Chapter 3: Critical Thinking, Ethical Decision Making and the Nursing Process

38. A nurse uses critical thinking every day when going through the nursing process. Which of the following is an outcome of critical thinking in nursing practice? A) A comprehensive plan of care with a high potential for success B) Identification of the nurses preferred goals for the patient C) A collaborative basis for assigning care D) Increased cost efficiency in health care

A) A comprehensive plan of care with a high potential for success

24. You are providing care for a patient who has a diagnosis of pneumonia attributed to Streptococcus pneumonia infection. Which of the following aspects of nursing care would constitute part of the planning phase of the nursing process? A) Achieve SaO2 92% at all times. B) Auscultate chest q4h. C) Administer oral fluids q1h and PRN. D) Avoid overexertion at all times.

A) Achieve SaO2 92% at all times.

17. While receiving report on a group of patients, the nurse learns that a patient with terminal cancer has granted power of attorney for health care to her brother. How does this affect the course of the patients care? A) Another individual has been identified to make decisions on behalf of the patient. B) There are binding parameters for care even if the patient changes her mind. C) The named individual is in charge of the patients finances. D) There is a document delegating custody of children to other than her spouse.

A) Another individual has been identified to make decisions on behalf of the patient.

The nurse caring for a patient who is two days post hip replacement notifies the physician that the patients incision is red around the edges, warm to the touch, and seeping a white liquid with a foul odor. What type of problem is the nurse dealing with? A) Collaborative problem B) Nursing problem C) Medical problem D) Administrative problem

A) Collaborative problem

33. Achieving adequate pain management for a postoperative patient will require sophisticated critical thinking skills by the nurse. What are the potential benefits of critical thinking in nursing? Select all that apply. A) Enhancing the nurses clinical decision making B) Identifying the patients individual preferences C) Planning the best nursing actions to assist the patient D) Increasing the accuracy of the nurses judgments E) Helping identify the patients priority needs

A) Enhancing the nurses clinical decision making C) Planning the best nursing actions to assist the patient D) Increasing the accuracy of the nurses judgments E) Helping identify the patients priority needs

23. You are writing a care plan for an 85-year-old patient who has community-acquired pneumonia and you note decreased breath sounds to bilateral lung bases on auscultation. What is the most appropriate nursing diagnosis for this patient? A) Ineffective airway clearance related to tracheobronchial secretions B) Pneumonia related to progression of disease process C) Poor ventilation related to acute lung infection D) Immobility related to fatigue

A) Ineffective airway clearance related to tracheobronchial secretions

13. An emergency department nurse is caring for a 7-year-old child suspected of having meningitis. The patient is to have a lumbar puncture performed, and the nurse is doing pre-procedure teaching with the child and the mother. The nurses action is an example of which therapeutic communication technique? A) Informing B) Suggesting C) Expectation-setting D) Enlightening

A) Informing

A medical nurse has obtained a new patients health history and completed the admission assessment. The nurse has followed this by documenting the results and creating a care plan for the patient. Which of the following is the most important rationale for documenting the patients care? A) It provides continuity of care. B) It creates a teaching log for the family. C) It verifies appropriate staffing levels. D) It keeps the patient fully informed.

A) It provides continuity of care.

22. Your older adult patient has a diagnosis of rheumatoid arthritis (RA) and has been achieving only modest relief of her symptoms with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). When creating this patients plan of care, which nursing diagnosis would most likely be appropriate? A) Self-care deficit related to fatigue and joint stiffness B) Ineffective airway clearance related to chronic pain C) Risk for hopelessness related to body image disturbance D) Anxiety related to chronic joint pain

A) Self-care deficit related to fatigue and joint stiffness

43. A group of students have been challenged to prioritize ethical practice when working with a marginalized population. How should the students best understand the concept of ethics? A) The formal, systematic study of moral beliefs B) The informal study of patterns of ideal behavior C) The adherence to culturally rooted, behavioral norms D) The adherence to informal personal values

A) The formal, systematic study of moral beliefs

25. You are the nurse who is caring for a patient with a newly diagnosed allergy to peanuts. Which of the following is an immediate goal that is most relevant to a nursing diagnosis of deficient knowledge related to appropriate use of an EpiPen? A) The patient will demonstrate correct injection technique with todays teaching session. B) The patient will closely observe the nurse demonstrating the injection. C) The nurse will teach the patients family member to administer the injection. D) The patient will return to the clinic within 2 weeks to demonstrate the injection.

