Chapter 10 My Nursing Test Banks

 

Kozier & Erbs Fundamentals of Nursing, 9/E
Chapter 10

Question 1

Type: MCSA

Nurses must use critical thinking in their day-to-day practice, especially in circumstances surrounding client care and wise use of resources. In which of the following situations would critical thinking be most beneficial?

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: 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.

Global Rationale: Page Reference: 164

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 01 Describe the significance of developing critical-thinking abilities in order to practice safe, effective, and professional nursing care.

Question 2

Type: MCSA

A rehab client has orders for active range of motion exercises to her shoulder following a stroke. The client doesnt like to do these because they are uncomfortable and she cant understand what good they will do anyway. Which of the following statements by the nurse demonstrates the critical-thinking component of 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: 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 but merely dismissing the clients concerns and feelings.

Rationale 3: This doesnt show any creativity but merely dismisses the clients feelings.

Rationale 4: Making the exercise routine into something morelike a game, or drawing a picture, or even decorating the walls, for examplewould raise a challenge to the client, take the focus off the why, and still achieve the end result.

Global Rationale: Page Reference: 164

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 02 Explore ways of demonstrating critical thinking in clinical practice.

Question 3

Type: MCSA

A student nurse who claims to be very uncreative doesnt understand why it is necessary to learn and develop new ideas in the clinical area. The best response by the nurse educator is:

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

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 to critical thinking but appears to dismiss the students statement.

Rationale 3: This option doesnt address the reason for creativity in nursing but merely trivializes its importance.

Rationale 4: This option doesnt address the reason for creativity in nursing but merely provides a personal motive for creativity.

Global Rationale: Page Reference: 164

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 01 Describe the significance of developing critical-thinking abilities in order to practice safe, effective, and professional nursing care.

Question 4

Type: MCSA

A nurse educator assigned students an activity to implement Socratic questioning in their daily lives. Which of the following is a question about reason using this 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: 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 do 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.

Global Rationale: Page Reference: 165

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 03 Discuss the skills and attitudes of critical thinking

Question 5

Type: MCSA

A client comes into the emergency department (ED) with a productive cough, audible coarse crackles, elevated temperature of 102.3F, chills, and body aches. The nurse identifies the problem as respiratory compromise. The nurse is using which of the following?

1. Deductive reasoning

2. Inductive reasoning

3. Socratic questioning

4. Critical analysis

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 asking questions to come to a conclusion about the situation that is not what is described in the stem.

Rationale 4: Critical analysis looks beneath the surface and asking questions to come to a conclusion about the situation.

Global Rationale: Page Reference: 165-166

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 02 Explore ways of demonstrating critical thinking in clinical practice.

Question 6

Type: MCSA

A nurse is taking a health history from a client who states that he 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 PhD in epidemiology and he has a rare form of a neurological disorder. The nurse who utilizes critical thinking will make this statement:

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: 4

Rationale 1: 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.

Global Rationale: Page Reference: 165

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 02 Explore ways of demonstrating critical thinking in clinical practice.

03 Discuss the skills and attitudes of critical thinking

Question 7

Type: MCSA

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. This is an example of which of the following?

1. Integrity

2. Perseverance

3. Fair-mindedness

4. Humility

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.

Global Rationale: Page Reference: 167

Cognitive Level: Understanding

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 02 Explore ways of demonstrating critical thinking in clinical practice.

Question 8

Type: MCSA

A nurse who just moved from an urban area to a sparsely populated rural area understands that certain customs and practices the nurse is familiar with may be quite foreign to the people in the new area. This nurse is practicing which of the attitudes of critical thinking?

1. Fair-mindedness

2. Insight into egocentricity

3. Intellectual humility

4. Intellectual courage to challenge the status quo and rituals

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. 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.

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.

Global Rationale: Page Reference: 167

Cognitive Level: Understanding

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 03 Discuss the skills and attitudes of critical thinking

Question 9

Type: MCSA

When implementing a quicker way to set up and initiate an IV while still following safe practice, a nurse is practicing which of the attitudes of critical thinking?

