Chapter 2: Critical Thinking PrepU
The nurse performs a focused assessment on a client who is reporting joint pain. To gain a better understanding of the client's pain, the nurse uses COLDSPA. Which question(s) should the nurse ask the client to determine the origin of the pain? Select all that apply. -"What makes the pain better or worse?" -"When does the pain occur?" -"Have you had any recent laboratory tests?" -"How would you describe the pain?" -"Could you show me where the pain is exactly?"
-"Could you show me where the pain is exactly?" -"When does the pain occur?"
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 used in assessment, whereas critical thinking is used in analysis." -"Diagnostic reasoning is a form of critical thinking used to interpret data correctly." -"Critical thinking is a form of diagnostic reasoning used to interpret data correctly." -"Critical thinking and diagnostic reasoning are not related."
-"Diagnostic reasoning is a form of critical thinking used to interpret data correctly."
During a health history interview the client states, "I have been short of breath." What is the priority action of the nurse? -Document the finding. -Ask the client what exacerbates their shortness of breath. -Move to the next system. -Ask the client if they currently feel short of breath.
-Ask the client if they currently feel short of breath.
When teaching the students about becoming effective diagnosticians, the nursing instructor includes the following common errors made by novice nurses. (Select all the apply.) -Realize that sometimes things are a shade of gray. -See things as either right or wrong. -Focus only on the details. -Maintain a broad perspective.
-Focus only on the details. -See things as either right or wrong.
A nurse is performing a focused assessment on a client admitted with symptoms of meningitis who underwent a lumbar puncture this morning and is now reporting a headache and photophobia. The nurse identifies clear drainage on the dressing and redness and swelling around the site. The nurse documents which of the following objective findings in the chart? Select all that apply. -headache -photophobia -redness around the site -swelling -clear drainage on dressing
-swelling -redness around the site -clear drainage on dressing
After an initial assessment, the nurse has identified supportive and abnormal cues and has clustered the cues. Which of the following phrases indicates a client concern? -A client with a diagnosis of heart disease -A client without an identified problem and without a desire to improve health -A client with a reddened area on the hand reporting a "bee sting" -A client with a diagnosis of heart disease and stress at work
A client with a diagnosis of heart disease and stress at work
A nurse is preparing to document conclusions after analyzing data and includes information about related factors and manifestations. What is the nurse formulating? -Risk nursing diagnosis -Problem for referral -Actual nursing diagnosis -Collaborative problem
Actual nursing diagnosis
A home health nurse has completed an assessment on a 78-year-old widower who lives alone and is dependent on a volunteer from the local community center to bring the client one meal every day. The client states they have no appetite and "fruits and vegetables are too difficult to chew." Before identifying a client concern, what would be next best step for the nurse to take? -Provide client education about the food pyramid. -Check for supporting data to support a client concern. -Ask the health care provider for an appetite stimulant. -Communicate with the family immediately.
Check for supporting data to support a client concern.
What is pivotal to determining how to move from each client problem to its goals? -Evaluation as an accurate historian of the client -Process in collecting physical data -Clinical reasoning process -Positive interpretation of the client's history
Clinical reasoning process
The nurse collected extensive data during a client assessment and is performing the first step in the process of data analysis. Successful completion of this step requires the nurse to do which of the following? -Differentiate between expected findings and abnormal findings. -Perform health promotion education. -Validate nursing diagnoses with the client and the client's family. -Integrate the client's medical diagnosis with nursing diagnoses.
Differentiate between expected findings and abnormal findings.
A client admitted to a health care facility for injuries received in a motor vehicle accident is given the nursing diagnosis of Impaired Nutrition: Less than Body Requirements. What change in the client's dietary requirements should the nurse anticipate? -Decrease the number of calories from fats -Encourage intake of high density foods several times a day -Increase consumption of complex carbohydrates -Limit the intake of fluids with meals
Encourage intake of high density foods several times a da
A nurse is gathering subjective data. Which of the following would the nurse be most likely to assess? -Mood -Feelings of happiness -Posture -Behavior
Feelings of happiness
A new nursing graduate recently made an oversight during the analysis of a client's assessment data that resulted in a postoperative complication. What characteristic of data analysis makes it a challenging aspect of nursing practice? -It requires the prior identification of supportive and abnormal cues. -Abnormal data must be identified. -Conclusions must be clearly and accurately documented. -It requires sophisticated diagnostic reasoning skills.
