(PrepU) Chapter 5: Thinking Critically to Analyze Data and Make Informed Nursing Judgments

The nursing student has learned that to correctly analyze data and make a proper diagnosis, the nurse must develop which of the following?

critical thinking Although time management, organizational skills, and psychomotor skills are all important components of being a good nurse, it is critical thinking that helps a nurse to make good judgments and accurate diagnoses.

The new graduate nurse asks the preceptor, "I keep hearing about learning to develop good critical thinking skills, but don't really understand what that is?" What is the best response by the preceptor?

"A way of processing information using to formulate conclusions or diagnoses." Critical thinking is the way in which the nurse processes information using knowledge, past experiences, intuition, and cognitive abilities to formulate conclusions or diagnoses.

A nursing instructor is teaching about diagnostic reasoning and the importance of culture. The student needs further explanation when making which statement?

"All clients have the same defining characteristics." The nurse should not overlook the client's culture when analyzing data collected. Patients from different cultures may be misdiagnosed because the defining characteristics and labels for specific diagnoses do not always accurately describe the human responses in their culture. Therefore, it is essential to closely look at cultural norms and responses for various diverse clients.

The RN may delegate which care component to a nursing assistant?

Ambulation assistance The RN may delegate individual components of care but does not delegate the nursing process itself. The main functions of assessment, planning, evaluation, and nursing judgment cannot be delegated. For example, if the nurse delegates taking vital signs to a nursing assistant, he or she is responsible for making sure that the data is accurately collected and for following up if findings are abnormal. The nursing assistant may collect vital signs, but the RN is responsible for evaluation. Assessment is always the RN's responsibility, which includes wound assessment and assessing pain level.

A nurse interacts with four different clients one afternoon at the health clinic. The nurse is able to directly assist three of them and makes a referral for the fourth. Which of the following clients should the nurse refer to another professional?

An elderly woman who needs daily therapy sessions to help her walk again after a hip fracture Referral is used for identified problems for which the nurse cannot prescribe definitive treatment. Referring can be defined as connecting clients with other professionals and resources. Teaching a client how to self-inject insulin, counseling a pregnant woman on prenatal vitamins, and administering a flu vaccine are all interventions that a nurse can easily accomplish. Providing daily therapy sessions to help an elderly woman walk again after a hip fracture, however, would be beyond the scope of practice of the nurse and should be referred to a physical therapist.

The nurse has learned that after completing the assessment phase of the nursing process, the next step is the diagnostic phase. What does the diagnostic phase allow for the nurse to do?

Analyze the data The second phase of the nursing process is the diagnostic phase, in which the nurse analyzes the data collected. Organizing, validating, and collecting data all occur during the first phase, which is step one or assessment.

The nursing instructor tells the students that in order to develop critical thinking skills there are some essential elements that must be obtained. What elements does the student need? (Select all that apply.)

Be nonjudgmental and keep an open mind. Use rationale to support opinions or decisions. Acquire an adequate knowledge base that continues to build. The essential elements of critical thinking are: Keep an open mind, use rationale to support opinions or decisions, reflect on thoughts before reaching a conclusion, use past clinical experiences to build knowledge, acquire an adequate knowledge base that continues to build, be aware of the interactions of others, and be aware of the environment.

A hospitalized client is prescribed a short course of corticosteroids. The client is placed on sliding scale regular insulin. The nurse should routinely assess which laboratory value while the client is hospitalized?

Capillary blood glucose The client has been placed on short term steroids which can lead to elevated glucose levels. Therefore, the glucose level should be monitored. The hemoglobin A1C level is monitored for long term diabetic control. Hematocrit levels and sodium electrolytes are not affected as readily as glucose levels.

What can the nurse use to learn new information and add to their knowledge base?

Clinical experience. The critical thinker uses each clinical experience to learn new information and to add to the knowledge base. Another important aspect of critical thinking involves awareness of human interactions and the environment, which provides cues and directly influence decisions and judgments.

Which step in the diagnostic reasoning process does the nurse look at the identified abnormal findings and strengths for cues that are related?

Cluster Data During the second step of the diagnostic reasoning process, the nurse looks at the identified abnormal findings and strengths for cues that are related. Cluster both abnormal cues and strength cues; a particular nursing framework should be used as a guide when possible.

