Chapter 22: Decision Making and Critical Thinking My Nursing Test Banks

Chapter 22: Decision Making and Critical Thinking

MULTIPLE CHOICE

1. Which of the following is Pauls definition of critical thinking?

a.

Thinking about your thinking while youre thinking in order to make your thinking better

b.

Purposeful, outcome-directed thinking based upon a body of non-scientific knowledge derived from research and other courses of evidence

c.

Making sense of our world by carefully examining our thinking and the thinking of others in order to clarify and improve our understanding

d.

Understanding of the argument, recognizing fallacies, and distinguishing premises from conclusions

ANS: A

Paul (1992) provided a rather interesting and somewhat amusing view of critical thinking as thinking about your thinking while youre thinking in order to make your thinking better. Other definitions include the making sense of our world through examination of our thinking and the thinking of others (questioning) and understanding of the argument, recognition of fallacies, and the recognition of premises from conclusions.

PTS: 1 DIF: Knowledge REF: CRITICAL THINKING

2. An instructor has just completed teaching a class on critical thinking to a group of sophomore nursing students. On the test the instructor asked, Which of the following are the basic components required for the development of sound critical thinking skills? Which of the following responses would indicate that further teaching is needed?

a.

Critical reading

c.

Critical listening

b.

Critical writing

d.

Critical evaluation

ANS: D

The four basic aptitudesreading, writing, listening, and speaking (not evaluation)are essential for the development of effective critical thinking skills. While being able to critically evaluate a given situation or decision is a valuable tool, it uses all of these critical aptitudes in order for the process of evaluation to take place.

PTS: 1 DIF: Application REF: CRITICAL THINKING

3. In class, students tell the teacher that they often watch or observe themselves as they perform tasks or make decisions about particular situations. The teacher would most likely inform the students that what they are doing is called:

a.

critical thinking.

c.

intuitive thinking.

b.

decision making.

d.

reflective thinking.

ANS: D

Pesut and Herman (1999) define reflective thinking as the watching or observing of ourselves while we perform a task or make a decision about a particular situation. Intuitive thinking concerns the use of an innate sense or gut feeling about a certain situation.

PTS: 1 DIF: Application REF: REFLECTIVE THINKING

4. Which of the following is not an integral part of reflective thinking?

a.

Evaluating a decision

b.

Observing themselves while performing tasks

c.

Thinking about what has happened

d.

Implementing changes or improvements

ANS: D

The process of reflection, as described by Pesut and Herman (1999), states that reflective thinking is watching or observing ourselves as we perform a task or make a decision about a particular situation. Reflection allows one to evaluate decisions and think about what has occurred. While the reflective process may enhance decisions to implement changes or improvements, this is not an integral part of the reflective thinking process.

PTS: 1 DIF: Application REF: REFLECTIVE THINKING

5. A nurse uses intuitive thinking when making decisions because intuitive thinking:

a.

can be a part of expert thinking.

b.

involves emotions and feelings instead of concrete examples.

c.

is a natural part of the nursing process.

d.

may be a result of unconscious assessment and intervention processes.

ANS: A

Intuitive thinking has been defined as an innate feeling or sense that nurses develop to help them act in certain situations, or a gut feeling that something may be wrong. Alfaro-LeFevre (2003) states that the result of using intuition and drawing upon evidence at the same time to make well-reasoned decisions (decision making) is a part of the expert thinking process.

PTS: 1 DIF: Application REF: INTUITIVE THINKING

6. The nurse preceptor asked a new graduate nurse to explain the primary difference between the nursing process and the problem-solving and decision-making processes? The new graduate would be correct in stating that:

a.

the nursing process works only for nurses.

b.

the problem-solving and decision-making processes require group decision making.

c.

the nursing process applies to patient situations or problems.

d.

the problem-solving and decision-making processes apply to all other problems except patient-centered ones.

ANS: C

While the nursing process does include aspects of problem solving and decision making, the process consists of assessment, diagnosis, outcome identification, planning, implementation, and evaluation, and it is applied to patient care situations or problems (not all types of problems). Decision making and problem solving, on the other hand, are processes that can be applied to all types of problems.

