Chapter 10 - critical thinking and clinical reasoning

Correct Answer: 2 Rationale 1: A fact can be verified through investigation. In this case, facts would be the elevated pulse and blood pressure readings. Rationale 2: Inferences are conclusions drawn from facts, going beyond facts to make a statement about something that is not currently known. In this case, acute, severe pain will most likely cause the blood pressure as well as pulse rate to be elevated as the bodys response to the painful experience. Rationale Judgment is evaluating facts and information that reflect values or other criteria; it is a type of opinion. Because the nurse understands the pathophysiology of pain, thinking about changes in vital signs is more than a judgmentit is an inference. Rationale 4: Opinions are beliefs formed over time and include judgments that may fit facts or be in error.

A client complaining of extreme low back pain is pale and diaphoretic and walks bent at the waist. Before taking vital signs, the nurse suspects that the blood pressure and heart rate will be elevated. What thought process did the nurse use to come to this conclusion? 1. Fact 2. Inference 3. Judgment 4. Opinion

Correct Answer: 3 Rationale 1: Clarity provides examples. That is not the process described in the scenario. Rationale 2: Accuracy is asking if something is true. That is not the process described in the scenario. Rationale 3: Logicalness would ask if the report follows from the evidence. In this case, it does not. However, the nurse is still questioning, which shows she is engaged in critically thinking through the situation. Rationale 4: Significance is prioritizing the facts. That is not the process described in the scenario.

A client complaining of shortness of breath has no pallor, cyanosis, or use of accessory muscles with respirations. The clients respiratory rate is 16 breaths per minute. The nurse is concerned that the clients report and the physical findings conflict. Which standard of critical thinking is the nurse using? 1. Clarity 2. Accuracy 3. Logical reasoning 4. Significance

Correct Answer: 1 Rationale 1: Deductive reasoning is reasoning from the general to the specific. The nurse starts with a framework and makes descriptive interpretations of the clients condition in relation to the framework. Productive cough, crackles, fever, and chills all point to problems with respiratory status. Rationale 2: Inductive reasoning would be making a generalization from a set of facts or observation. In this case, the nurse using inductive reasoning could presume that the client has bronchitis or a bacterial respiratory infection. Rationale 3: Socratic questioning looks beneath the surface and asks questions to come to a conclusion about the situation; that is not what is described in this scenario. Rationale 4: Critical analysis looks beneath the surface and asks questions to come to a conclusion about the situation.

A client is experiencing a productive cough, audible coarse crackles, elevated temperature of 102.3F, chills, and body aches. What did the nurse use to determine that this patient is experiencing respiratory compromise? 1. Deductive reasoning 2. Inductive reasoning 3. Socratic questioning 4. Critical analysis

Correct Answer: 4 Rationale 1: Explaining the rationale for doing or not doing the exercises is not using creativity. It is merely explaining the reason. Rationale 2: This shows no creativity and merely dismisses the clients concerns and feelings. Rationale 3: This shows no creativity and merely dismisses the clients feelings. Rationale 4: Making the exercise routine into something more fun such as a game, drawing a picture, or even decorating the walls, for example would raise a challenge to the client, take the focus off the why, and still achieve the end result.

A client recovering from a stroke does not want to perform prescribed shoulder exercises. What should the nurse say to the client that demonstrates critical thinking with creativity? 1. Youll only get worse if you dont do these exercises. 2. As soon as you get these into your routine, youll feel better. 3. Your physician wouldnt have ordered these if they werent important. 4. Heres a marker. See how many circles you can make on this board in 10 minutes.

Correct Answer: 4 Rationale 1: Asking why questions make clients very defensive, and doing so does not utilize critical thinking skills. Rationale 2: Asking a yes/no question offers little other information, and doing so does not utilize critical thinking skills. Rationale 3: Asking the client what he wants does not help to find out more information about the clients situation or prior history, and doing so does not utilize critical thinking skills. Rationale 4: In critical thinking, the nurse also differentiates statements of fact, inference, judgment, and opinion. The nurse will have to ascertain the accuracy of information and evaluate the credibility of the information sources.