A client has 3+ pitting edema, crackles in lungs, and dyspnea. The nurse is monitoring the client's vital signs and O2 saturations, and the physician has prescribed 40 mg of intravenous Furosemide (Lasix). What type of problem is this considered?

Collaborative problem Collaborative problems are defined as "certain physiological complications that nurses monitor to detect their onset or changes in status; nurse manage collaborative problems using physician-prescribed and nursing-prescribed interventions to minimize the complication of events.

The nurse reviews data collected during an assessment. Which data should the nurse validate? Select all that apply.

Data that is inconsistent with another finding Subjective and objective data are inconsistent Gap between what the client said and what is in the medical record Conditions in which data should be validated include findings that are abnormal or are inconsistent with other findings, discrepancy between subjective and objected data collected, and a gap between what the client says now versus what was said or documented in the past. Vital signs do not need to be validated unless there is a huge discrepancy. Respiratory rates are slower during sleep. Body temperature peaks in the evening.

The nurse recognizes that the second step or phase of the nursing process is difficult. Why is data analysis a difficult step?

Diagnostic reasoning skills are required to interpret data accurately. As the second step or phase of the nursing process, data analysis is a very difficult step because the nurse is required to use diagnostic reasoning skills to interpret data accurately.

A client has been diagnosed with diabetes mellitus, and the nurse knows that the client requires education on the dietary restrictions. What would be an appropriate intervention by the nurse?

Make a referral to the dietician. Referring can be defined as connecting clients with other professionals and resources. This client would receive the greatest benefit from the professional that is able to give them the education required to manage their disease process.

A client presents to the clinic with reports of an itchy rash all over the body. The nurse observes lesions on the client's arms and legs as well as the presence of a dry, hacky cough and sneezing. Which data collected from the client can be classified as a subjective abnormal finding?

Itchy feeling Based on the data gathered from the client, the nurse can classify the clients report of an itchy feeling all over the body as a subjective abnormal finding, as this information has been provided by the client about what the client feels and experiences. The presence of rash, cough, and continuous sneezing are data that the nurse observes during the examination and are therefore objective data.

The nursing student demonstrates a need for further teaching when she states which of the following?

Patients do not need to understand their problems. It is essential for the client to understand the problem so that treatment can be properly implemented. If the client is not coherent, it is proper to consult with the family or significant other or even other health care workers. Validation is also important with the client who has a collaborative problem or who requires a referral.

A client presents to the emergency department complaining of new onset chest pain. What is the priority action of the nurse?

Place on cardiac monitor. The nurse should prioritize care and address physiological, urgent needs first. The client should be placed on the cardiac monitor. The health history and medication use data can be collected while the client is being monitored. The nurse should ask the client about any allergies first as the client may be allergic to certain stickers used for cardiac monitoring. However, any allergies can be recorded after place on continuous monitoring.

The nurse enters an unassigned client's room to investigate an alarm. The client's intravenous (IV) bag is empty and the IV bag on the pole, left by the client's assigned nurse to hang next, is a different solution. What is the nurse's best action?

Review the client's prescribed medication orders. The nurse should review the client's current orders to confirm which IV solution should be infused. Hanging the IV bag that was left on the pole is assuming that the assigned nurse hung the correct IV solution. Nurses should always verify orders themselves. Obtaining a bag of the current IV solution to hang is assuming, rather than verifying, as well. Discontinuing the solution is not necessary while verifying the orders.

A nurse assesses an older adult client with confusion. When collecting clinical information from the client, which factor is the most important for the nurse to consider?

The quality of the data may be low. Due to client confusion, the quality of the data obtained directly from the client will likely be low. In order to ensure the quality of the client data, the nurse will need to confer with colleagues and client family members. In addition, the nurse should review the client history and pertinent literature to clarify uncertainties. The incorrect options may be likely; however, they are not possible if the nurse is unable to obtain reliable assessment data.

The nurse assesses the urine output (UOP) of several assigned clients. Which finding is priority for the nurse to address?

UOP 50 mL in 5 hours Urine output less than 50 mL over 4 hours warrants immediate attention and intervention.

A client presents to the emergency department following an accident at a construction site. The client is bleeding profusely from a deep wound on his head and states he cannot feel his leg. The nurse notes that the client is lethargic and mildly confused. What subjective data should the nurse document on this client?