1. Independence

2. Intellectual courage to challenge the status quo or rituals

3. Integrity

4. Confidence

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 stem.

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 stem.

Rationale 4: Confidence is the self assurance to act on ones own beliefs; that is not what is described in the stem.

Global Rationale: Page Reference: 166

Cognitive Level: Understanding

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 01 Describe the significance of developing critical-thinking abilities in order to practice safe, effective, and professional nursing care.

02 Explore ways of demonstrating critical thinking in clinical practice.

Question 10

Type: MCSA

A nurse continues to question 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. This nurse is practicing which of the critical-thinking attitudes?

1. Confidence

2. Perseverance

3. Curiosity

4. Integrity

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 still 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 still 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.

Global Rationale: Page Reference: 168

Cognitive Level: Understanding

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 01 Describe the significance of developing critical-thinking abilities in order to practice safe, effective, and professional nursing care.

Question 11

Type: MCSA

A seasoned nurse works in a busy ICU unit. When a particularly complex client is admitted, the nurse uses past experiences and knowledge gained from those situations to help care for this client. This nurse is practicing which of the attributes of critical thinking?

1. Reflection

2. Context

3. Dialogue

4. Time

Correct Answer: 4

Rationale 1: Reflection involves being able to determine what data are relevant and to make connections between that data and the decisions reached but that is not what is described in the stem..

Rationale 2: Context is an essential consideration in nursing since care must always be individualized, taking knowledge and applying it to real people but that is not what is described in the stem.

Rationale 3: Dialoque is a purposed exchange of information but that is not what is described in the stem

Rationale 4: The attribute of time emphasizes the value of using past learning in current situations that then guide future actions.

Global Rationale:

Cognitive Level: Understanding

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 02 Explore ways of demonstrating critical thinking in clinical practice.

04 Discuss the relationships among critical thinking, the problem-solving process, and the decision-making process.

Question 12

Type: MCSA

A nurse is taking an admission history from a client who is easily distracted and offers irrelevant information about his health and social history. Although careful to document what the client relates, the nurse sorts out the relevant data to determine the best nursing care for this client. This nurse is practicing which attribute of critical thinking?

1. Reflection

2. Context

3. Dialogue

4. Time

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.

Rationale 2: Context is an essential consideration in nursing since care must always be individualized, taking knowledge and applying it to real people but that is not what is described in the stem.

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.

Global Rationale: Page Reference: 170-171

Cognitive Level: Understanding

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 01 Describe the significance of developing critical-thinking abilities in order to practice safe, effective, and professional nursing care.

Question 13

Type: MCSA

A client is complaining of shortness of breath, has no pallor, no cyanosis, and no accessory muscle use with respirations. The clients respiratory rate is 16 breaths per minute. The nurse is concerned that the clients report and the physical findings conflict. This nurse is using which universal standard of critical thinking?

1. Clarity

2. Accuracy

3. Logicalness

4. Significance

Correct Answer: 3

Rationale 1: Clarity provides examplesand that is not the process described in the stem.

Rationale 2: Accuracy is asking if something is true and that is not the process described in the stem.

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 and that is not the process described in the stem.

Global Rationale: Page Reference: 168

Cognitive Level: Understanding

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 02 Explore ways of demonstrating critical thinking in clinical practice.

Question 14

Type: MCSA

A nurse enters the room of a critically ill child and has a sense that something isnt right. After performing an initial physical assessment and finding that 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. This nurse was utilizing which method of problem solving?

1. Trial and error

2. Intuition

3. Judgment

4. Scientific method

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.

Global Rationale: Page Reference: 168

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Safety and Infection Control

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 04 Discuss the relationships among critical thinking, the problem-solving process, and the decision-making process.

Question 15

Type: MCSA

A client has had a nonhealing wound for a period of time. The home health nurse decides to implement a variety of wound care products to see if any of them work. Each day, the nurse switches to a different brand or product. In this situation, the nurse is utilizing which method of problem solving?