PTS: 1 DIF: Analysis REF: PROBLEM-SOLVING

7. What starts with a problem and ends with a solution?

a.

Decision making

c.

Problem planning

b.

Problem solving

d.

Critical thinking

ANS: B

The process of beginning with a problem and ending with a solution is called problem solving. Critical thinking may be involved but does not necessarily begin with a problem or end with its solution. Decision making involves certain behaviors of making a selection and implementing a course of action from possible alternatives, and problem planning involves an organized plan for real or potential problems but not necessarily for their solution.

PTS: 1 DIF: Comprehension REF: PROBLEM-SOLVING

8. The new graduate considers and selects interventions from a collection of actions that assist the achievement of a desired result. The new graduate in most likely implementing which of the following strategies?

a.

Critical thinking

c.

Decision making

b.

Problem solving

d.

Reflective thinking

ANS: C

DeLaune and Ladner (2006) defined decision making as considering and selecting interventions from a repertoire of actions that facilitate the achievement of a desired outcome. Critical and reflective thinking are processes that may be used during the decision-making process, and all of these processes may be used in the solving of problems.

PTS: 1 DIF: Application REF: DECISION MAKING

9. During the evaluation and review of departmental practices, the nurse manager uses PERT because it is a:

a.

tool used for timing of decisions.

c.

decision tree.

b.

type of conditioner.

d.

type of PDA.

ANS: A

The program evaluation and review technique (PERT) is a tool used in decision making for assessing the timing of decisions. It includes a flowchart of the sequence of actions needed to accomplish a project as well as descriptions of those actions and the timing involved.

PTS: 1 DIF: Application

REF: DECISION MAKING TOOLS AND TECHNOLOGY

10. In order to visualize a complete picture of unit projects, including the time from the beginning to the end, the nurse manager would most likely use which of the following?

a.

Flowchart

c.

Pareto diagram

b.

Decision tree

d.

PERT

ANS: D

PERT (the program evaluation and review technique) diagrams are useful for showing the complete sequence of timing from the beginning of a project to the end. They include the tasks involved, the amount of time needed to complete those tasks, and the sequence of events required for the conclusion of the project.

PTS: 1 DIF: Comprehension

REF: DECISION MAKING TOOLS AND TECHNOLOGY

11. You have just completed an in-service on the advantages of working in groups. You recognize that further clarification is needed if one of the participants indicated that which of the following is an advantage of groups? Groups:

a.

are an easy and inexpensive way to share information.

b.

provide an opportunity for face-to-face communication.

c.

obscures the identities of individual group members.

d.

can facilitate socialization.

ANS: C

Some known advantages of groups and working in groups are that they are an easy and inexpensive way to share information, provide an opportunity for face-to-face interaction, and can be a means for socialization. Adisadvantage is that they tend to obscure ones individual identity and may tend to promote groupthink behaviors.

PTS: 1 DIF: Application

REF: TABLE 22-5 ADVANTAGES AND DISADVANTAGES OF GROUPS

12. When questioning the participants of your in-service program on the disadvantages of working in groups, which response by participants would indicate that further teaching is needed? Some of the disadvantages of working in groups include:

a.

the fact that working in groups can be time consuming and it can foster dependency.

b.

a potential for personality conflicts and for individual opinions to be influenced by others.

c.

promotion of ownership of problems and solutions.

d.

inequity of time to share individual information and dependency may be fostered.

ANS: C

Some known disadvantages of group and group decision making are that individual opinions and thoughts are influenced by others, dependency may be fostered, they are time consuming, there is an inequity of time available for individuals to share information or opinions, and there is the potential for personality conflicts. An advantage of groups is the promotion of ownership of solutions and problems, not a disadvantage.

PTS: 1 DIF: Analysis

REF: TABLE 22-5 ADVANTAGES AND DISADVANTAGES OF GROUPS

13. You are implementing the decision-making process, and you decide that at this time it is too early to do which of the following?

a.

Identify the need for a decision

b.