It requires sophisticated diagnostic reasoning skills.
A client comes to the health care facility with reports of abnormal bleeding from his gums, chills, and recurrent infection. How should the nurse cluster the data collected from the client? -Hypothesize and generate possible nursing diagnoses -Check for defining characteristics for the clustered data -Look for related cues in the abnormal findings and strengths -Verify the cue data with the client and other health care professionals
Look for related cues in the abnormal findings and strengths
what additional information might you want to elicit to try and pinpoint the client's "real problem"? -More information from the client's peers -More information regarding family history -More information regarding psychosocial issues -More information regarding cognition
More information regarding psychosocial issues
A nurse has completed data analysis. Which of the following would the nurse identify first as the result? -Plan of care -Outcome evaluation -Interventions -Nursing diagnosis
Nursing diagnosis
A nurse is caring for a hospitalized client undergoing a thoracentesis at the bedside. The nurse explains to the client that the health care provider will insert a needle to remove fluid from the pleural space of the lung. After the procedure, the client reports shortness of breath. What is the best action of the nurse? -The nurse should notify the health care provider. -The nurse should reinforce the dressing. -The nurse should perform a focused respiratory assessment. -The nurse should notify the critical assessment team.
The nurse should perform a focused respiratory assessment.
The nurse has completed a comprehensive assessment and physical examination on a 28-year-old client recently admitted to the medical-surgical unit after suffering non-life-threatening injuries in a motor vehicle accident. The nurse identifies possible client concerns after analyzing and making inferences from the abnormal and supportive cues. What is the next best action for the nurse to take? -Document the client concerns. -Collaborate with other health care professionals. -Refer the client for identified medical problems. -Validate client concerns with the client.
Validate client concerns with the client.
The nurse is caring for a group of clients in the community. Which of the following clients can the nurse treat independently? -a client with a history of hypertension who requires hypertensive medication -a 15-year-old soccer player with a sprained ankle -a client with new onset hyperglycemia (diabetes) -a 75-year-old client with suspected aspiration pneumonia
a 15-year-old soccer player with a sprained ankle
A nurse is applying the clinical judgment process in the care of a client. Which description best characterizes the step referred to as Clustering Data? -evaluation of both subjective and objective data to identify strengths and abnormal findings -examining identified abnormal findings and strengths for cues that are related -documentation of all professional judgments and data that support those judgments -hypothesizing of any potentially applicable opportunities to improve health, risks for client concerns, and actual client concerns
examining identified abnormal findings and strengths for cues that are related
A client is admitted for observation after complaining of chest pain. A 12-lead electrocardiogram (ECG) reveals a normal sinus rhythm. The staff nurse questions the charge about whether the client can be observed or should be sent home because the ECG is normal. What is the charge nurse's best response? -"It's acceptable for a client to be admitted for observation." -"Call the healthcare provider to change the admitting diagnosis." -"Refuse to admit the client without a proper medical diagnosis." -"Tell the client that insurance will not pay for observation."
"It's acceptable for a client to be admitted for observation."
Which of the following statements is true of nursing diagnoses? -They are rooted in subjective rather than objective data. -They focus on the responses of clients to health problems and events. -They are less specific but more holistic than medical diagnoses. -They encompass psychological rather than physiological problems.
-They focus on the responses of clients to health problems and events.
The nurse is collecting data from a client. Which of the following best reflects objective data? -Occupation -Age -Appearance
appearance
A nurse is collecting data on a client's chief complaint, which is a spell of numbness and tingling on her left side. Which of the following questions would be best for eliciting information related to associated factors? -"How long did the spell last?" -"Where did the numbness and tingling occur?" -"How bad was the tingling and numbness?" -"What other symptoms occurred during the spell?"
"What other symptoms occurred during the spell?"