A) The patient will demonstrate correct injection technique with todays teaching session.

6. You have just taken report for your shift and you are doing your initial assessment of your patients. One of your patients asks you if an error has been made in her medication. You know that an incident report was filed yesterday after a nurse inadvertently missed a scheduled dose of the patients antibiotic. Which of the following principles would apply if you give an accurate response? A) Veracity B) Confidentiality C) Respect D) Justice

A) Veracity

The nurse has just taken report on a newly admitted patient who is a 15year-old girl who is a recent immigrant to the United States. When planning interventions for this patient, the nurse knows the interventions must be which of the following? Select all that apply. A) Appropriate to the nurses preferences B) Appropriate to the patients age C) Ethical D) Appropriate to the patients culture E) Applicable to others with the same diagnosis

B) Appropriate to the patients age C) Ethical D) Appropriate to the patients culture

A nurse is unsure how best to respond to a patients vague complaint of feeling off. The nurse is attempting to apply the principles of critical thinking, including metacognition. How can the nurse best foster metacognition? A) By eliciting input from a variety of trusted colleagues B) By examining the way that she thinks and applies reason C) By evaluating her responses to similar situations in the past D) By thinking about the way that an ideal nurse would respond in this situation

B) By examining the way that she thinks and applies reason

In response to a patients complaint of pain, the nurse administered a PRN dose of hydromorphone (Dilaudid). In what phase of the nursing process will the nurse determine whether this medication has had the desired effect? A) Analysis B) Evaluation C) Assessment D) Data collection

B) Evaluation

3. An adult patient has requested a do not resuscitate (DNR) order in light of his recent diagnosis with late stage pancreatic cancer. The patients son and daughter-in-law are strongly opposed to the patients request. What is the primary responsibility of the nurse in this situation? A) Perform a slow code until a decision is made. B) Honor the request of the patient. C) Contact a social worker or mediator to intervene. D) Temporarily withhold nursing care until the physician talks to the family.

B) Honor the request of the patient.

39. A nurse provides care on an orthopedic reconstruction unit and is admitting two new patients, both status post knee replacement. What would be the best explanation why their care plans may be different from each other? A) Patients may have different insurers, or one may qualify for Medicare. B) Individual patients are seen as unique and dynamic, with individual needs. C) Nursing care may be coordinated by members of two different health disciplines. D) Patients are viewed as dissimilar according to their attitude toward surgery.

B) Individual patients are seen as unique and dynamic, with individual needs.

7. A nurse has begun creating a patients plan of care shortly after the patients admission. It is important that the wording of the chosen nursing diagnoses falls within the taxonomy of nursing. Which organization is responsible for developing the taxonomy of a nursing diagnosis? A) American Nurses Association (ANA) B) NANDA C) National League for Nursing (NLN) D) Joint Commission

B) NANDA

47. While developing the plan of care for a new patient on the unit, the nurse must identify expected outcomes that are appropriate for the new patient. What resource should the nurse prioritize for identifying these appropriate outcomes? A) Community Specific Outcomes Classification (CSO) B) Nursing-Sensitive Outcomes Classification (NOC) C) State Specific Nursing Outcomes Classification (SSNOC) D) Department of Health and Human Services Outcomes Classification (DHHSOC)

B) Nursing-Sensitive Outcomes Classification (NOC)

10. The nurse is caring for a patient who is withdrawing from heavy alcohol use and who is consequently combative and confused, despite the administration of benzodiazepines. The patient has a fractured hip that he suffered in a traumatic accident and is trying to get out of bed. What is the most appropriate action for the nurse to take? A) Leave the patient and get help. B) Obtain a physicians order to restrain the patient. C) Read the facilitys policy on restraints. D) Order soft restraints from the storeroom.