A client with a PhD in epidemiology has been to numerous physicians and has had numerous laboratory tests, all of which were abnormal, and exploratory surgery, but no one is able to explain the etiology of his problem. The client also states that he has a rare form of a neurological disorder. Which statement should the nurse make that demonstrates critical thinking? 1. Why dont you just tell your physician what you think you have? 2. Did you bring your prior tests and results with you, so we dont repeat anything? 3. If you know what you have, what do you want from us? 4. Describe what tests youve had and explain the symptoms of this disorder.

Correct Answer: 2 Rationale 1: Identifying the purpose, in this case, would be determining that the client needs intervention to control the dysrhythmia. Rationale 2: In this step, the decision maker (nurse) identifies possible ways to meet the criteria. Alternatives considered are which by route to give a certain medication: IV versus oral. The nurse is utilizing his experience, taking what he knows about cardiac problems and pharmacology, and will make a selection based on that information. Rationale 3: Projecting is when the nurse applies creative thinking and skepticism to determine what might go wrong as a result of a decision and develops plans to prevent, minimize, or overcome any problems. Rationale 4: Implementation is taking the plan into action.

A client with unstable cardiac dysrhythmias has orders for medications, one of which is by oral route, the other by IV delivery. The nurse realizes that the IV route would be fastest, but is also concerned about the side effects that this drug may produce and the fact that the client has never taken the drug, so any adverse effect is unknown. Which part of the decision-making process is the nurse using? 1. Identify the purpose 2. Seek alternatives 3. Project 4. Implement

Correct Answer: 2 Rationale 1: Trial and error uses a number of approaches until a solution is found. Rationale 2: Intuition is the understanding or learning of things without the conscious use of reasoning. It is also known as the sixth sense, hunch, instinct, feeling, or suspicion. In this case, the educator has a sense that the student is struggling, although there are no real facts to support it. Rationale 3: The research process is a systematic, analytical, and logical way to problem solve. Rationale 4: Experience is part of intuition, but by itself, not a particular way to problem solve.

A clinical instructor senses that a student has been struggling with clinical skills learned in lab. To combat this, the educator pairs the student with a staff nurse who has clients with a variety of treatments and cares. Which type of problem solving is the instructor using? 1. Trial and error 2. Intuition 3. Research process 4. Experience

Correct Answer: 1 Rationale 1: Intellectual integrity requires that individuals apply the same rigorous standards of proof to their own knowledge and beliefs as they apply to the knowledge and beliefs of others. Trying new teaching techniques in the hope that students might respond positively shows that the first educator is willing to question her own practices, just as she would question those of another. Rationale 2: Perseverance is determination that enables critical thinkers to clarify concepts and sort out related issues, in spite of difficulties and frustrations. Rationale 3: Fair-mindedness is assessing all viewpoints with the same standards and not basing judgments on personal or group bias or prejudice. Rationale 4: Intellectual humility means having an awareness of the limits of ones own knowledge. Critical thinkers are willing to admit what they do not know, seek new information, and rethink their conclusions in light of new knowledge.

A nurse educator has always believed that lectures with focused outlines are the best way to present theory content in class. A colleague, who teaches the same group of students, but a different subject, utilizes group work and in-class activities to teach difficult content and finds that students perform as well, or better, on their tests. The first educator in this situation is starting to rethink her position. What behavior is the first educator demonstrating? 1. Integrity 2. Perseverance 3. Fair-mindedness 4. Humility

Correct Answer: 1 Rationale 1: Reflection involves being able to determine what data are relevant and to make connections between that data and the decisions reached. The nurse reflects on previous clinical experiences similar to this one and determines if the outcomes of care improved the clients conditions. Rationale 2: Context is an essential consideration in nursing because care must always be individualized, taking knowledge and applying it to real people, but that is not what is described in the scenario. Rationale 3: Dialogue is a purposed exchange of information, but that is not what is described in the scenario. Rationale 4: The attribute of time is a part of reflection.