Identify alternatives/actions with benefits/consequences

c.

Decide on the action

d.

Intervene and evaluate the decision

ANS: D

The five steps of decision making can be applied to almost all situations. They consist of identifying the need for a decision, determining the goal or outcome, identifying the alternatives/actions with their associated benefits/consequences, deciding on the action to take, and implementing (not intervening) and evaluating the decision.

PTS: 1 DIF: Application REF: CLINICAL APPLICATION

14. Vroom and Yetton (1973) identified eight questions that may help managers to decide when a group decision is called for. Which of the following is not one of those eight questions?

a.

Does the individual nurse have all the information needed?

b.

Is it absolutely critical that the individual group accept the decision before its implementation?

c.

Does the course of action chosen make a difference to the organization?

d.

How does this decision impact relationships with internal and external stakeholders?

ANS: D

Some of the eight questions that are useful for nurses when deciding whether to use an individual or group process for decision making are Does the individual nurse have all the information needed?, Is it absolutely critical that the individual group accept the decision before its implementation?, and Does the course of action chosen make a difference to the organization? How the decision impacts relationships with both internal and external stakeholders is a good consideration in certain instances, but it is not part of Vroom and Yettons recommended questioning.

PTS: 1 DIF: Comprehension

REF: TABLE 22-4 INDIVIDUAL VS. GROUP DECISION-MAKING QUESTIONS

15. A nursing instructor tested a group of students on information related to the use of groups in the hospital. Which response by the students would indicate that they know the key component of the nominal group technique?

a.

It is useful when there are nominal resources available.

b.

It is useful when there are nominal people involved.

c.

It is timely.

d.

It is nonverbal.

ANS: D

The nominal group technique is another type of group decision making that can be useful in certain situations. Nominal refers to the nonverbal aspects of this technique in that in the first step, no discussion is involved and group members write out their ideas or responses to questions posed by the group leader.

PTS: 1 DIF: Application REF: NOMINAL GROUP TECHNIQUE

16. A nurse asks the supervisor about the primary difference between the nominal technique and the Delphi technique. Which response by the supervisor would be most appropriate?

a.

Group members meet face to face.

b.

Group members do not meet face to face.

c.

Group members think alike.

d.

Group members do not think alike.

ANS: B

In the nominal technique for group decision making, the members are meeting in a face-to-face environment. A key advantage of the Delphi technique is that it is not held in a face-to-face environment, and therefore it can involve a large number of participants sharing a greater number of ideas.

PTS: 1 DIF: Application REF: DELPHI GROUP TECHNIQUE

17. The idea that everyone agrees 100 percent is a common misconception related to which of the following?

a.

Groupthink

c.

Delphi technique

b.

Consensus building

d.

Nominal technique

ANS: B

Having a consensus on a decision or solution to a problem means that all group members can live with and fully support the decision made regardless of whether they totally agree with it 100 percent. The common misconception is that they must all agree 100 percent.

PTS: 1 DIF: Comprehension REF: CONSENSUS BUILDING

18. You are a member of your churchs Womens Club. The club members decide to use a majority rule vote when making decisions. The club members do not want to use consensus building because one of the disadvantages of consensus building is that it:

a.

facilitates agreement with each other.

b.

is likely to create disagreement with each other.

c.

is time consuming trying to convince others.

d.

is an encouragement for thoughts of invincibility.

ANS: C

While using the consensus approach can be advantageous when all members of the group are affected by the decision, one disadvantage is that it is not a timely means of making a decision. Due to its time-consuming nature, it should be reserved for important decisions where strong support is needed from the participants who will implement them. Agreement with each other is an advantage, but consensus building does not necessarily mean total agreement; it means that the group members can live with and support the decision made. Any time people get together, there is a potential for disagreement; however, disagreement is not a characteristic of consensus building. A sense of invincibility is a characteristic of groupthink behaviors.

PTS: 1 DIF: Analysis REF: CONSENSUS BUILDING

19. A group leader wants to determine if group members understand the concept of groupthink behavior and strategies to avoid groupthink. Which of the following suggested behaviors made by the group members would indicate that further clarification is needed?

a.