B) Obtain a physicians order to restrain the patient.

The nursing instructor cites a list of skills that support critical thinking in clinical situations. The nurse should describe skills in which of the following domains? Select all that apply. A) Self-esteem B) Self-regulation C) Inference D) Autonomy E) Interpretation

B) Self-regulation C) Inference E) Interpretation

1. A nurse has been offered a position on an obstetric unit and has learned that the unit offers therapeutic abortions, a procedure which contradicts the nurses personal beliefs. What is the nurses ethical obligation to these patients? A) The nurse should adhere to professional standards of practice and offer service to these patients. B) The nurse should make the choice to decline this position and pursue a different nursing role. C) The nurse should decline to care for the patients considering abortion. D) The nurse should express alternatives to women considering terminating their pregnancy.

B) The nurse should make the choice to decline this position and pursue a different nursing role.

15. A medical nurse is caring for a patient who is palliative following metastasis. The nurse is aware of the need to uphold the ethical principle of beneficence. How can the nurse best exemplify this principle in the care of this patient? A) The nurse tactfully regulates the number and timing of visitors as per the patients wishes. B) The nurse stays with the patient during his or her death. C) The nurse ensures that all members of the care team are aware of the patients DNR order. D) The nurse liaises with members of the care team to ensure continuity of care.

B) The nurse stays with the patient during his or her death.

4. An elderly patient is admitted to your unit with a diagnosis of community-acquired pneumonia. During admission the patient states, I have a living will. What implication of this should the nurse recognize? A) This document is always honored, regardless of circumstances. B) This document specifies the patients wishes before hospitalization. C) This document that is binding for the duration of the patients life. D) This document has been drawn up by the patients family to determine DNR status.

B) This document specifies the patients wishes before hospitalization.

28. An audit of a large, university medical center reveals that four patients in the hospital have current orders for restraints. You know that restraints are an intervention of last resort, and that it is inappropriate to apply restraints to which of the following patients? A) A postlaryngectomy patient who is attempting to pull out his tracheostomy tube B) A patient in hypovolemic shock trying to remove the dressing over his central venous catheter C) A patient with urosepsis who is ringing the call bell incessantly to use the bedside commode D) A patient with depression who has just tried to commit suicide and whose medications are not achieving adequate symptom control

C) A patient with urosepsis who is ringing the call bell incessantly to use the bedside commode

26. A recent nursing graduate is aware of the differences between nursing actions that are independent and nursing actions that are interdependent. A nurse performs an interdependent nursing intervention when performing which of the following actions? A) Auscultating a patients apical heart rate during an admission assessment B) Providing mouth care to a patient who is unconscious following a cerebrovascular accident C) Administering an IV bolus of normal saline to a patient with hypotension D) Providing discharge teaching to a postsurgical patient about the rationale for a course of oral antibiotics

C) Administering an IV bolus of normal saline to a patient with hypotension

41. Critical thinking and decision-making skills are essential parts of nursing in all venues. What are examples of the use of critical thinking in the venue of genetics-related nursing? Select all that apply. A) Notifying individuals and family members of the results of genetic testing B) Providing a written report on genetic testing to an insurance company C) Assessing and analyzing family history data for genetic risk factors D) Identifying individuals and families in need of referral for genetic testing E) Ensuring privacy and confidentiality of genetic information

C) Assessing and analyzing family history data for genetic risk factors D) Identifying individuals and families in need of referral for genetic testing E) Ensuring privacy and confidentiality of genetic information

29. A patient has been diagnosed with small-cell lung cancer. He has met with the oncologist and is now weighing the relative risks and benefits of chemotherapy and radiotherapy as his treatment. This patient is demonstrating which ethical principle in making his decision? A) Beneficence B) Confidentiality C) Autonomy D) Justice

