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

A nursing student is explaining to a roommate the relationship between diagnostic reasoning and critical thinking. Which of the following is the correct statement for the nursing student to make?

"Diagnostic reasoning is a form of critical thinking used to interpret data correctly." Explanation: 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. Diagnostic reasoning is a form of critical thinking.

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. Explanation: 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 community health nurse provides information to a patient with newly diagnosed multiple sclerosis for a support group at the local hospital for patients diagnosed with multiple sclerosis and their families. Providing this information is an example of which of the following?

A referral Explanation: Referring is the process of sending or guiding the patient to another source for assistance. Consultation is the process of inviting another professional to evaluate the patient and make recommendations to you about his or her treatment. Conferring is to consult with someone to exchange ideas or seek information, advice, or instructions. Reporting is the oral, written, or computer-based communication of patient data to others.

The nurse has learned that after completing the assesment 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 Explanation: 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 nurse has completed a plan of care for a client having a total knee replacement. In order to develop goals which are realistic for the client, what should the nurse do prior to implementing the plan?

Ask the client for opinions and willingness to proceed with the interventions. Explanation: The plan of care should be agreeable to the patient. Before finalizing the plan, it is important for the nurse to share the information with the patient and seek out opinions and willingness to proceed with the interventions. Although discussing the plan of care with the all health care providers involved, involving the client in the process is the only way to know if the goals are realistic for his unique needs. Sharing the assessment and plan of care with the client's primary health care provider will only be necessary once the client has voiced his opinion and willingness to proceed with the interventions. The client's family should be involved in the plan of care and likely serve to make it more effective. The client must agree first and demonstrate willingness prior to discussing it with the family.

A nurse proposes a nursing diagnosis for a client based on subjective and objective data. What step should the nurse perform before the diagnosis can be confirmed or ruled out?

Check for the presence of major and minor defining characteristics Explanation: Once a nurse has selected possible nursing diagnoses for a client, major and minor defining characteristics must be present for the diagnosis to be confirmed. If the client does not present with at least one major defining characteristic the nursing diagnosis is ruled out. Validation of subjective information is performed during the analysis phase of the nursing process. Validation can also be do ne with a client who has a collaborative problem or requires a referral. Resources are important to give a client who needs a referral or requires assistance. Inferences are performed before proposing nursing diagnoses.

A client with an elevated blood pressure asks the nurse why he is not taking his blood pressure medication from home while he is hospitalized. The nurse reviews the orders and discovers that indeed the client is not taking his usual blood pressure medication. Which preventive measure was most likely omitted on admission?

Medication reconciliation Explanation: Medication reconciliation is a preventive measure to ensure the continuity of care for a client and the continuation of medications taken at home that are necessary for the client's well being. SBAR is a communication tool to ensure appropriate information is given to the healthcare provider to care for the client. High-alert labeling is utilized to identify many sound alike medications. The teaching of side effects is crucial to informed care, yet is not the most likely cause of omission of medication from home.

A nurse provided dietary counsel for a client who recently immigrated to the United States from Japan. During the initial interview, the client had his eyes lowered and did not make eye contact with the nurse. In analysis of the data, the nurse wrote down the following hunch: "risk for imbalanced nutrition related to client's unwillingness to listen to dietary advice." At the next meeting with the client a month later, however, the nurse was surprised to find that the client had adopted all recommended changes from their initial interview. Which error did the nurse commit in this case?

Overlooking consideration of the clients cultural background Explanation: The nurse erred in this case by interpreting the lack of eye contact on the part of the client as an unwillingness to listen to recommendations. In some cultures, including Japanese, eye contact is not considered appropriate in certain social situations. The other errors listed do not apply in this case, as the nurse did not cluster together unrelated cues, diagnose the client without hypothesizing several diagnoses, or incorrectly word a diagnostic statement.

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

Patients do not need to understand their problems. Explanation: It is essential for the patient to understand the problem so that treatment can be properly implemented. If the patient 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 patient 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. Explanation: 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 continous 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. Explanation: 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. Explanation: 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 is determining a priority problem that would be appropriate for a client with heart failure. Which problem would have the highest priority for the client?

Weight gain of 3 pounds (1.5 kilograms) over 1-2 days Explanation: Nursing diagnoses are based on alterations in body system processes, lifestyle, personal issues, and specific causes. For the client with heart failure, the problem that would have the highest priority would be the weight gain of 3 pounds (1.5 kilograms) over 1-2 days. This change can related to a decline in cardiac functioning and needs to be addressed first. Once this priority problem has been investigated, other problems can be addressed. Ineffective health maintenance can be addressed last. Knowledge deficit related to lack of information regarding low-sodium diet would be the next in priority after activity intolerance because learning how to reduce sodium could help control the heart failure. Anxiety about hospitalization and inability to attend to home and work needs would be addressed after the knowledge deficit.

The nurse understands that, after clustering data and drawing inferences, if the problem is something a nurse could manage independently the next step would be which of the following?

analyzing the data Explanation: After clustering data, the nurse writes down hunches and determines whether it is something that the nurse can treat independently. If so the nurse can intervene and then move to the next step, which is analysis of data to formulate a nursing diagnosis. Identifying abnormal data is step one, confirming the diagnosis is step six, and documenting conclusions is the last step.

The nurse has completed an assessment on a new patient. 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 patient Explanation: Sharing the assessment and plan with the patient will allow the patient to offer his or her opinion, concerns, and willingness to proceed with the interventions. This makes the patient an active participant in his or her plan of care.

A patient who is 2 days postoperative reports pain and requests pain medication. After assessing the patient's pain level, the nurse decides to give the patient oral oxycodone hydrochloride-acetaminophen instead of intravenous morphine. This nurse is doing which step of the nursing process?

implementation Explanation: This step is implementation, because the nurse is taking appropriate action by giving oral medication. Assessment is the first step of the nursing process when the nurse collects data. Diagnosis is determining the problem. Evaluation is the final step to see if patient has achieved established goals.

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

intuition Explanation: 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 patient is not what the nurse is acting upon in this case.

The nurse is developing goals after completing the assessment of a newly admitted medical patient. The nurse would document the goals under which part of the nursing process?

planning Explanation: Goal setting and interventions are part of the planning section of the nursing process.

The nursing instructor realizes that the nursing student understands all the criteria necessary for developing expertise when making clinical professional judgments by identifying the following as being a barrier to diagnostic reasoning.

seeing things as only right or wrong Explanation: Developing expertise with making professional judgments comes with accumulation of both knowledge and experience. It is a process that develops over time and with practice. Seeing things as only right or wrong does not allow for seeing things as gray and may make you miss the bigger picture.

A nursing student demonstrates understanding of the different types of nursing problems when choosing the following to indicate that the patient has the opportunity for an enhanced health state:

wellness diagnosis Explanation: A wellness diagnosis indicates that the patient has the opportunity for enhancement of a health state. A risk diagnosis indicates that the patient does not currently have the problem, but is at high risk for developing it. An actual diagnosis indicates that the patient is currently experiencing the stated problem or has a dysfunctional pattern. A medical diagnosis is treated by the physician and is usually stated as a disease process.