1. Intuition

2. Scientific method

3. Research process

4. Trial and error

Correct Answer: 4

Rationale 1: 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 since the nurse is changing them on a daily basis. Intuition is the learning of things without conscious use of reasoningalso known as the sixth sense, hunch, or instinct. Scientific method and research process are both formalized, systematic, and logical approaches to solving problems.

Rationale 2: 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 since the nurse is changing them on a daily basis. Intuition is the learning of things without conscious use of reasoningalso known as the sixth sense, hunch, or instinct. Scientific method and research process are both formalized, systematic, and logical approaches to solving problems.

Rationale 3: 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 since the nurse is changing them on a daily basis. Intuition is the learning of things without conscious use of reasoningalso known as the sixth sense, hunch, or instinct. Scientific method and research process are both formalized, systematic, and logical approaches 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 since the nurse is changing them on a daily basis. Intuition is the learning of things without conscious use of reasoningalso known as the sixth sense, hunch, or instinct. Scientific method and research process are both formalized, systematic, and logical approaches to solving problems.

Global Rationale: Page Reference: 168

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 02 Explore ways of demonstrating critical thinking in clinical practice.

Question 16

Type: MCSA

A nurse is caring for a client who has unstable cardiac dysrhythmias. The client 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. The nurse is implementing which step of the decision-making process?

1. Identify the purpose

2. Seek alternatives

3. Project

4. Implement

Correct Answer: 2

Rationale 1: In this step, the decision maker (nurse) identifies possible ways to meet the criteria. Alternatives considered are which 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. Identifying the purpose, in this case, would be determining that the client needs intervention to control the dysrhythmia. 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. Implementation is taking the plan into action.

Rationale 2: In this step, the decision maker (nurse) identifies possible ways to meet the criteria. Alternatives considered are which 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. Identifying the purpose, in this case, would be determining that the client needs intervention to control the dysrhythmia. 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. Implementation is taking the plan into action.

Rationale 3: In this step, the decision maker (nurse) identifies possible ways to meet the criteria. Alternatives considered are which 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. Identifying the purpose, in this case, would be determining that the client needs intervention to control the dysrhythmia. 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. Implementation is taking the plan into action.

Rationale 4: In this step, the decision maker (nurse) identifies possible ways to meet the criteria. Alternatives considered are which 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. Identifying the purpose, in this case, would be determining that the client needs intervention to control the dysrhythmia. 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. Implementation is taking the plan into action.

Global Rationale: Page Reference: 170

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 02 Explore ways of demonstrating critical thinking in clinical practice.

03 Discuss the skills and attitudes of critical thinking

Question 17

Type: MCSA

A nurse is checking over the past charting of the previous shift, paying special attention to how a particular client responded to nursing interventions throughout the day. The nurse is caring for this client and wants to see what has been effective, as well as what didnt work. This nurse is utilizing which of the steps of the decision-making process?

1. Set the criteria

2. Examine alternatives

3. Implement

4. Evaluate the outcome

Correct Answer: 4

Rationale 1: 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. Setting criteria is based on three questions: What is the desired outcome? What needs to be preserved? What needs to be avoided? Examining alternatives ensures that there is an objective rationale in relation to the established criteria for choosing one strategy over another. In this case, the nurse is evaluating the previous nurses alternatives, not choosing new ones. Implementation is putting a plan into action.

Rationale 2: 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. Setting criteria is based on three questions: What is the desired outcome? What needs to be preserved? What needs to be avoided? Examining alternatives ensures that there is an objective rationale in relation to the established criteria for choosing one strategy over another. In this case, the nurse is evaluating the previous nurses alternatives, not choosing new ones. Implementation is putting a plan into action.