Allowing the group time to gather additional data

b.

Encouraging independent thinking

c.

Preventing this from happening by removing anyone who begins to encourage these behaviors

d.

Encouraging members to verbalize their ideas

ANS: C

The group leader would need to clarify the group members responses related to removing another member. A better approach is that when a leader observes group members beginning to display or encourage certain known groupthink behaviors, the group leader should take them aside (outside the group) and talk with them about what is occurring and how these behaviors may negatively impact the group. This is a more sound management strategy than removing these members totally. Allowing time to gather additional information and to reflect upon what already exists; encouraging independent (not group) thinking; and encouraging members to verbalize their own opinions, thoughts, and ideas are ways of preventing groupthink behaviors from occurring.

PTS: 1 DIF: Analysis REF: GROUP THINK

20. Several obstacles to effective decision making exist. Which of the following is least likely to be one of the obstacles?

a.

Past experiences

c.

Values

b.

Morals

d.

Preconceived ideas

ANS: B

Past experiences, values, and preconceived ideas are some obstacles or potential barriers to effective decision making. Morals, while an important factor in certain decisions and circumstances, are not necessarily barriers to this process unless they contain unhealthy or biased beliefs.

PTS: 1 DIF: Analysis

REF: LIMITATIONS TO EFFECTIVE DECISION MAKING

21. You are the nurse manager of a mental health unit. During the morning community meeting, a group of patients complain that the lights from the hallway disturb their sleep when the nurses open the doors to make room checks. The patients ask if the lights in the hallway can be turned off at night. One of the nurses becomes defensive and responds that the lights are always dimmed at 9 P.M. Because the discussion becomes very intense, the group leader suggests that the problem be addressed by you as the nurse manager. After the meeting, you decide to implement a problem-solving approach to address the issue. What is the next step you should take?

a.

Identify the problem

b.

Gather and analyze data

c.

Generate alternatives and select an action

d.

Implement the selected action, and evaluate the selected action

ANS: B

Because the problem has already been identified as patients being disturbed by the lights in the hallway when the nurses open the doors, the next step would be to gather and analyze data.

PTS: 1 DIF: Analysis REF: PROBLEM-SOLVING

22. A nurse manager wants to implement a new method for delivery of patient care. While the nurses do not all agree that primary care will be the solution, they acknowledge that they will be able to live with and support the groups decision. This is an example of which of the following?

a.

Decision making

c.

Consensus building

b.

Problem solving

d.

Nursing process

ANS: C

The nurses have implemented what is known as consensus building. Consensus means that all group members can live with and fully support the decision regardless of whether they totally agree. Building consensus is useful with groups because all group members participate and can realize the contributions each member makes to the decision.

PTS: 1 DIF: Analysis REF: CONSENSUS BUILDING

23. You are caring for a 5-year-old patient who is scheduled for a tonsillectomy in the morning. Both the child and mother are extremely anxious about the upcoming surgery and the mother requests permission to spend the night with the child. You begin to use your decision-making skills to help you to decide what to do next. You have considered the hospital policy, the child and mothers anxiety, and the mothers request. What would be your next course of action?

a.

Determine the outcomes

c.

Identify the alternatives

b.

Make a decision

d.

Evaluate your decision

ANS: A

Using the decision-making process, since you have already determined that a decision needs to be made, your next step is to determine the outcomes. The issues to be considered are whether the child and mothers anxiety will be reduced and whether they will become satisfied consumers of the health care you provide as a result. Identifying the alternates, making a decision, and evaluating your decisions are involved in steps 3 through 5 of the decision-making process.

PTS: 1 DIF: Application REF: CLINICAL APPLICATION

24. Your supervisor asks whether you would be willing to work a double shift. Before answering, you implement your decision-making skills. You realize that you could use the extra money to pay your childs tuition, but who will pick your child up from school? You begin to think about your support system and decide to call your mother. She informs you that she is available and would love to have her grandchild spend the night with her. You notify the supervisor that your are willing to work the double shift. What is your next step regarding this decision?

a.

