Chapter 12: Critical and Diagnostic Thinking for Better Clinical Judgment My Nursing Test Banks

Chapter 12: Critical and Diagnostic Thinking for Better Clinical Judgment

Test Bank

MULTIPLE CHOICE

1. Critical thinking is a purposeful, goal-directed process of inquiry that uses available facts, principles, theories, and abstractions. Which statement best describes the processes that are accomplished through critical thinking?

a.

Make inferences, solve problems, arrive at decisions.

b.

Persuade others, induce debate, use intuition.

c.

Make inferences, reduce fractions, make decisions.

d.

Solve problems, elevate issues, reflect actions.

ANS: A

Although critical thinking may play a part in many processes, the primary uses are to make inferences, solve problems, and arrive at decisions.

DIF: Cognitive Level: Comprehension REF: Page 175 OBJ: Define critical thinking.

TOP: Critical Thinking MSC: NCLEX: Nursing Process

2. Reasoned thought is characterized by the lack of:

a.

reflection.

b.

emotion.

c.

parity.

d.

contrast.

ANS: B

Reasoned thought is discriminating and prudent and does not allow emotion, feelings, or prejudices to skew decisions. Individuals who practice reasoned thought recognize when negative factors may be interfering with their ability to think clearly.

DIF: Cognitive Level: Knowledge REF: Page 176

OBJ: Identify the types of reasoning based on critical thinking. TOP: Reasoning

MSC: NCLEX: Nursing Process

3. Using clinical judgment, the nurse makes decisions on whether to proceed with or revise a course of action. The inquiry (investigational or exploratory) subprocess necessary for sound clinical judgment is _____ thinking.

a.

reflective

b.

persuasive

c.

critical

d.

intuitive

ANS: C

Through clinical judgment, the nurse makes decisions on whether to proceed with or revise a course of action. The inquiry (investigational or exploratory) subprocess necessary for sound clinical judgment is critical thinking.

DIF: Cognitive Level: Comprehension REF: Page 177

OBJ: Identify the types of reasoning based on critical thinking.

TOP: Reasoning: Clinical Judgment MSC: NCLEX: Nursing Process

4. Critical thought is a(n):

a.

disciplined, rational, and self-directed activity that uses standards and criteria.

b.

intuitive process that relies only on the nurses experience.

c.

persuasive process leading to sound decisions.

d.

reactive process after an intervention is completed.

ANS: A

Critical thought is a disciplined, rational, and self-directed activity that uses standards and criteria. Critical thought assists the nurse in making more effective clinical decisions. The nurse who engages in critical thought will meet more of the patients needs and effect positive patient outcomes.

DIF: Cognitive Level: Knowledge REF: Page 175

OBJ: Identify the types of reasoning based on critical thinking. TOP: Reasoning: Critical Thought

MSC: NCLEX: Nursing Process

5. A patient has a problem that prevents him from shaving himself, tying his shoes, or fixing his meals. He is not physically able to compensate for the problem, so he is in need of assistance. Data support the nursing diagnosis impaired physical mobility by what mode of reasoning?

a.

Induction

b.

Deduction

c.

Reduction

d.

Reflection

ANS: B

Taking general assessment data, drawing conclusions, identifying problems or needs, and formulating a plan of care are components of a deductive reasoning process. The nursing process is an example of deductive reasoning because it involves taking data and deducing a plan of care.

DIF: Cognitive Level: Analysis REF: Page 178

OBJ: Compare inductive and deductive reasoning.

TOP: Inductive and Deductive Reasoning MSC: NCLEX: Nursing Process

6. An RN has been working with a patient on the nursing unit for a 12-hour shift. The nurse recognizes that each time the patient is turned to the left, the blood pressure drops 15 mm Hg. The same RN has seen this phenomenon in several other patients and makes the connection that patients with right-sided heart failure (the medical diagnosis) will experience a blood pressure drop if they are turned to their left side. This type of reasoning is called:

a.

inductive.

b.

deductive.

c.

reductive.

d.

reflective.

ANS: A

The nurse uses inductive reasoning when a patient has symptoms or problems the nurse has seen before. From the assessment data gathered, the nurse makes inferences (conclusions or assumptions), asks further questions, and makes decisions. The nurse, using inductive reasoning, goes from specifics to generalities and infers the likely outcomes based on supporting data.

DIF: Cognitive Level: Analysis REF: Page 178

OBJ: Compare inductive and deductive reasoning.

TOP: Inductive and Deductive Reasoning MSC: NCLEX: Nursing Process

7. Each element of the nursing process involves critical thinking. Which definition of assessment reflects critical thinking?

a.

Correctly and completely documenting the assessment data on a form

b.

A process of discovery and decision-making about the nature of the patients needs

c.

Using a systematic approach to ensure comprehensive collection of assessment data

d.