A seasoned nurse uses past experiences and knowledge gained from previous care situations to care for a client with complex health issues. Which attribute of critical thinking is this nurse practicing? 1. Reflection 2. Context 3. Dialogue 4. Time

Correct Answer: 1 Rationale 1: Creativity is thinking that results in the development of new ideas and products and is the ability to develop and implement new and better solutions. When nurses incorporate creativity into their thinking, they are able to find unique solutions to unique problems. Creativity does make the nurse look beyond the answers found in the text, but it also brings originality and individuality to nursing. Rationale 2: This option does not address the reason creativity is a major component of critical thinking, and appears to dismiss the students statement. Rationale 3: This option doesnt address the reason for creativity in nursing and merely trivializes its importance. Rationale 4: This option doesnt address the reason for creativity in nursing and merely provides a personal motive for creativity.

A student nurse resists when encouraged to be creative when providing client care. What should the nurse educator say to encourage this student to be creative? 1. Creativity allows unique solutions to unique problems. 2. Not all your answers are going to be from your textbook. 3. Creativity makes nursing more fun. 4. Youll get bored if you dont learn to be creative.

Correct Answer: 1, 2, 4, 5 Rationale 1: Patients are sicker, with multiple problems, and so nursing care requires a more critical form of thinking in order to meet their nursing needs. Rationale 2: Redesigning care delivery is useless if nurses dont have the thinking skills required to deal with todays world. Rationale 3: Although this might be true, medicine and nursing have evolved tremendously, and so has the need for nurses to be critical thinkers. Rationale 4: Consumers and payers demand to see evidence of benefits, efficiency, and results. Rationale 5: Todays progress often creates new problems that cant be solved by old ways of thinking.

During a clinical conference, a staff nurse states that critical thinking is essential when providing client care. What additional statements should this nurse make to support the use of critical thinking? Standard Text: Select all that apply. 1. Patient acuity is so much greater than it was even 10 years ago. 2. Care delivery systems are only as good as the nurses delivering care. 3. Nurses have always relied on commonsense thinking to provide quality, appropriate nursing care. 4. With health care being so expensive, nursing has to take on responsibility to keep the costs controlled. 5. My practice involves caring for clients who require care that didnt even exist when I went to school.

Correct Answer: 1 Rationale 1: Suspending judgment means tolerating ambiguity for a time. If an issue is complex, it may not be resolved quickly and judgment should be postponed. In this case, the nurse just doesnt have enough information to give a good answer to the parents. For a while, the nurse will need to say I dont know and be comfortable with that answer. Rationale 2: Telling the parents to agree with the physician before the nurse knows all the facts might be premature, even if he is the best physician in the area. Rationale 3: Nurses should not give advice or counsel. Rationale 4: It would be premature to tell the parents to get another opinion.

Parents ask why invasive diagnostic tests were prescribed for their ill child. The nurse has just gotten out of report and has not had a chance to review additional information. What should the nurse respond to the parents? 1. Im not sure I can answer your question just now. 2. Its a good idea to listen to what your physician wants. 3. Your childs doctor is the best there is. I dont see why you wouldnt follow his advice. 4. Maybe you should get another opinion if youre not comfortable with your doctor.

Correct Answer: 4 Rationale 1: Setting criteria is based on three questions: What is the desired outcome? What needs to be preserved? What needs to be avoided? Rationale 2: Examining alternatives ensures that there is an objective rationale in relation to the established criteria for choosing one strategy over another. Rationale 3: Implementation is putting a plan into action. Rationale 4: In evaluating, the nurse determines the effectiveness of the plan and whether the initial purpose was achieved. In this situation, the nurse wants to determine what worked on the previous shift and what didnt. This will help with deciding on interventions for the client during the shift.

Prior to providing client care, the nurse reviews previous shift charting and the responses to nursing interventions. Which decision-making action is the nurse using? 1. Set the criteria 2. Examine alternatives 3. Implement 4. Evaluate the outcome

Correct Answer: 3 Rationale 1: Assessment is the process of collecting data. Rationale 2: Diagnosing is putting a label on the problem. Rationale 3: The planning portion of the nursing process involves setting criteria, weighting the criteria, and seeking/examining alternatives when compared to the decision-making process. Rationale 4: Evaluating is reviewing the outcome.