Identify the need for a decision

b.

Determine the outcomes

c.

Identify all alternative actions and benefits

d.

Evaluate your decision

ANS: D

You have followed the steps of the decision-making process. The final step is to evaluate your decision. This might be done when you return home and question your child and mother about their visit.

PTS: 1 DIF: Analysis REF: CLINICAL APPLICATION

25. You are seven months pregnant and your primary care provider has told you that you need more rest. You now have to decide whether to continue working full-time, start working part-time, or stop working until the baby is born. To make your decision, you develop a graphic presentation of your options. The most effective way to visualize your options would be to develop which of the following?

a.

Gantt chart

c.

Histogram

b.

Decision tree

d.

Frequency table

ANS: B

The decision tree would be the most effective means for visualizing your options. Each of your alternatives can be identified as well as the factors related to the alternatives.

PTS: 1 DIF: Application

REF: FIGURE 22-5 DECISION TREE FOR DECIDING WHETHER TO GO BACK TO SCHOOL

MULTIPLE RESPONSE

1. Which of the following may negatively affect a nurses decision-making or problem-solving ability? Select all that apply.

a.

Failing to obtain all the necessary information

b.

Jumping to conclusions without examining the situation thoroughly

c.

Failing to involve the nurse manager and other experts in identifying a solution

d.

Failing to choose and communicate a rational solution

e.

Choosing decisions that are too broad, too complicated, or lack definition

f.

Failing to intervene and evaluate the decision or solution appropriately

ANS: A, B, D, E, F

Delaune and Ladner (2011) have identified actions that may negatively affect the decision-making or problem-solving processes. They include jumping to conclusions without examining the situation thoroughly; failing to obtain all of the necessary information; choosing decisions that are too broad, too complicated, or lack definition; failing to choose and communicate a rational solution; and failing to intervene and evaluate the decision or solution appropriately. It may not be necessary to involve the nurse manager and other experts in identifying the solution if the nurse has obtain the needed information to make the decision.

PTS: 1 DIF: Comprehension

REF: LIMITATIONS OF EFFECTIVE DECISION MAKING

2. You recently graduated from nursing school and are now working on a pediatric unit. It is important for you to make sound decisions that can potentially affect your personal and professional life. In order to be effective in your decision-making ability, you decide to do which of the following each time a major issue occurs? Select all that apply.

a.

Trust yourself

b.

Make only those decisions that are yours to make

c.

Procrastinate as long as possible since you are a recent graduate

d.

Only consider your decision if it affects you

e.

Leave patient care decisions to the more expert nurses

f.

Write down pros and cons of an issue to help clarify your thinking

ANS: A, B, F

In order to make sound decisions, you should trust yourself, make only decisions that are yours to make, and consider not only yourself but how your decisions will affect others. Additional strategies to use include writing down pros and cons of an issue to help clarify your thinking; writing notes and keeping ideas visible about decisions in order to utilize all relevant information; and making decisions as you go along rather than procrastinating and letting them accumulate. While expert nurses can provide valuable information, you as a new graduate can still make decisions related to patient care.

PTS: 1 DIF: Application

REF: TABLE 22-6 DOS AND DONT OF DECISION MAKING

3. Which of the following are examples of reflective thinking? Select all that apply.

a.

You develop a plan to study for the NCLEX-RN.

b.

A nurse reviews all options for returning to school in order to obtain a Masters Degree.

c.

A nurse thinks about a decision she made to return to school.

d.

A group of nurses share ideas about the upcoming Christmas party.

e.

After completing a dressing change, you think about additional strategies to be used when changing a sterile dressing.

f.

You have just completed the NCLEX-RN and wonder if your answers were the best.

ANS: C, E, F

Thinking about a decision which has been made, a better way of changing a dressing, or the way you answered questions on the NCLEX-RN are all examples of reflective thinking. Reflective thinking involves watching or observing ourselves as we perform a task or make a decision about a particular situation.

PTS: 1 DIF: Analysis REF: REFLECTIVE THINKING

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