Selecting the most accurate NANDA-I nursing diagnosis for the patient

ANS: B

Assessment is a process of discovering and making decisions about the nature of the patients nursing problems or needs. It involves purposeful and systematic data gathering about the patients present illness or situation and past health history (subjective data), data gathering by physical examination (objective data), and review of functional health patterns for both subjective and objective data.

DIF: Cognitive Level: Analysis REF: Page 175

OBJ: Explain the importance of critical thinking in nursing. TOP: Critical Thinking

MSC: NCLEX: Nursing Process

8. A novice RN is caring for a patient who is saying that something is wrong. Vital signs are normal and there are no new specific findings. The novice RN calls another, more experienced RN who briefly talks with the patient, calls the health care provider, and initiates a transfer to the ICU. Which statement is most likely true of the more experienced RN?

a.

The experienced RN is an advanced beginner with better assessment skills than the novice nurse.

b.

The experienced RN is proficient in assessment and the use of hospital protocol.

c.

The experienced RN is an expert nurse with intuitive judgment that the experienced nurse cannot quite explain.

d.

The experienced RN is arrogant, foolish, and likely to get in trouble for her assertive behavior.

ANS: C

The expert RN is able to connect the understanding of a situation with an appropriate action. The expert RN has an intuitive grasp of each situation and zeroes in on the accurate region of the problem without wasteful consideration of alternative actions. The strength of inference by the expert RN is based on the extent of the RNs knowledge and experience. The RN with limited experience and with developing knowledge may rely on the proven and look to others for validation of decisions. Practice at this stage demonstrates the highest level of critical thinking in that the expert RN knows holistically what to do without consciously thinking through the process of critical thinking.

DIF: Cognitive Level: Application REF: Pages 177, 179

OBJ: Identify the types of reasoning based on critical thinking. TOP: Reasoning

MSC: NCLEX: Nursing Process

9. An RN has collected extensive data on a patient with attention deficit disorder. When weighing potential actions to help the patient and considering alternative solutions, which of the attributes of the critical thinker is the RN demonstrating?

a.

Creativity

b.

Rational thought

c.

Reflection

d.

Curiosity

ANS: A

Creativity is the ability to be innovative, resourceful, and inventive in finding solutions. Rational thought is fueled by knowledge gained through study and experience. Reflection allows the critical thinker to look back and review ideas, thoughts, and actions. Curiosity is the desire to understand what something is or how something works.

DIF: Cognitive Level: Application REF: Page 182

OBJ: Identify attributes of critical thinkers.

TOP: Attributes of Critical Thinkers MSC: NCLEX: Nursing Process

10. A nurse manager is designing orientation processes for new graduate nurses by using the work of Hansten and Washburn as a model. All of the new graduates are instructed in the model during orientation. The manager knows that a graduate nurse needs more instruction if which comment is made during the evaluation interview?

a.

I think I need more mentoring to continue to build my thinking skill.

b.

Improving my critical thinking will assist in decreasing the risk of sentinel events for my patients.

c.

Using my improving thinking skills will help improve patient care.

d.

If my thinking skills are what they should be, fewer errors will happen in patient care.

ANS: A

Hansten and Washburn (1999) indicated that the nurse must be able to think critically as a way to decrease errors and sentinel events and assist in cultivating an improved patient care system. Mentoring new employees is not discussed.

DIF: Cognitive Level: Evaluation REF: Page 176

OBJ: Identify the types of reasoning based on critical thinking. TOP: Reasoning

MSC: NCLEX: Nursing Process

11. The nurse has received a shift report. Which patient should the nurse assess first?

a.

The patient diagnosed with type 2 diabetes mellitus who is complaining of dizziness with a glucose level of 120

b.

The patient diagnosed with sleep apnea who is complaining of a morning headache

c.

The patient diagnosed with diverticulitis who has a hard, rigid, abdomen and a temperature of 101.3F

d.

The patient diagnosed with a stomach virus who vomited three times during the previous shift

ANS: C

Clinical judgment is perceptive understanding of a situation based on knowledge, empirical data (data that can be observed or experienced), theory, and scientific inquiry. Clinical judgment requires a series of decisions based on changing observations and collected data. A hard, rigid abdomen and elevated temperature are abnormal in any circumstance, and the nurse should assess this patient first. These are clinical manifestations of peritonitis, a potentially life-threatening condition. A glucose level of 120 is normal for a patient with type 2 diabetes. The patient complaining of a headache is the least urgent compared with the other patients. The patient who vomited three times is an urgent patient requiring monitoring of hydration, but less urgent than a patient with a potentially life-threatening condition.