The nurse completes collecting data from a client and determines a list of problems. Which step in the nursing process should the nurse perform next? 1. Assess 2. Diagnose 3. Plan 4. Evaluate

Correct Answer: 1, 3, 4, 5, 6 Rationale 1: Attributes that foster critical thinking include independence. Rationale 2: Attributes that foster critical thinking include insight into egocentricity (which is open to the possibility that biases or social pressures and customs can affect ones thinking) but not egocentricity itself. Rationale 3: Attributes that foster critical thinking include intellectual humility. Rationale 4: Attributes that foster critical thinking include fair-mindedness. Rationale 5: Attributes that foster critical thinking include confidence. Rationale 6: Attributes that foster critical thinking include perseverance.

The nurse desires to improve critical thinking skills when providing client care. On which attributes should the nurse focus when developing these skills? Standard Text: Select all that apply. 1. Independence 2. Egocentricity 3. Intellectual humility 4. Fair-mindedness 5. Confidence 6. Perseverance

Correct Answer: 1 Rationale 1: Socratic questioning is a technique one can use to look beneath the surface, recognize and examine assumptions, search for inconsistencies, examine multiple points of view, and differentiate what one knows from what one merely believes. Questions about evidence and reason focus on just that (e.g., what evidence is there, how you know, what would change your mind). Rationale 2: Asking about ways to study would be a question about the problem (studying), which is not an example of Socratic questioning. Rationale 3: Asking about the effects of studying is questioning about implications and consequences, which is not an example of Socratic questioning. Rationale 4: Asking about the effects of studying is questioning about implications and consequences, which is not an example of Socratic questioning.

The nurse educator assigns students an activity to implement Socratic questioning in their daily lives. Which question provided by a student demonstrates this reasoning technique? 1. What makes you think cramming for a test is an ineffective way to study? 2. What other ways of studying could you implement? 3. If you didnt study for your test, what is the probability you will fail? 4. If you study all the unit outcomes, what effect will that have?

Correct Answer: 2 Rationale 1: Trial and error is solving problems through a number of approaches until a solution is found. Rationale 2: Intuition is the understanding or learning of things without the conscious use of reasoning. It is also known as sixth sense, hunch, instinct, feeling, or suspicion. Clinical experience allows the nurse to recognize cues and patterns and begin to reach correct conclusions using intuition. Finding no cause for concern in the physical assessment of the client, the nurse is not satisfied and continues to assess the clients surroundings, finding the error. Rationale 3: Judgment is not part of problem solving. Rationale 4: The scientific method requires that the nurse evaluate potential solutions to a given problem in an organized, formal, and systematic approach.

The nurse enters the room of a critically ill child after sensing that something isnt right. Once the nurse determines the child is stable, the nurse continues to perform a check of all the lines and equipment in the room and finds that the last IV solution hung by the previous nurse was not the correct solution. Which problem solving method did this nurse use? 1. Trial and error 2. Intuition 3. Judgment 4. Scientific method

Correct Answer: 1 Rationale 1: Nurses who can think for themselves and consider different methods of performing technical skillsnot just the way they may have been taught in schooldevelop an attitude of independence. Rationale 2: Courage to challenge the status quo comes from recognizing that sometimes beliefs are false or misleading. Integrity requires that individuals apply the same rigorous standards of proof to their own knowledge and beliefs; that is not what is described in the scenario. Rationale 3: Integrity requires that individuals apply the same rigorous standards of proof to their own knowledge and beliefs; that is not what is described in the scenario. Rationale 4: Confidence is the self assurance to act on ones own beliefs; that is not what is described in the scenario.

