Module 36: Clinical Decision Making
The nurse is considering opposing views before making a decision. Which attribute of critical thinking is the nurse exhibiting? A.) Fair-mindedness B.) Perseverance C.) Integrity D.) Open-mindedness
A, "Fair-Mindedness." The critical thinking attribute that encourages being open to new ideas and ways of doing things is fair-mindedness. Open-mindedness refers to being open to different ideas or different methods to reach the same goal and is similar to independence. Challenging ideas and methods of carrying out nursing care explains integrity. Being motivated to find the best solution for quality client outcomes is perseverance.
The nurse is preparing a school-aged child for surgery. Which intervention increases cooperation and decreases anxiety? A.) Having the child explore and operate the equipment when possible B.) Obtaining the child's assent for the treatment C.) Using play therapy D.) Involving the parents to keep the child company while waiting
A, "Having the child explore and operate the equipment when possible." School-aged children need direct and simple explanations and like to explore the equipment in a hands-on manner. Letting them do this can help reduce anxiety and increase cooperation. Play therapy is best for toddlers or preschoolers. Getting assent is best from an adolescent or teen client. Infants need to be comforted and made to feel secure through the entire healthcare process.
The nurse is using scenario-based simulations to teach the staff about clinical judgment. Which approach is the nurse using? A.) Lasater's assessment rubric B.) Tanner's clinical judgment model C.) Maslow's hierarchy of needs D.) Benner's skill acquisition model
A, "Lasater's assessment rubric." The Lasater clinical judgment rubric is designed to allow for student reflection on the level of observed development of decision making and clinical judgment skills. This is exemplified with the use of simulation in a nursing lab. Tanner's clinical judgment model emphasizes the importance of elements the nurse uses in cognitive processing, including book knowledge, past experiences, and previous knowledge. Benner's skill acquisition model is based on the idea that the ability to make clinical judgments progresses as nurses gain experience and build their skills. Maslow's hierarchy of needs is a model nurses can use to inform how they prioritize care for a client.
The nurse states, "Chronic obstructive pulmonary disease (COPD) is a chronic pulmonary disease and the nurse should place the client in high Fowler position." Which clinical reasoning concept is the nurse using in this statement? (Select all that apply.) A.) Opinion B.) Judgment C.) Inference D.) Fact E.) Inquiry
A, D. The nurse is using both fact and opinion in the statement. Facts can be confirmed by research—chronic obstructive pulmonary disease (COPD) is a chronic pulmonary disease. Opinions may be based on fact and are beliefs made over time, including nursing interventions such as placing the client with COPD in high Fowler position. Judgment is an evaluation of facts that reveal values; for example, place the client with COPD in high Fowler when the SpO2 is below a certain level. An inference is a conclusion that is drawn from facts, but goes beyond the established information. Inquiry is a form of research and does not apply here.
The nurse is planning care for a new client with unstable blood glucose levels. Which should be the first action by the nurse? A.) Establish a specific nursing diagnosis. B.) Complete an assessment on the client. C.) Carry out solutions to manage the problem. D.) Create a plan of nursing care for the client.
B, "Complete an assessment on the client." The five steps of the nursing process are assessment, diagnosis, planning, implementation, and evaluation. The nurse should first perform a thorough assessment and then create a nursing diagnosis based on the assessment data. The nurse should then create a plan of care with nursing interventions to address the diagnosis, follow the plan, and then evaluate the effectiveness of the nursing interventions.
The nurse is discussing Benner's skill acquisition model. Which statement should the nurse include? (Select all that apply.) A.) "An advanced beginner is intentional in planning care." B.) "New graduates are typically considered advanced beginners." C.) "Proficient nurses can see the whole picture." D.) "A novice acts by following rules." E.) "A competent nurse usually has 2-3 years of experience."
B, C, D, E. According to Benner's model, a competent nurse, not an advanced beginner, is intentional in planning care. This statement would reflect the need for further teaching. All other statements are correct and reflect understanding of this model by the student nurse.