Rationale 3: 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. Setting criteria is based on three questions: What is the desired outcome? What needs to be preserved? What needs to be avoided? Examining alternatives ensures that there is an objective rationale in relation to the established criteria for choosing one strategy over another. In this case, the nurse is evaluating the previous nurses alternatives, not choosing new ones. 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. Setting criteria is based on three questions: What is the desired outcome? What needs to be preserved? What needs to be avoided? Examining alternatives ensures that there is an objective rationale in relation to the established criteria for choosing one strategy over another. In this case, the nurse is evaluating the previous nurses alternatives, not choosing new ones. Implementation is putting a plan into action.

Global Rationale: Page Reference: 170

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 02 Explore ways of demonstrating critical thinking in clinical practice.

03 Discuss the skills and attitudes of critical thinking

Question 18

Type: MCSA

A nurse is being questioned by the parents of a client whose physician ordered a battery of invasive tests. They are wondering why their child should have to go through all the pain and discomfort of these studies. The nurse is not familiar with the situation and has just come on duty for the evening shift. A limited report was given by the previous shift. The nurse understands that the child is stable at this time and has no pain, but the nurse has not been able to review the chart or do an initial assessment at this point. The best response by the nurse is:

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: 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. 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. It would also be premature to tell the parents to get another opinion. Nurses should not give advice or counsel, merely information.

Rationale 2: 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. 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. It would also be premature to tell the parents to get another opinion. Nurses should not give advice or counsel, merely information.

Rationale 3: 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. 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. It would also be premature to tell the parents to get another opinion. Nurses should not give advice or counsel, merely information.

Rationale 4: 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. 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. It would also be premature to tell the parents to get another opinion. Nurses should not give advice or counsel, merely information.

Global Rationale: Page Reference: 172

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 03 Discuss the skills and attitudes of critical thinking

Question 19

Type: MCSA

A client comes into the clinic with complaints of extreme low back pain after helping to move a heavy object. The client is pale and diaphoretic and walks bent at the waist. Before taking vital signs, the nurse projects that the blood pressure as well as heart rate will be elevated. This is an example of which of the following?

1. Fact

2. Inference

3. Judgment

4. Opinion

Correct Answer: 2

Rationale 1: 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. Fact can be verified through investigation. In this case, fact would be the elevated pulse and blood pressure readings. 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. Opinions are beliefs formed over time and include judgments that may fit facts or be in error.

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. Fact can be verified through investigation. In this case, fact would be the elevated pulse and blood pressure readings. 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. Opinions are beliefs formed over time and include judgments that may fit facts or be in error.

Rationale 3: 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. Fact can be verified through investigation. In this case, fact would be the elevated pulse and blood pressure readings. 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. Opinions are beliefs formed over time and include judgments that may fit facts or be in error.

Rationale 4: 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. Fact can be verified through investigation. In this case, fact would be the elevated pulse and blood pressure readings. 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. Opinions are beliefs formed over time and include judgments that may fit facts or be in error.

Global Rationale: Page Reference: 169

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 02 Explore ways of demonstrating critical thinking in clinical practice.

03 Discuss the skills and attitudes of critical thinking

Question 20

Type: MCSA

A nurse is completing a plan of care for a client. The statement client will be able to walk 10 feet, twice a day without shortness of breath is which part of the nursing process (in comparison to the decision-making process)?

1. Assess

2. Diagnose

3. Plan

4. Evaluate

Correct Answer: 3

Rationale 1: The planning portion of the nursing process involves setting criteria (walking 10 feet twice a day), weighting the criteria, and seeking/examining alternatives when compared to the decision-making process. Assessment is the same as identifying the purpose. Diagnosing is putting a label on the problem. Evaluating is reviewing the outcome.

Rationale 2: The planning portion of the nursing process involves setting criteria (walking 10 feet twice a day), weighting the criteria, and seeking/examining alternatives when compared to the decision-making process. Assessment is the same as identifying the purpose. Diagnosing is putting a label on the problem. Evaluating is reviewing the outcome.

Rationale 3: The planning portion of the nursing process involves setting criteria (walking 10 feet twice a day), weighting the criteria, and seeking/examining alternatives when compared to the decision-making process. Assessment is the same as identifying the purpose. Diagnosing is putting a label on the problem. Evaluating is reviewing the outcome.