C) Autonomy

40. A class of nursing students is in their first semester of nursing school. The instructor explains that one of the changes they will undergo while in nursing school is learning to think like a nurse. What is the most current model of this thinking process? A) Critical-thinking Model B) Nursing Process Model C) Clinical Judgment Model D) Active Practice Model

C) Clinical Judgment Model

18. In the process of planning a patients care, the nurse has identified a nursing diagnosis of Ineffective Health Maintenance related to alcohol use. What must precede the determination of this nursing diagnosis? A) Establishment of a plan to address the underlying problem B) Assigning a positive value to each consequence of the diagnosis C) Collecting and analyzing data that corroborates the diagnosis D) Evaluating the patients chances of recovery

C) Collecting and analyzing data that corroborates the diagnosis

16. The care team has deemed the occasional use of restraints necessary in the care of a patient with Alzheimers disease. What ethical violation is most often posed when using restraints in a long-term care setting? A) It limits the patients personal safety. B) It exacerbates the patients disease process. C) It threatens the patients autonomy. D) It is not normally legal.

C) It threatens the patients autonomy.

14. The nurse, in collaboration with the patients family, is determining priorities related to the care of the patient. The nurse explains that it is important to consider the urgency of specific problems when setting priorities. What provides the best framework for prioritizing patient problems? A) Availability of hospital resources B) Family member statements C) Maslows hierarchy of needs D) The nurses skill set

C) Maslows hierarchy of needs

44. Your patient has been admitted for a liver biopsy because the physician believes the patient may have liver cancer. The family has told both you and the physician that if the patient is terminal, the family does not want the patient to know. The biopsy results are positive for an aggressive form of liver cancer and the patient asks you repeatedly what the results of the biopsy show. What strategy can you use to give ethical care to this patient? A) Obtain the results of the biopsy and provide them to the patient. B) Tell the patient that only the physician knows the results of the biopsy. C) Promptly communicate the patients request for information to the family and the physician. D) Tell the patient that the biopsy results are not back yet in order temporarily to appease him.

C) Promptly communicate the patients request for information to the family and the physician.

5. A nurse has been providing ethical care for many years and is aware of the need to maintain the ethical principle of nonmaleficence. Which of the following actions would be considered a contradiction of this principle? A) Discussing a DNR order with a terminally ill patient B) Assisting a semi-independent patient with ADLs C) Refusing to administer pain medication as ordered D) Providing more care for one patient than for another

C) Refusing to administer pain medication as ordered

2. A terminally ill patient you are caring for is complaining of pain. The physician has ordered a large dose of intravenous opioids by continuous infusion. You know that one of the adverse effects of this medicine is respiratory depression. When you assess your patients respiratory status, you find that the rate has decreased from 16 breaths per minute to 10 breaths per minute. What action should you take? A) Decrease the rate of IV infusion. B) Stimulate the patient in order to increase respiratory rate. C) Report the decreased respiratory rate to the physician. D) Allow the patient to rest comfortably.

C) Report the decreased respiratory rate to the physician.

21. During discussion with the patient and the patients husband, you discover that the patient has a living will. How does the presence of a living will influence the patients care? A) The patient is legally unable to refuse basic life support. B) The physician can override the patients desires for treatment if desires are not evidence-based. C) The patient may nullify the living will during her hospitalization if she chooses to do so. D) Power-of-attorney may change while the patient is hospitalized.

C) The patient may nullify the living will during her hospitalization if she chooses to do so.

30. A patient with migraines does not know whether she is receiving a placebo for pain management or the new drug that is undergoing clinical trials. Upon discussing the patients distress, it becomes evident to the nurse that the patient did not fully understand the informed consent document that she signed. Which ethical principle is most likely involved in this situation? A) Sanctity of life B) Confidentiality C) Veracity D) Fidelity

C) Veracity

12. During report, a nurse finds that she has been assigned to care for a patient admitted with an opportunistic infection secondary to AIDS. The nurse informs the clinical nurse leader that she is refusing to care for him because he has AIDS. The nurse has an obligation to this patient under which legal premise? A) Good Samaritan Act B) Nursing Interventions Classification (NIC) C) Patient Self-Determination Act D) ANA Code of Ethics

D) ANA Code of Ethics

19. You are following the care plan that was created for a patient newly admitted to your unit. Which of the following aspects of the care plan would be considered a nursing implementation? A) The patient will express an understanding of her diagnosis. B) The patient appears diaphoretic. C) The patient is at risk for aspiration. D) Ambulate the patient twice per day with partial assistance.

