. Delegation is ineffective if the registered nurse (RN) fails to carry out proper supervision and evaluation of care. Following through on tasks is necessary but not constant oversight.

The nurse is new to a postoperative ward. The nurse finds it difficult to care for the immediate needs of a patient. Which measures should the nurse take to improve caregiving? Select all that apply. 1 Spend more time in initial assessment. 2 Request an assignment to another unit. 3 Provide nonspecific interventions to the patient. 4 Observe the patient's behavior and measure physical findings. 5 Constantly assess and monitor patients for health needs.

1, 4, 5 The nurse should improve 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 the care plan can be modified as needed. Transferring the nurse to a less demanding position may bring learning to a halt. Providing nonspecific interventions is not ethically acceptable.

Which method should the student nurse use to reflect on and analyze the student's own thoughts, actions, and knowledge? 1 Meditation 2 Reflective journaling 3 Thoughtfulness 4 Mindfulness

2 Reflective journaling is a method by which the nurse can find reasons for a particular behavior and analyze thought process, actions, and knowledge. Reflective journaling 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.

A patient had hip surgery 16 hours ago. During the previous shift the patient had 40 mL of drainage in the surgical drainage collection device over an 8-hour period. The nurse refers to the written plan of care and notes that the health care provider should be notified when drainage in the device exceeds 100 mL for the day. On entering the room, the nurse looks at the device and carefully notes the amount of drainage currently in it. What is this an example of? 1 Planning 2 Evaluation 3 Intervention 4 Diagnosis

2 The patient's baseline for wound drainage was 40 mL, representing the initial assessment of the patient's wound condition. In this example the nurse evaluates the amount of drainage to determine if there has been a change, which indicates the progress of wound healing.

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

2, 3, 4 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.

A 40-year-old patient is admitted to the hospital with severe pain in the lower abdomen. The student nurse is assigned to care for this patient. After nursing interventions, the pain did not subside substantially. The nursing student then started looking for different approaches to the patient's pain relief. Which aspect of critical thinking did the student nurse display? 1 Fairness 2 Discipline 3 Creativity 4 Risk-taking

3 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.

A patient on a surgical unit develops sudden shortness of breath and a drop in blood pressure. The staff responds, but the patient dies 30 minutes later. The manager of the nursing unit calls a meeting of the nursing staff involved in the emergency response. The staff discusses what occurred over the 30-minute time frame, the actions taken, and whether other steps should have been implemented. In this situation, what are the nurses doing? 1 Solving a problem 2 Showing humility 3 Conducting reflective practice 4 Exercising responsibility

3 Reflective practice is a conscious process of thinking, analyzing, and learning from previous work situations. The staff may discuss problems that occurred, but in this case they are reflecting on them to learn for future patient situations.

Which action by the nurse indicates the application of self-regulation skill in clinical practice? 1 Collecting and organizing a patient's data in a systemic manner 2 Finding relationships between subjective and objective findings of a patient 3 Choosing an alternative way based on experience while caring for a patient to achieve better outcomes 4 Ignoring prior knowledge and experience before choosing a strategy for patient care

3 Self-regulation is a critical thinking skill applied by the nurse while making complex decisions about a patient and care. Based on patient outcomes, the nurse chooses an alternative way to achieve better outcomes. This enables the nurse to attain success and satisfaction in clinical practice. Interpretation is the skill applied by the nurse while collecting and organizing the patient data in a systemic manner. Inference is the skill applied by the nurse in order to find a relationship between assessment findings of the patient. Ignoring prior knowledge and experience before choosing a strategy for patient care does not demonstrate self-regulation. The nurse should use prior knowledge to apply the skill of self-regulation.

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

3 The nurse has exhibited truth seeking, which is characterized by courage, honesty, and being objective about asking questions in a situation. Analyticity is characterized by anticipating possible consequences and using evidence-based knowledge. Systematicity is characterized by organization, focus toward work, and working hard in any inquiry. Self-confidence is characterized by trust and executing practice in a refined process.