The nurse is discussing the role of intellect in critical thinking. Which benefit should the nurse include? (Select all that apply.) A.) Helps the nurse think outside the box B.) Approaches situations objectively C.) Differentiates fact from opinion D.) Helps to clarify concepts E.) Assists with evaluating performance
B, C, D. The critical thinking skill of intellect helps nurses differentiate facts from opinions, approach situations objectively, and clarify concepts. The critical thinking skill of creativity helps nurses think outside of the box. The critical thinking skill of inquiry helps nurses evaluate performance.
The nurse uses a clinical decision tree to determine the best course of action for a client who has signs and symptoms of a myocardial infarction. Which statement is true regarding this clinical decision tool? (Select all that apply.) A.) It cannot be implemented by all nurses. B.) It can assist in decision making. C.) It requires no decision making. D.) It requires higher-level decision making. E.) It requires standardization of care.
B, E. Clinical decision trees and protocols can assist in decision making, especially for nurses who do not have enough nursing experience or nursing knowledge to make decisions. This tool can assist in standardizing care because the tool can be used for all clients who present with similar symptoms. Because the tool has steps of decisions presented, it does not require higher-level decision making. However, the tool still requires some decision making by the nurse to ensure interventions are appropriate for the client.
A 15-year-old client tells the nurse that he wishes to make his own medical decisions. Which is the nurse's best response? A.) "You will need to provide written consent for procedures in addition to your parents giving consent." B.) "If you want to make your own healthcare decisions, you will need to consult an attorney." C.) "Your parents will need to sign the consent form until you turn 18 years of age." D.) "You can sign the legal consent form if you prefer and make the medical decisions for your care."
B, "If you want to make your own healthcare decisions, you will need to consult an attorney." The teen will need to consult with an attorney to gain the legal right to medical autonomy. Although it is correct that teens under the age of 18 will need their parent or legal guardian to make their medical decisions and sign consent forms, it is not a complete answer and does not help the teen. There is no written consent form for the adolescent to sign.
When reprimanded for failing to label the date of changing a dressing the nurse states, "No one else on the unit does it either." Which type of faulty reasoning is the nurse demonstrating? A.) Either-or fallacy B.) Circular reasoning C.) Bandwagon D.) Overgeneralization
C, "Bandwagon." The nurse is using bandwagon faulty reasoning, which is doing something because everyone else is doing or not doing it. The either-or fallacy is the misbelief that a situation only has two solutions. Circular reasoning is the act of supporting an opinion by restating it using different words. Overgeneralization is the process of coming to a conclusion when there is not enough evidence to do so.
The nurse is tasked with purchasing a few items that would help preschoolers in the healthcare environment. Which items should the nurse consider purchasing? A.) Coloring books and crayons B.) Building blocks C.) Both male and female dolls D.) Handheld video games
C, "Both male and female dolls." Dolls and stuffed animals can be used to demonstrate procedures or help a small child explain or process pain or discomfort. Building blocks, coloring books and crayons, and handheld video games would all be age appropriate, but would not have an impact on their ability to understand the healthcare environment.
The nurse is caring for a pregnant client who wants a healthcare provider who will let her make all the decisions. Which decision-making model is the client looking for? A.) Holistic B.) Mutualistic C.) Consumerist D.) Paternalistic
C, "Consumerist." Providers who follow a consumerist model of decision making tend to provide the important clinical information, but allow the client to make all of the decisions. Holistic and mutualistic providers focus on working together with the client to find a mutually agreeable solution. Paternalistic providers assume that their experience and education means that they will make the best decision for the client.
The nurse attended a program on shared decision making with older clients. Which statement by the nurse indicates effective learning? A.) "I must communicate directly with the client's next-of-kin or designated decision maker." B.) "I better be careful to use the correct medical terminology when appropriate." C.) "I may need to repeat the instructions a few times." D.) "I will provide the instructions for multiple steps at a time."