The nurse implements a quicker way to set up and initiate an intravenous infusion while still following safe practice. Which attitude of critical thinking is this nurse practicing? 1. Independence 2. Intellectual courage to challenge the status quo or rituals 3. Integrity 4. Confidence

Correct Answer: 2 Rationale 1: Administering IV meds (even to critically ill clients) does not require much reasoning. There are standard procedures to follow and, most of the time, clear answers about the rationale. Rationale 2: Nurses who utilize good critical thinking skills are able to think and act in areas where there are neither clear answers nor standard procedures. Treatment options, especially for the home health client, can be extensive. There are many points to consider (good and bad), and choosing between treatment options can cause conflict among family members. The nurse in this case must use creativity, analysis based on science, and problem-solving skillsall of which contribute to critical thinking skills. Rationale 3: Teaching new parents about car seat safety does not require much reasoning. There are standard procedures to follow and, most of the time, clear answers about the rationale. Rationale 4: Teaching correct use of crutches does not require much reasoning. There are standard procedures to follow and, most of the time, clear answers about the rationale.

The nurse is providing care to a group of clients. For which situation would the nurses use of critical thinking be a priority? 1. Administering IV push meds to critically ill clients 2. Educating a home health client about treatment options 3. Teaching new parents car seat safety 4. Assisting an orthopedic client with the proper use of crutches

Correct Answer: 1, 3, 4, 5 Rationale 1: Empathetic listening shows the ability to imagine others feelings and difficulties, which is characteristic of critical thinking. Rationale 2: Proactive anticipation of consequences, planning ahead, and acting as opportunities and events require are characteristic of real thinking. Rationale 3: Courageously advocating for others demonstrates attributes characteristic of critical thinking. Rationale 4: Flexible changing of approaches as needed to get the best results is a characteristic of critical thinking. Rationale 5: Sensitivity to diversity, expressing appreciation of human differences related to values and culture, is a characteristic of critical thinking.

The nurse manager determines that a new staff nurse is demonstrating characteristics of a critical thinker. What did the manager observe the nurse perform? Standard Text: Select all that apply. 1. Listening with empathy to a client who recently has been diagnosed. 2. Waiting for the medical team to determine the focus of the clients supportive care. 3. Questioning a medication order that does not appear to meet the clients needs for pain management. 4. Exhibiting a willingness to try alternate methods of addressing a clients care needs. 5. Practicing nursing in a culturally competent fashion.

Correct Answer: 3 Rationale 1: Confidence comes from cultivating reasoning and examining arguments. In this case, the nurse did not reason anything out, but is asking questions. Rationale 2: Perseverance happens from determination in clarifying concepts and sorting out related issues, in spite of difficulties and frustrations. This nurse is asking questions, not making any changes in spite of difficulties or frustrations. Rationale 3: The internal conversation going on within the mind of a critical thinker is filled with questions. The curious nurse may value tradition but is not afraid to examine traditions to be sure they are still valid, as in this case. This nurse is asking valid questions. Rationale 4: Integrity requires that individuals apply the same rigorous standards of proof to their own knowledge and beliefs as they apply to the knowledge and beliefs of others.

The nurse questions the practice of administering rectal suppositories to residents in a long-term care facility at bedtime, rather than earlier in the day. When told that this is the best time for staff and thats the routine that has been practiced for a long time, the nurse continues to research whether there would be a better time, especially in the best interest of the residents. Which critical thinking attitude is this nurse demonstrating? 1. Confidence 2. Perseverance 3. Curiosity 4. Integrity

Correct Answer: 4 Rationale 1: Intuition is the learning of things without conscious use of reasoning also known as the sixth sense, hunch, or instinct. Rationale 2: The scientific method is a formalized, systematic, and logical approach to solving problems. Rationale 3: The research process is a formalized, systematic, and logical approach to solving problems. Rationale 4: Trial and error is solving problems by utilizing a number of approaches. Trial-and-error methods can be dangerous in nursing because the client might suffer harm if an approach is inappropriate. In this case, the client may not suffer harm, but there will be no way to know if one product used is effective because the nurse is changing them on a daily basis.

The nurse systematically tries a variety of products to help with healing of a clients wound. Which problem solving method is the nurse using? 1. Intuition 2. Scientific method 3. Research process 4. Trial and error

Correct Answer: 2 Rationale 1: Fair-mindedness means assessing all viewpoints with the same standards and not basing judgments on personal or group bias or prejudice. Rationale 2: Critical thinkers are open to the possibility that their personal biases or social pressures and customs could unduly affect their thinking. They actively try to examine their own biases and bring them to awareness each time they make a decision. Understanding that how things were done and what practices were common may be completely different in the new surroundings is an example of the nurse implementing this attitude. Rationale 3: Intellectual humility means having an awareness of the limits of ones own knowledge. Rationale 4: Intellectual courage to challenge the status quo and rituals is taking a fair examination of ones own ideas or views, especially those to which one may have a strongly negative reaction.