A nurse has selected several nursing diagnoses in the process of data analysis of a client with poorly controlled type 1 diabetes. One of these diagnoses is Ineffective Health Maintenance related to infrequent blood glucose monitoring as manifested by elevated HgA1C. How would the nurse best corroborate this diagnosis with the client? -"I need you to tell me a few things you could begin doing to better maintain your health." -"Based on my assessment, I think you have a nursing diagnosis of Ineffective Health Maintenance." -"Would you agree that there's room for improvement in your routines around blood sugar monitoring?" -"After assessing you, I believe that you're not maintaining your health effectively, specifically around your diabetes."
"Would you agree that there's room for improvement in your routines around blood sugar monitoring?"
The nurse is analyzing data in order to identify appropriate nursing diagnoses for a client. Which action should the nurse take to avoid making diagnostic errors? Select all that apply. -Consider the client's cultural background. -Hypothesize several diagnoses. -Appropriately word the diagnostic statement. -Ensure clustered cues are related to each other. -Collect an adequate amount of data.
-Consider the client's cultural background. -Appropriately word the diagnostic statement. -Ensure clustered cues are related to each other. -Hypothesize several diagnoses.
The new nurse understands that analyzing data requires critical thinking skills. Which of the following statements are features of critical thinking? Select all that apply. -Critical thinking is purposeful. -Critical thinking considers opinions when making clinical judgments. -Critical thinking is based on facts. -Critical thinking considers alternatives when making clinical judgments. -Critical thinking is self-directed. -Critical thinking is based on personal experience.
-Critical thinking is self-directed. -Critical thinking is purposeful. -Critical thinking considers alternatives when making clinical judgments. -Critical thinking is based on facts.
A nursing student is learning how to use critical thinking in formulating a plan of care. The student understands which of the following to be things needed to demonstrate that the process of thinking critically has begun? (Select all that apply.) -uses past knowledge and experience to analyze data -disregards literature and sound rationale when looking to support own opinion -explores other alternatives before making a decision -reserves a final opinion until further collecting data
-explores other alternatives before making a decision -uses past knowledge and experience to analyze data
A client reports sudden hair loss and a continuous itching sensation all over the body. The client appears anxious and seems to be worried about her appearance. Which abnormal finding should the nurse classify as objective data? -Itching sensation all over body -Worried about appearance -Reports of hair loss -Anxious appearance
Anxious appearance
A nurse has identified the personal goal of developing critical thinking skills. In order to facilitate this goal, what action should the nurse prioritize? -Maintaining an open mind -Maintaining a stable and static knowledge base -Applying quick decision-making -Seeking new experiences
Maintaining an open mind
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? -Give the client a printed diet. -Make a referral to the dietician. -Call the physician and ask them to come and talk with the client about their diet. -Inform the client that they can look up a diabetic diet on the internet.
Make a referral to the dietician.
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 -nursing rationale -nursing intervention -data organization
nursing diagnosis
The nursing student has learned that diagnostic reasoning has several pitfalls. The second set of pitfalls usually occurs during the analysis phase and involves which of the following? -too much data -invalid data -cues that are clustered yet unrelated -too few data
cues that are clustered yet unrelated
A common error for beginning nurses who are formulating nursing diagnoses during data analysis is to -obtain an insufficient number of cues and cluster patterns. -quickly make a diagnosis without hypothesizing several diagnoses. -formulate too many nursing diagnoses for the client and family. -include too much data about the client in the history.
quickly make a diagnosis without hypothesizing several diagnoses.
A client with a history of chronic renal failure is receiving continuous intravenous fluids. The nurse understands that this client is at risk for fluid overload. How should the nurse document this potential client concern? -fluid overload associated with chronic renal failure and receiving continuous intravenous fluid -risk for fluid overload associated with receiving intravenous fluid and having a history of renal failure -fluid overload associated with renal failure and use of continuous intravenous fluid -risk for fluid overload risk associated with the client's history of chronic renal failure and currently receiving continuous intravenous fluids
risk for fluid overload risk associated with the client's history of chronic renal failure and currently receiving continuous intravenous fluids