Rationale 4: The planning portion of the nursing process involves setting criteria (walking 10 feet twice a day), weighting the criteria, and seeking/examining alternatives when compared to the decision-making process. Assessment is the same as identifying the purpose. Diagnosing is putting a label on the problem. Evaluating is reviewing the outcome.

Global Rationale: Page Reference: 169-170

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 04 Discuss the relationships among critical thinking, the problem-solving process, and the decision-making process.

Question 21

Type: MCSA

A nurse is caring for a client of a different culture. The nurse is not familiar with the customs of this particular client and becomes disturbed when the clients spouse makes all the decisions about care and treatments. The nurses reaction is an example of which of the following?

1. Inference

2. Judgment

3. Opinion

4. Evaluation

Correct Answer: 3

Rationale 1: 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. Inferences are conclusions drawn from the facts, going beyond facts to make a statement about something not currently known. Judgment is an evaluation of facts or information that reflects values or other criteria; it is a type of opinion. Evaluation is considering the results or outcome.

Rationale 2: 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. Inferences are conclusions drawn from the facts, going beyond facts to make a statement about something not currently known. Judgment is an evaluation of facts or information that reflects values or other criteria; it is a type of opinion. Evaluation is considering the results or outcome.

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. Inferences are conclusions drawn from the facts, going beyond facts to make a statement about something not currently known. Judgment is an evaluation of facts or information that reflects values or other criteria; it is a type of opinion. Evaluation is considering the results or outcome.

Rationale 4: 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. Inferences are conclusions drawn from the facts, going beyond facts to make a statement about something not currently known. Judgment is an evaluation of facts or information that reflects values or other criteria; it is a type of opinion. Evaluation is considering the results or outcome.

Global Rationale: Page Reference: 170

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 03 Discuss the skills and attitudes of critical thinking

Question 22

Type: MCSA

Before beginning a particularly stressful shift in a critical care nursery, a nurse is in the practice of reviewing his attitudes and feelings about death and dying, dignity of people, and the parental role in understanding and questioning cares and treatments. This nurse is cultivating which of the following?

1. Critical-thinking attitudes

2. Dissonance

3. Ambiguity

4. Self-assessment

Correct Answer: 4

Rationale 1: Nurses are in and around situations that require attitudes of curiosity, fair-mindedness, humility, courage, and perseverance. They need attitudes that foster critical thinking. A rigorous personal assessment may help determine what attitudes a nurse already possesses and which need to be cultivated. Identifying weak or vulnerable attitudes and reflecting on situations where decisions were made and then later regretted helps to assess the nurses own biases and perceptions.

Rationale 2: Nurses are in and around situations that require attitudes of curiosity, fair-mindedness, humility, courage, and perseverance. They need attitudes that foster critical thinking. A rigorous personal assessment may help determine what attitudes a nurse already possesses and which need to be cultivated. Identifying weak or vulnerable attitudes and reflecting on situations where decisions were made and then later regretted helps to assess the nurses own biases and perceptions.

Rationale 3: Nurses are in and around situations that require attitudes of curiosity, fair-mindedness, humility, courage, and perseverance. They need attitudes that foster critical thinking. A rigorous personal assessment may help determine what attitudes a nurse already possesses and which need to be cultivated. Identifying weak or vulnerable attitudes and reflecting on situations where decisions were made and then later regretted helps to assess the nurses own biases and perceptions.

Rationale 4: Nurses are in and around situations that require attitudes of curiosity, fair-mindedness, humility, courage, and perseverance. They need attitudes that foster critical thinking. A rigorous personal assessment may help determine what attitudes a nurse already possesses and which need to be cultivated. Identifying weak or vulnerable attitudes and reflecting on situations where decisions were made and then later regretted helps to assess the nurses own biases and perceptions.