A patient has undergone throat surgery and is unable to speak. The following day while performing routine care, the nurse finds it difficult to interact with the patient. How should the nurse manage this situation? 1 Wait until the patient is able to speak. 2 Make physical assessments as directed. 3 Use message boards to communicate with the patient. 4 Consult with the primary health care provider for further actions.

3 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, because 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. Asking the primary health care provider for further actions is not appropriate in this case.

The student nurse uses the scientific method when doing a research project, which is required to obtain a graduate degree. Arrange the steps of the scientific method in the correct order. 1. Collection of data 2. Formulation of a hypothesis 3. Identification of the problem 4. Evaluation of the test or study results 5. Testing the question or hypothesis

3, 1, 2, 5, 4 The scientific method is a systematic way to solve general problems using reasoning. There are five steps in the scientific method, which should be performed in the following order: identification of the problem, collection of data, formulation of a question or hypothesis, testing a question or hypothesis, and evaluation of results of the test or study.

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

3, 1, 2, 5, 4 The scientific method of critical thinking is a systematic approach to gathering data about the patient and solving problems. The nurse uses the scientific method when testing research questions in nursing practice scenarios. The steps of the scientific method of critical thinking are identifying the problem, collecting essential data regarding the problem, formulating questions to explore the problem, testing the questions, and evaluating the results of tests.

A pregnant patient with epilepsy was prescribed phenytoin, which is teratogenic. Which critical action should the nurse take? 1 Follow the prescription. 2 Replace phenytoin with carbamazepine. 3 Stop giving the medication. 4 Question the prescription.

4 Based on knowledge, the nurse should question the prescription and analyze the situation. The nurse should not follow the prescription blindly, because it could cause potential adverse effects. The nurse cannot change the drug without the primary health care provider's approval. The nurse shouldn't stop giving the medication, because doing so could make the disease worse.

A patient tells the night-shift nurse that the day-shift nurse did not administer pain medications. As a critical thinker, which action should the nurse take? 1 Appreciate the patient for telling the nurse. 2 Administer the pain medication that was missed. 3 Apologize to the patient for negligence. 4 Listen to the patient but also confirm with the day-shift nurse.

4 The nurse should be fair in treatment. The nurse should listen to the patient but also confirm with the day-shift nurse. There could have been changes in the prescription that the patient was not aware of. The nurse should appreciate the patient but also confirm the situation. The drug should not be administered before confirming with the nurse or the health care provider. The nurse cannot know whether the missed dose resulted from negligence or a change in prescription, so the nurse should not apologize.

A 40-year-old patient is admitted to the hospital with severe pain in the lower abdomen and is very uncomfortable. The student nurse is assigned to care for this patient. Which attitude of critical thinking should the student nurse adopt when approaching the patient? 1 Integrity 2 Curiosity 3 Risk taking 4 Confidence

4 The nursing student needs to be confident when meeting the patient. The nurse should speak with conviction and must never give the patient the impression that the nurse is unable to perform 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 involves being courageous and questioning interventions if needed.

The nurse follows the scientific method to determine the cause of a drug's side effect. In which order should the nurse perform the steps of the scientific method? 1. Collect data from different resources. 2. Formulate questions or hypotheses. 3. Evaluate results of the test or study. 4. Identify the problem. 5. Test the questions or hypotheses.

4, 1, 2, 5, 3 The scientific method is a systematic approach to problem solving. First, the problem is identified, either by clinical examination or as reported by a patient. Second, data about the situation are collected. The third step involves formulating questions. The fourth step is to test the questions or hypotheses. Finally, all the data are evaluated and a conclusion is made about the drug's side effect.

Place the steps of the scientific method in their correct order with number 1 being the first step of the process. 1. Formulate a question or hypothesis. 2. Evaluate results of the study. 3. Collect data. 4. Identify the problem. 5. Test the question or hypothesis. A. 4, 3, 1, 5, 2 B. 3, 4, 1, 2, 5 C. 4, 3, 2, 1, 5 D. 3, 4, 1, 5, 2

A The correct order of the steps of the scientific method are: Identify the problem, collect data, formulate a question or hypothesis, test the question or hypothesis, and evaluate results of the test or study.