DIF: Cognitive Level: Application REF: Pages 176-177

OBJ: Explain the importance of critical thinking in nursing. TOP: Critical Thinking

MSC: NCLEX: Nursing Process

12. The nurse has received a change-of-shift report about these four patients. Which one should the nurse plan to assess first?

a.

A 23-year-old patient with cystic fibrosis who has pulmonary function testing scheduled in 30 minutes

b.

A 35-year-old patient who was admitted the previous day with bacterial pneumonia and has a temperature of 100.2F

c.

A 46-year-old patient who is complaining of dyspnea after having a thoracentesis 1 hour previously

d.

A 77-year-old patient with TB who has four antitubercular medications due in 15 minutes

ANS: C

Clinical judgment is perceptive understanding of a situation based on knowledge, empirical data (data that can be observed or experienced), theory, and scientific inquiry. Clinical judgment requires a series of decisions based on changing observations and collected data. Dyspnea after a thoracentesis may indicate pneumothorax or hemothorax and requires immediate evaluation by the nurse. The other patients should also be assessed as soon as possible, but there is no indication that they may need immediate action to prevent deterioration.

DIF: Cognitive Level: Application REF: Pages 176-177

OBJ: Explain the importance of critical thinking in nursing. TOP: Critical Thinking

MSC: NCLEX: Nursing Process

13. As elements of reasoning and critical thought, why are implications or consequences of outcomes important to consider?

a.

They can help the nurse make confident clinical decisions.

b.

They help the nurse understand complex ideas and events.

c.

They help the nurse understand how the patient is responding to the demands of the treatment.

d.

They can be expected or unexpected and affect the completion of a nursing intervention.

ANS: D

Implications or consequences are defined through outcomes. Implications or consequences can be expected or unexpected, but each must be considered. For example, an expected consequence of bathing is a clean patient with intact skin that can fight infection or breakdown. An unexpected consequence is fatigue, which can cause stress on the patients body and affect healing and recovery. Every action or nursing intervention has consequences, so the nurse must critically think about the intervention and the consequences of performing the intervention. Inferences help nurses make confident clinical decisions. Concepts can help the nurse understand complex ideas, events, actions and entities, thereby defining and shaping our thought processes. Gathering data helps the nurse understand how the patient is responding to the demands of the treatment.

DIF: Cognitive Level: Application REF: Page 180

OBJ: Identify the types of reasoning based on critical thinking. TOP: Reasoning

MSC: NCLEX: Nursing Process

14. Which patient would the nurse see first at the start of the shift?

a.

A patient admitted yesterday with osteomyelitis of the right arm with a T of 101.0F

b.

A patient with hepatic encephalopathy who is being rude to the nursing assistant

c.

A patient with lupus who has been on long-term corticosteroids and whose blood sugar is 180

d.

A patient with circumferential burns of the right leg who is complaining of numbness in the right foot

ANS: D

People who engage in critical thought can be said to practice cultivated thinking, which is organized, enlightened, and educated. By organizing the thought process, the individual is able to make sense of information. Circumferential burns to the extremities can cause circulatory compromise distal to the burn with subsequent neurologic impairment of the affected extremity. The patient with a T of 101.0F, the patient being rude, and the patient with a blood sugar of 180 are not exhibiting emergency conditions needing immediate attention.

DIF: Cognitive Level: Application REF: Pages 177, 179

OBJ: Explain the importance of critical thinking in nursing. TOP: Critical Thinking

MSC: NCLEX: Nursing Process

15. Which statement best assists the nurse in planning care for the patient who is not adhering to the treatment regimen?

a.

Patients health attitudes directly affect behavior and therefore influence adherence.

b.

Patients usually go to the hospital without preconceived ideas about what is wrong with them.

c.

Most patients adhere to the advice of health care providers even if they do not believe that the treatment will work.

d.

Noncompliance with prescribed treatment is irrational behavior.

ANS: A

Understanding the patients health attitudes helps the nurse to understand the patients point of view about the treatment regimen. All thinking stems from a point of view. An enlightened thinker is able to interpret data and clarify meaning from several points of view, that is, to explain or illustrate how the data can be understood from multiple positions. The RN can recognize that a routine treatment may seem strange and frightening from the patients point of view. In gathering data to support this assumption, the nurse will ask questions to better understand how the patient is responding to the demands of the treatment. An unenlightened nurse may make erroneous assumptions that label the patient as problematic and noncompliant. All the other answer choices have nothing to do with understanding the patients point of view.

DIF: Cognitive Level: Application REF: Page 179

OBJ: Explain the importance of critical thinking in nursing. TOP: Critical Thinking

MSC: NCLEX: Nursing Process

16. Select the hospital patient who has the best chance of avoiding a nosocomial infection.

a.

A 42-year-old patient who had abdominal surgery

b.

A 35-year-old patient with a closed leg fracture

c.

A 5-month-old non-breastfed infant

d.