Global Rationale: Page Reference: 170-171

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 03 Discuss the skills and attitudes of critical thinking

Question 23

Type: MCSA

A nurse educator senses that a student has been struggling with clinical skills learned in lab. In the clinical area, this student is usually lagging behind and seems to be involved when the other students have opportunities to perform some of the tasks. The educator pairs the student with a particularly outgoing staff nurse who has a number of unique clients with a variety of treatments and cares. The educator is utilizing which type of problem solving?

1. Trial and error

2. Intuition

3. Research process

4. Experience

Correct Answer: 2

Rationale 1: 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, though there are no real facts to support it. Experience is part of intuition, but by itself, not a particular way to problem solve. Trial and error uses a number of approaches until a solution is found, which is not the case here. Trial-and-error methods in nursing care can be dangerous because the client might suffer harm if an approach is inappropriate. The research process is a systematic, analytical, and logical way to problem solve.

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, though there are no real facts to support it. Experience is part of intuition, but by itself, not a particular way to problem solve. Trial and error uses a number of approaches until a solution is found, which is not the case here. Trial-and-error methods in nursing care can be dangerous because the client might suffer harm if an approach is inappropriate. The research process is a systematic, analytical, and logical way to problem solve.

Rationale 3: 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, though there are no real facts to support it. Experience is part of intuition, but by itself, not a particular way to problem solve. Trial and error uses a number of approaches until a solution is found, which is not the case here. Trial-and-error methods in nursing care can be dangerous because the client might suffer harm if an approach is inappropriate. The research process is a systematic, analytical, and logical way to problem solve.

Rationale 4: 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, though there are no real facts to support it. Experience is part of intuition, but by itself, not a particular way to problem solve. Trial and error uses a number of approaches until a solution is found, which is not the case here. Trial-and-error methods in nursing care can be dangerous because the client might suffer harm if an approach is inappropriate. The research process is a systematic, analytical, and logical way to problem solve.

Global Rationale: Page Reference: 168

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 02 Explore ways of demonstrating critical thinking in clinical practice.

Question 24

Type: MCMA

Critical-thinking nurses must develop which of the following specific attitudes or traits?

Standard Text: Select all that apply.

1. Independence.

2. Egocentricity.

3. Intellectual humility.

4. Fair-mindedness.

5. Confidence.

6. Perseverance.

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.

Global Rationale: Page Reference: 170-172

Cognitive Level: Understanding

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 03 Discuss the skills and attitudes of critical thinking

Question 25

Type: MCMA

A nurse shows an understanding of the reasons critical thinking is so vital to todays nursing profession when stating:

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 common sense 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: 1,2,4,5

Rationale 1: According to R. Alfaro LeFevres Top 10 Reasons to Improve Thinking, 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: According to R. Alfaro LeFevres Top 10 Reasons to Improve Thinking, redesigning care delivery is useless if nurses dont have the thinking skills required to deal with todays world.

Rationale 3: While this might be true, medicine and nursing have evolved tremendously, and so has the need for nurses to be critical thinkers.

Rationale 4: According to R. Alfaro LeFevres Top 10 Reasons to Improve Thinking, consumers and payers demand to see evidence of benefits, efficiency, and results.

Rationale 5: According to R. Alfaro LeFevres Top 10 Reasons to Improve Thinking, todays progress often creates new problems that cant be solved by old ways of thinking.

Global Rationale: Page Reference: 163

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 01 Describe the significance of developing critical-thinking abilities in order to practice safe, effective, and professional nursing care.

Question 26

Type: MCMA

A nurse displays characteristics of a critical thinker:

Standard Text: Select all that apply.

1. When listening with empathy to a client who recently has been diagnosed.

2. When waiting for the medical team to determine the focus of the clients supportive care.

3. When questioning a medication order that does not appear to meet the clients needs for pain management.

4. When exhibiting a willingness to try alternate methods of addressing a clients care needs.

5. When practicing nursing in a culturally competent fashion.

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.

Global Rationale: Page Reference: 165

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 03 Discuss the skills and attitudes of critical thinking

Kozier & Erbs Fundamentals of Nursing, 9/E Test Bank

Copyright 2012 by Pearson Education, Inc.

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