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.

A The mother had difficulty breastfeeding first time. The nurse relied on reflection to consider her previous actions and review what was successful and the opportunities for improvement. The nurse has not yet problem solved but might do so after reflection in anticipation of the patient's next clinic visit.

A nurse is preparing medications for a patient. The nurse checks the name of the medication on the label with the name of the medication on the doctor's order. At the bedside the nurse checks the patient's name against the medication order as well. The nurse is following which critical thinking attitude: A. Responsible B. Complete C. Accurate D. Broad

A The nurse is demonstrating responsibility for correct medication and patient identification. The other three choices are critical thinking intellectual standards.

Anticipate how a patient might respond to a treatment

Analyticity

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? A. Keep a journal B. Participate in a unit meeting to discuss feelings about the patient deaths C. Ask the nurse manager to assign you to less difficult patients D. Review the policy and procedure manual on proper care of patients after death

B 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.) Consider availability of assistive personnel to obtain the specimen Combine activities to resolve more than one patient problem Analyze the diagnoses/problems and decide which are most urgent based on patients' needs Plan a family conference for tomorrow to make decisions about resources the patient will need to go home Identify the nursing diagnoses for the patient going home

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? A. Curiosity B. Adequacy C. Discipline D. Thinking independently

C

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? A. Working in multiple health care settings B. Learning good communication skills C. Spending time establishing relationships with patients D. Relying on evidence in practice

C Knowing the patient relates to a nurse's experience with caring for patients, time spent in a specific clinical area, and having a sense of closeness with them. However, a critical aspect to knowing the patient and thus being able to make timely and appropriate decisions is spending time establishing relationships with them.

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 Correct D. Experience Correct E. Reflection

C, D The nurse relies on experience and the ability to adapt a procedure such as a dressing change (complex critical thinking) to make it successful.

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: A. Accuracy. B. Reflection. C. Risk taking. D. Basic critical thinking

D Basic critical thinking is concrete and based on a set of rules or principles such as the guidelines in a hospital procedure manual. The nurse's approach is not accurate because accuracy requires use of all of the facts (e.g., the patient's discomfort). A critical thinker is willing to take risks to try different ways to solve problems; following one basic approach is not risk taking. This is also not an example of reflection.

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 Diagnostic reasoning begins when you interact with a patient or make physical or behavioral observations. An expert nurse sees the context of a patient situation (e.g., patient lives alone, has fallen in past), observes patterns and themes, and makes a diagnostic decision.

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: A. Creativity. B. Fairness. C. Clinical reasoning. D. Applying ethical criteria.

D The use of ethical criteria for nursing judgment allows a nurse to focus on a patient's values and beliefs. Clinical decisions are then just, faithful to the patient's choices, and beneficial to the patient's well-being.

Be tolerant of the patient's views and beliefs.

Open-mindedness

The nurse wants to experiment with a new intervention on a patient. How should the nurse confirm the effectiveness of this intervention in an ethical manner? Select all that apply. 1 Follow evidence-based practice. 2 Focus on the patient's values and beliefs related to the new intervention. 3 Perform intervention without informing the patient. 4 Give priority to scientific knowledge over the patient's beliefs. 5 Try interventions irrespective of their beneficial effects.

1, 2 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.

The nurse is caring for a patient with diabetes mellitus. The nurse uses diagnostic reasoning to determine the patient's health problems. Which parameters should the nurse include when using diagnostic reasoning for this patient? Select all that apply. 1 Lightheadedness 2 Weakness 3 Blurred vision 4 Pressure ulcers 5 Risk of hemorrhage

1, 2, 3 Diagnostic reasoning is the analytical process for determining a patient's health problems. Before determining a course of action the nurse must accurately recognize the patient's problems. In this patient, the nurse observes symptoms such as lightheadedness, weakness, and blurred vision. Based on the symptoms, the nurse determines the problems are due to hypoglycemia. Once the health problem is diagnosed, the appropriate measures can be taken; in this case, the nurse can offer food items containing glucose to the patient. Pressure ulcers and risk of hemorrhage are clinical parameters that help to choose the best clinical intervention.