C, "I may need to repeat the instructions a few times." Older clients may need to have the instructions repeated a few times to ensure that they understand. The nurse should also provide directions for a single step or task at a time to minimize confusion. Using simple, direct, and easy to understand language can also increase comprehension. The nurse and other healthcare providers should communicate directly with the client as long as possible, with the goal to allow clients to participate in their care.
The proficient nurse notices that an unconscious client has a heart rate of 42 beats/min. Which action should the nurse perform? A.) Review the client's medication list and look for potential side effects. B.) Document the findings and continue to monitor closely. C.) Notify the rapid response team. D.) Consult the policy and procedure book to determine at which heart rate to notify the code team.
C, "Notify the rapid response team." A proficient nurse would recognize the risk of impending cardiac arrest and the need to notify the rapid response team to restore normal cardiac functioning. Simply documenting the findings and waiting to act are not associated with proficiency. Reviewing the client's medication list for side effects or consulting the policy and procedure book for advice is an action usually performed by a novice or advanced beginner.
The nurse has several clients who need care. Which type of decision does the nurse need to make? A.) Value decision B.) Time management decision C.) Priority decision D.) Scheduling decision
C, "Priority Decision." The nurse must prioritize which client to see first based on acuity and severity of the health problem. This is a priority decision. Scheduling and time management decisions involve scheduling client care or nursing activities to be most efficient with time. A value decision is required when there is a decision regarding nursing values, such as client confidentiality.
The nurse is an advanced beginner within Benner's skill acquisition model of clinical judgment. Which characteristic describes the nurse? (Select all that apply.) A.) Follows rules when acting B.) Is able to intentionally plan care C.) Is a new graduate D.) Can see the whole picture E.) Begins to recognize cues
C, E. Characteristics of an advanced beginner nurse are being a new graduate and beginning to recognize significant cues from internal cognitive processing. A characteristic of a competent nurse is being able to intentionally plan care. A characteristic of a novice nurse is following rules when providing care. Being able to see the whole picture, when providing client care is characteristic of the proficient nurse.
The nurse assesses a client further to determine which ordered prn pain medication to administer. Which type of clinical decision making is the nurse using? A.) Intuition B.) Problem-solving C.) Trial and error D.) Choosing among alternatives
D, "Choosing among alternatives." The nurse is choosing between two different alternatives for pain medication. The nurse is not using intuition, which is acting on a gut instinct about something. Trial and error is trying different options, which the nurse has not done. Problem solving is managing obstacles to maintain an orderly workday.
The nurse caring for a client who has a falling blood pressure is trying to decide what action to take next. Which is the first step in making the decision? A.) Put the identified option into action. B.) List the different options and their risks and benefits. C.) Select the best option to try in the situation. D.) Identify the problem and decision to be made.
D, "Identify the problem and decision to be made." When making a clinical decision, it is important for the nurse to first identify the problem or decision to be made. Next, the nurse should list the different options and identify the advantages and disadvantages to each. The nurse should then select the best option and put it into action.
The nurse is explaining Tanner's clinical judgment model to a student nurse. Which element should the nurse explain is needed first to make a clinical judgment? A.) Intuition B.) Multiple years of experience C.) Initiation of practice D.) Learning in nursing school
D, "Learning in nursing school." According to Tanner's clinical judgment model, thinking like a nurse begins with nursing education, which teaches fundamental nursing skills and knowledge. Intuition develops from experience and nursing knowledge over time. Initiation of practice does improve critical thinking skills, but is not the initiating factor.
The nurse notes that a baby is not sitting independently and recommends that a developmental evaluation be performed. Which attribute of critical thinking is the nurse using? A.) Creativity B.) Faulty reasoning C.) Inductive reasoning D.) Salient cues
D, "Salient Cues." Salient cues are significant findings that direct a nurse to draw conclusions about a client's health status. The nurse has observed that the baby is not meeting developmental tasks, which directs the nurse to suggest further evaluation. The nurse is not using creativity or inductive reasoning, which is a bottom-up approach to client care. The nurse is not using faulty reasoning, which is an error in reasoning, in this situation.