Unable to feel his leg Based on the conditions in which the client has been brought to the health care facility, the client's inability to feel his legs can be noted as a subjective abnormal finding. Data such as the client is bleeding profusely from the wound and the presence of lethargy and confusion should be noted as objective abnormal findings.

A hospital nurse is in the process of analyzing physical assessment data the nurse has collected on a client. Which characteristics of critical thinking should the nurse employ in the analysis? Select all that apply.

Use past clinical experience to build knowledge. Reflect on thoughts before reaching a conclusion. Use rationale to support opinions and decisions. When analyzing the data collected from the client during physical assessment, the nurse should develop the following characteristics of critical thinking—use rationale to support opinions and decisions, reflect on thoughts before reaching a conclusion, and use past experience to build knowledge. Hypothesizing only one diagnosis before diagnosing the client and avoiding considering the client's cultural background when analyzing data are two of the pitfalls the nurse should avoid at the analysis stage.

A client who is overweight tells the nurse that he wants to lose weight but he doesn't know the best way to begin. The client states that he participates in routine exercise, but wants to increase the intensity of his workout. Which type of nursing diagnosis should the nurse choose for this client based on this information?

Wellness diagnosis A wellness diagnosis indicates that the client is ready to make changes to enhance his healthy state. The client states that he wants to lose weight and increase his exercise routine. A collaborative problem is one that suggests the need for both medical and nursing interventions to resolve the problem. A risk diagnosis indicates that the client does not currently have the problem but is at high risk for developing it. A referral, in which the nurse connects the client with other professionals and resources, is not necessary unless the nurse cannot assist the client with his needs.

The nurse has completed an assessment on a new client. After gathering the data, formulating a nursing diagnosis, and developing a plan of care, it is important for the nurse, before finalizing the plan, to

discuss the plan with the client Sharing the assessment and plan with the client will allow the client to offer his or her opinion, concerns, and willingness to proceed with the interventions. This makes the client an active participant in his or her plan of care.

The nurse divides collected data into subjective and objective categories. What should the nurse do next in the critical thinking process?

identify abnormal data and strengths Before beginning the analysis phase of the nursing process, the nurse must complete the collection of data then identify abnormal data and strengths. Clustering the data occurs after the abnormalities and strengths have been identified. Nursing diagnoses occurs after the data are clustered. Interventions are chosen according to selected nursing diagnoses.

A nursing student demonstrates understanding of the different types of nursing diagnoses when choosing which of the following to be an actual diagnosis?

impaired skin integrity Risk for impaired skin integrity and risk for infection are both "risk for" diagnoses, while readiness for enhanced skin integrity is a wellness diagnosis. The only actual diagnosis is impaired skin integrity.

A nurse is working with a client who has a history of chronic obstructive pulmonary disease (COPD). While bathing the client, the nurse senses that something is not quite right and takes the client's vital signs and obtains an oxygen saturation reading. The nurse is acting on which of the following?

intuition The nurse is acting on intuition, in this case, the feeling that something is not quite right. Scientific rationale is an explanation based on science. Knowledge is based on science and theories that the nurse learned in school. Prior history of the client is not what the nurse is acting upon in this case.

The nursing student understands that data analysis is referred to as the diagnostic phase because the end result is the identification of which of the following?

nursing diagnosis Data analysis is referred to as the diagnostic phase of the nursing process because the end result is the identification of a nursing diagnosis. A nursing intervention is done during the implementation phase, nursing rationale is identified when choosing the interventions, and data organization must be done during the collection of the data while still in the assessment phase.

The nursing instructor informs the students that there are pitfalls that decrease the reliability of cues and decrease diagnostic reasoning. The first set of pitfalls is related to the collection of data and includes which of the following?

too many or too few data Pitfalls decrease the reliability of cues and decrease diagnostic accuracy. One set of pitfalls includes too many or too few data, unreliable data, or invalid data and an insufficient number of cues available to support the diagnosis. Valid data, reliable data, and cues that support the diagnosis are desirable.

One characteristic of a nurse who is a critical thinker is the ability to

validate information and judgments. One characteristic of a critical thinker is the ability to validate information and judgments with experts in the field.