A 75-year-old patient receiving chemotherapy

ANS: B

Clinical judgment is perceptive understanding of a situation based on knowledge, empirical data (data that can be observed or experienced), theory, and scientific inquiry. Clinical judgment requires a series of decisions based on changing observations and collected data. The patient with the closed leg fracture is the patient with the best chance of avoiding a nosocomial infection. The patient with abdominal surgery is at risk for contracting a hospital-acquired infection because of healing surgical wounds. The non-breastfed infant and the patient receiving chemotherapy are patients with compromised immune systems that put them at risk for a hospital-acquired infection.

DIF: Cognitive Level: Application REF: Pages 176-177

OBJ: Explain the importance of critical thinking in nursing. TOP: Critical Thinking

MSC: NCLEX: Nursing Process

17. The nurse is caring for a 19-year-old trauma patient paralyzed from the neck down. He is alert and oriented, requires assistance with ADLs, and keeps his spirits up with frequent visitors. A priority for the nurse is:

a.

rounding hourly to assess the patients support system and acceptance of his condition.

b.

feeding the patient to maintain his nutritional status.

c.

ensuring the patient has constant stimuli through his friends because teenagers are peer-focused.

d.

watching and preventing skin breakdown as a result of immobility.

ANS: D

Clinical judgment is perceptive understanding of a situation based on knowledge, empirical data (data that can be observed or experienced), theory, and scientific inquiry. Clinical judgment requires a series of decisions based on changing observations and collected data. Patient safety is a nurses priority. Watching and preventing skin breakdown are the priorities for an immobile patient. Hourly rounding, nutritional status, and ensuring that the patient is kept busy are important but of lower priority.

DIF: Cognitive Level: Application REF: Pages 176-177

OBJ: Explain the importance of critical thinking in nursing. TOP: Critical Thinking

MSC: NCLEX: Nursing Process

18. Which of the following is the best example of an open-ended question regarding a patients pain?

a.

For how many weeks have you been having this pain?

b.

Does it feel like a burning pain?

c.

Where on your body does the pain begin and end?

d.

Can you describe your pain for me?

ANS: D

Curiosity, an element of reasoning, stimulates the RN to apply all available facts, principles, and theories, as well as specific knowledge of the situation, to formulate the plan of care. Open-ended questions such as Can you describe your pain for me? allow the patient to think and express thoughts freely without limitations. The other answer choices are limiting and draw specific responses.

DIF: Cognitive Level: Application REF: Page 182

OBJ: Identify the types of reasoning based on critical thinking. TOP: Reasoning

MSC: NCLEX: Nursing Process

MULTIPLE RESPONSE

1. The nurse who can think critically will make more effective clinical decisions, meet more of the patients needs, and affect positive patient outcomes. How this is accomplished? (Select all that apply.)

a.

Committing to test ones own thought process for clarity, accuracy, and logic

b.

Accepting an individual responsibility to develop critical thinking skills

c.

Joining nursing organizations to keep current on nursing policies affecting patient care

d.

Constantly seeking out others for answers to difficult clinical questions and problems

e.

Requesting that health care organizations adopt and foster a culture of critical thinking

f.

Maintaining the required amount of continued education units for license renewal

ANS: A, B, E

Committing to test ones own thought process for clarity, accuracy, and logic; accepting individual responsibility to develop critical thinking skills; and requesting that health care organizations adopt and foster a culture of critical thinking are all ways to foster critical thinking. Joining nursing organizations to keep current on nursing policies affecting patient care is not discussed. Constantly seeking out others for answers to difficult clinical questions and problems is incorrect because critical thinkers demonstrate specific attributes that support the process, including curiosity, diligence in the pursuit of evidence and information, rational thought, reflection, and creativity. Maintaining the required amount of continued education units for license renewal is not discussed.

DIF: Cognitive Level: Analysis REF: Pages 177, 179

OBJ: Identify attributes of critical thinkers.

TOP: Attributes of Critical Thinkers MSC: NCLEX: Nursing Process

2. The complexity of the current health care environment requires nursing to (select all that apply):

a.

be guided by theory and practice standards.

b.

have a more scientific, research-based approach.

c.

be more collaborative with other health care disciplines.

d.

be open to new policies and procedures.

e.

be a multicultural representative of the global demographics.

ANS: A, B

Nursing care is becoming research based and guided by theory and practice standards. As nursing requires a more scientific approach, the RN must become more knowledgeable with regard to following standards of care. Nursing requiring more collaboration with other health care disciplines, new policies and procedures, and a multicultural representative of global demographics were not discussed.

DIF: Cognitive Level: Comprehension REF: Page 177

OBJ: Identify the types of reasoning based on critical thinking.

TOP: Reasoning: Clinical Judgment MSC: NCLEX: Nursing Process

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