The nurse who just moved from an urban area to a sparsely populated rural area understands that certain customs and practices the nurse follows may be quite foreign to the people in the new area. Which attitude of critical thinking is the nurse demonstrating? 1. Fair-mindedness 2. Insight into egocentricity 3. Intellectual humility 4. Intellectual courage to challenge the status quo and rituals

Correct Answer: 4 Rationale 1: Curiosity is questioning the status quo. The curious nurse may value tradition but is not afraid to examine traditions to be sure they are still valid. Rationale 2: Clinical reasoning is the analysis of a clinical situation as it unfolds or develops. Rationale 3: Setting priorities is determining what needs to be completed in a specific order to support client care needs. Rationale 4: Developing rationales is when the nurse transfers nursing knowledge to the clinical situation to justify the plan of care.

The staff nurse asks why unlicensed assistive personnel are responsible for stocking the unit refrigerator with refreshments when dietary personnel place the items on the shelf in the kitchen. What characteristic of critical thinking is this nurse demonstrating? 1. Curiosity 2. Clinical reasoning 3. Setting priorities 4. Developing rationales

Correct Answer: 1, 2, 3, 5 Rationale 1: Concept mapping is a technique that uses a graphic depiction of nonlinear and linear relationships to represent critical thinking. A general benefit is that it highlights key areas. Rationale 2: Concept mapping is a technique that uses a graphic depiction of nonlinear and linear relationships to represent critical thinking. Concept maps provide an opportunity to visualize things. Rationale 3: Concept mapping is a technique that uses a graphic depiction of nonlinear and linear relationships to represent critical thinking. A general benefit of these maps is that they are quicker than note taking. Rationale 4: Concept mapping is a technique that uses a graphic depiction of nonlinear and linear relationships to represent critical thinking. It is easy to learn and does not take years of study. Rationale 5: Concept mapping is a technique that uses a graphic depiction of nonlinear and linear relationships to represent critical thinking. Also known as mind maps, concept maps are context dependent and can be used to develop analytical skills. The attributes of the concept are linked, making meaning of the concept they represent.

The staff nurse is helping a new graduate understand the relationship between care concepts and planned interventions. What value would it be for the staff nurse to encourage the new graduate to use a concept map? Standard Text: Select all that apply. 1. Used to highlight key areas 2. Provides a visual representation 3. Can be quicker than taking notes 4. Takes years to study how to create 5. Aids in developing critical thinking

Correct Answer: 3 Rationale 1: Inferences are conclusions drawn from the facts, going beyond facts to make a statement about something not currently known. Rationale 2: Judgment is an evaluation of facts or information that reflects values or other criteria. Rationale 3: Opinions are beliefs formed over time and include judgments that may fit facts or be in error. In this case, the nurse may not understand that, culturally, this may be very appropriate and fitting for this client. If this is the case, the nurse should not become disturbed by the spouses attention. Rationale 4: Evaluation is considering the results or outcome.

While caring for a client of a different culture, the nurse becomes disturbed when the clients spouse makes all the decisions about care and treatments. What behavior is this nurse demonstrating? 1. Inference 2. Judgment 3. Opinion 4. Evaluation

Correct Answer: 2 Rationale 1: Reflection involves being able to determine what data are relevant and to make connections between that data and the decisions reached. Rationale 2: Context is being considerate of the whole situation including relationships, background, and environment and its relevant to the current situation. Rationale 3: Dialogue, which need not involve other persons, refers to the process of serving as both teacher and student in learning from situations. Rationale 4: Time emphasizes the value of using past learning in current situations that then guide future actions.

While listening to a client describe current symptoms, the nurse considers the clients entire situation. Which attribute of critical thinking is the nurse practicing? 1. Reflection 2. Context 3. Dialogue 4. Time