Which components can restrict the student nurse's ability to move from a basic level to a complex level of critical thinking? Select all that apply. 1 Inexperience 2 Inflexible attitude 3 Weak competency 4 Lack of specific knowledge base 5 Lack of policy related to procedures

1, 2, 3 Student nurses mostly apply the basic level of critical thinking in practice because they are still learning and are task oriented. The student's inexperience due to less exposure, inflexible attitude due to less practice, and weak competency due to less exposure can restrict the ability to move from a basic level to a complex level of critical thinking in practice. Student nurses work in all domains and believe that experts have the right answer for every problem. Therefore, they do not acquire a domain-specific knowledge base. The student nurse uses a specific hospital procedure manual in practice, which is developed with a good set of standards. Therefore, lack of policy related to procedures will have no role in the student nurse's advancement in critical thinking skills.

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

1, 2, 3 The nurse should have performed a proper analysis by being open-minded while looking at the patient's information. The incorrect diagnosis of gastritis might have been avoided by correlating the patient's data, so the nurse should review the data to see what was missed. The nurse should explain care clearly and in a straightforward manner to the patient. The nurse should not avoid the situation. Instead of defending the diagnosis, the nurse should accept the mistake.

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.) A. Consider availability of assistive personnel to obtain the specimen B. Combine activities to resolve more than one patient problem C. Analyze the diagnoses/problems and decide which are most urgent based on patients' needs D. Plan a family conference for tomorrow to make decisions about resources the patient will need to go home E. Identify the nursing diagnoses for the patient going home

A, B, C Analyzing urgency of problems helps to prioritize as does considering the resources that are available (such as assistive personnel) to complete patient care activities. Deciding how to combine activities is good time management. Holding a family conference is a good idea but in this case would be too late to be beneficial to the patient. To determine priorities the nurse must identify nursing diagnoses for all patients.

Which of the following describes a nurse's application of a specific knowledge base during critical thinking? (Select all that apply.) A. Initiative in reading current evidence from the literature B. Application of nursing theory C. Reviewing policy and procedure manual D. Considering holistic view of patient needs E. Previous time caring for a specific group of patients A nurse's specific knowledge base will vary but includes basic nursing education, continuing education courses, and additional college degrees. In addition, it includes the knowledge gained from a nurse reading the nursing literature and acquiring information and theory from the basic sciences, humanities, behavioral sciences, and nursing. Nurse's knowledge base also involves a different way of thinking holistically about patient problems.

A, B, D A nurse's specific knowledge base will vary but includes basic nursing education, continuing education courses, and additional college degrees. In addition, it includes the knowledge gained from a nurse reading the nursing literature and acquiring information and theory from the basic sciences, humanities, behavioral sciences, and nursing. Nurse's knowledge base also involves a different way of thinking holistically about patient problems

In which of the following examples is a nurse applying critical thinking skills in practice? (Select all that apply.) A. The nurse thinks back about a personal experience before administering a medication subcutaneously. B. The nurse uses a pain-rating scale to measure a patient's pain. C. The nurse explains a procedure step by step for giving an enema to a patient care technician. D. The nurse gathers data on a patient with a mobility limitation to identify a nursing diagnosis. E. A nurse offers support to a colleague who has witnessed a stressful event.

A, B, D Reflection, using a pain-rating scale to be precise and specific, and nursing assessment (the first step of the nursing process) are examples of critical thinking skills. Explaining a procedure based on policy is not critical thinking. However, performing a procedure following policy is basic critical thinking. Offering support to a colleague is an important way to help another manage stress but is not a critical thinking skill.