Basic Nursing Chapter Two Clinical Judgement

Which of the nurse's questions demonstrates critical thinking?

"Have I gathered enough data to make a decision?"

Which statement best reflects a critical-thinking philosophy?

"Think about different interventions that can be used with this client."

Which are vital components of exemplary patient care?

Critical thinking Problem-solving Clinical reasoning Decision making

What is included in the nurse's ability to make a clinical judgment decision?

Observation and assessment of the presenting situations. Identification and prioritization of concerns. Generation of evidence-based solutions. Evaluation of outcomes of the solutions. Continuous adjustment of care.

Which nursing action is part of the evaluation phase when performing wound care for a client?

Obtaining wound measurements once a week

The nurse recognizes that a client's respiratory rate has increased from 16 to 24 over the last 2 hours. What action should the nurse take?

Prioritize the need for further inquiry.

Which nursing action reflects the nurse assisting the client in maintaining belief as a component of caring?

Providing encouragement to a client with a new amputation

Which is the best example of intellectual courage?

A nurse fairly examines their own values and beliefs even when uncomfortable.

Which action made by the nurse indicates the use of clinical judgment?

Analyzing a client's temperature changes and assessing for signs of infection

The nurse enters a client's room to obtain a fasting blood glucose reading and notices the breakfast tray is in front of the client. Which action best indicates the nurse using critical thinking?

Asking the client if they have eaten any food yet

A nurse receives an order to deliver a unit of blood if the client's hemoglobin falls below 7.0 g/dL. The nurse enters the room to obtain consent and the client says, "I choose not to take blood; it's not supported by my religion." The nurse makes a note and does not deliver the blood. Which aspect of critical thinking is this nurse using to guide client care?

Clients Culture

An older adult client is thinking about several treatment options for a new diagnosis of cancer. The client's family is strongly encouraging the client to take the most aggressive medications despite the client's hesitation. The nurse is asked to provide an opinion. Which critical-thinking attitude should the nurse present?

Fair Mindedness

A nurse is ambulating a client in the hallway who says, "I feel a little dizzy." The nurse immediately grabs a chair and slides it behind the client, having him sit down. According to Tanner's Model of Clinical Judgment, which reasoning skill is the nurse using after hearing this statement?

Intuitive reasoning

What is the best way for a nurse to develop clinical judgment skills?

Look for clinical changes and question why.

A nurse is instructing nursing students about incorporating critical thinking into client care. Which attributes should the nurse include during this lesson?

Need to find the truth Openness to other options Use of reasoned thinking Capacity to reflect on situations

A nurse is working in a healthcare facility with a protocol stipulating that clients with pneumonia should turn, cough, and deep breathe. This nurse is assigned to care for a client admitted with pneumonia but does not encourage the client to cough because the client also has esophageal varices from cirrhosis. Which aspect of critical thinking is this nurse using to guide client care?

Individual differences

A nurse with several years of experience in the intensive care unit obtains a new job in the newborn nursery at the healthcare facility. Which critical-thinking attitude would be best for the nurse to employ in this new setting when asking for guidance?

Intellectual humility

Which is an example of a nurse who is using clinical judgment?

The nurse identifies abnormal findings, investigates if the findings are new or old, and adjusts the plan of care accordingly.

Which critical-thinking skills will a nurse utilize when reviewing the health record of a new client to prepare a nursing diagnosis? Select all that apply.

Visualizing potential solutions to a problem Prioritizing or ranking data as needed Separating relevant from irrelevant data