D) Ambulate the patient twice per day with partial assistance.

20. The physician has recommended an amniocentesis for an 18-year-old primiparous woman. The patient is 34 weeks gestation and does not want this procedure. The physician is insistent the patient have the procedure. The physician arranges for the amniocentesis to be performed. The nurse should recognize that the physician is in violation of what ethical principle? A) Veracity B) Beneficence C) Nonmaleficence D) Autonomy

D) Autonomy

27. A nurse has been using the nursing process as a framework for planning and providing patient care. What action would the nurse do during the evaluation phase of the nursing process? A) Have a patient provide input on the quality of care received. B) Remove a patients surgical staples on the scheduled postoperative day. C) Provide information on a follow-up appointment for a postoperative patient. D) Document a patients improved air entry with incentive spirometric use.

D) Document a patients improved air entry with incentive spirometric use.

11. A patient admitted with right leg thrombophlebitis is to be discharged from an acute-care facility. Following treatment with a heparin infusion, the nurse notes that the patients leg is pain-free, without redness or edema. Which step of the nursing process does this reflect? A) Diagnosis B) Analysis C) Implementation D) Evaluation

D) Evaluation

31. The nursing instructor is explaining critical thinking to a class of first-semester nursing students. When promoting critical thinking skills in these students, the instructor should encourage them to do which of the following actions? A) Disregard input from people who do not have to make the particular decision. B) Set aside all prejudices and personal experiences when making decisions. C) Weigh each of the potential negative outcomes in a situation. D) Examine and analyze all available information.

D) Examine and analyze all available information.

36. The nurse is providing care for a patient with chronic obstructive pulmonary disease (COPD). The nurses most recent assessment reveals an SaO2 of 89%. The nurse is aware that part of critical thinking is determining the significance of data that have been gathered. What characteristic of critical thinking is used in determining the best response to this assessment finding? A) Extrapolation B) Inference C) Characterization D) Interpretation

D) Interpretation

32. A care conference has been organized for a patient with complex medical and psychosocial needs. When applying the principles of critical thinking to this patients care planning, the nurse should most exemplify what characteristic? A) Willingness to observe behaviors B) A desire to utilize the nursing scope of practice fully C) An ability to base decisions on what has happened in the past D) Openness to various viewpoints

D) Openness to various viewpoints

37. A nurse is admitting a new patient to the medical unit. During the initial nursing assessment, the nurse has asked many supplementary open-ended questions while gathering information about the new patient. What is the nurse achieving through this approach? A) Interpreting what the patient has said B) Evaluating what the patient has said C) Assessing what the patient has said D) Validating what the patient has said

D) Validating what the patient has said

The nurse admits a patient to an oncology unit that is a site for a study on the efficacy of a new chemotherapeutic drug. The patient knows that placebos are going to be used for some participants in the study but does not know that he is receiving a placebo. When is it ethically acceptable to use placebos? A) Whenever the potential benefits of a study are applicable to the larger population B) When the patient is unaware of it and it is deemed unlikely that it would cause harm C) Whenever the placebo replaces an active drug D) When the patient knows placebos are being used and is involved in the decision-making process

D) When the patient knows placebos are being used and is involved in the decision-making process

42. A student nurse has been assigned to provide basic care for a 58-year-old man with a diagnosis of AIDS-related pneumonia. The student tells the instructor that she is unwilling to care for this patient. What key component of critical thinking is most likely missing from this students practice? A) Compliance with direction B) Respect for authority C) Analyzing information and situations D) Withholding judgment

D) Withholding judgment