Chapter 8: Critical Thinking, the Nursing Process, and Clinical Judgment My Nursing Test Banks

Chapter 8: Critical Thinking, the Nursing Process, and Clinical Judgment

Test Bank

MULTIPLE CHOICE

1. Critical thinking in nursing needs to include which of the following important variables?

a.

Consideration of ethics and responsible decision making

b.

Ability to act quickly, often on impulse

c.

Ability to determine the best nursing interventions regardless of patients values and beliefs

d.

Flexible thinking that rarely follows a pattern or considers standards

ANS: A

Feedback

A

Critical thinking in nursing is based on ethics and standards of the profession.

B

Critical thinking is consciously developed, complex, and purposeful, never impulsive.

C

Critical thinking and decision making are based on patients values and beliefs.

D

Critical thinking is based on a decision-making model and nursing standards.

DIF: Cognitive Level: Comprehension REF: p. 154

2. A nursing student asks a faculty member how to improve critical thinking. Which response by the faculty is best?

a.

Dont worry too much; it will come with time and experience.

b.

Pay close attention to how you solve problems; assess your own style of thinking.

c.

Spend time shadowing an experienced nurse to see how it is done.

d.

Use ethical standards to guide how you approach patient situations.

ANS: B

Feedback

A

Although time and experience are important in developing critical thinking, people actually must actively consider how they think in order to improve critical thinking.

B

Making thinking a focus of concern and actively thinking about it is the best advise the faculty can give.

C

While observing an experienced nurse may be helpful, the student needs to be an active participant to improve critical thinking.

D

Using ethical and professional standards is a part of critical thinking, but that is only a portion of what makes a good critical thinker.

DIF: Cognitive Level: Analysis REF: p. 154

3. Which of the following is a characteristic of an accomplished critical thinker?

a.

Inquisitiveness

b.

Narrow focus

c.

Unaffected by other arguments

d.

Quick decision making

ANS: A

Feedback

A

The accomplished critical thinker needs to ask questions when things do not seem quite right.

B

The accomplished critical thinker thinks broadly, considering all possibilities.

C

The accomplished critical thinker considers all information and all arguments before deciding on a course of action.

D

The accomplished critical thinker considers the facts, fits them into known patterns, considers all aspects of the problem, and makes decisions based on knowledge, not on instinct.

DIF: Cognitive Level: Comprehension REF: p. 153

4. Which of the following statements describes the purpose of the nursing process?

a.

Process of documentation designed to decrease liability

b.

Process designed to maximize reimbursement potential

c.

A sophisticated time-management strategy

d.

Process used to identify and solve patient problems

ANS: D

Feedback

A

Although proper documentation is part of the nursing process, it is a problem-solving process, not a documentation process.

B

The nursing process is not used with reimbursement potential in mind.

C

The nursing process is not a time-management strategy.

D

The purpose of the nursing process is to identify and solve patient problems.

DIF: Cognitive Level: Knowledge REF: p. 156

5. Which of the following is considered subjective data in information gathering from the patient?

a.

Pulse and blood pressure measurements

b.

ECG pattern

c.

Diaphoresis

d.

Pain

ANS: D

Feedback

A

Pulse rate and blood pressure measurements are signs or objective data that can be confirmed by observation.

B

The ECG pattern is objective data.

C

Diaphoresis is objective data.

D

Subjective data are the patients perceptions, sometimes called symptoms.

DIF: Cognitive Level: Comprehension REF: p. 157

6. A nursing student is complaining about writing care plans. Which response by the faculty is best to help the student see the importance of this activity?

a.

Using the nursing process will help nurses get reimbursement for their services.

b.

You need a written plan of care so everyone is on the same page as you are.

c.

The nursing process is a way to systematically think about and use patient data.

d.

Most state nurse practice acts require them, so you need to learn how to do them.

ANS: C

Feedback

A

Demonstrating use of the nursing process may be important in obtaining reimbursement, but it is not the primary reason for using the nursing process (and writing care plans).

B

Having a detailed plan that other nurses can follow is important, but it is not the primary reason for using the nursing process (and writing care plans).

C

Writing care plans teaches students to use the nursing process, which is a systematic way of thinking about and processing patient data.

D

State nurse practice acts do require that nurses demonstrate the use of the nursing process, but this statement does not describe why the process itself is important.

DIF: Cognitive Level: Comprehension REF: p. 156

7. Which of the following is considered objective data obtained from the patient?

a.

I cant catch my breath.

b.

Patient expresses concern about missing work.

c.

Patient nods, indicating an affirmative answer to a question.

d.

Blood pressure is 110/70 at 8 PM.

ANS: D

Feedback

A

A patients expression of a problem is subjective data.

B

The patient expressing concern about missing work is an inference based on what a patient has said.

C

Patient nods, indicating an affirmative answer to a question is interpretation of a movement.

D

Objective data are measurable and observable.

DIF: Cognitive Level: Comprehension REF: p. 157

8. The nurse observes a patient lying rigidly in bed and taking shallow breaths. The patient reports a pain score of 4 out of 5 and says, My leg hurts. The nurse determines that the objective and subjective data are

a.

incongruent and require more assessment.

b.

insufficient to make any conclusions.

c.

congruent and support that the patient is in pain.

d.

unclear; the nurse needs to talk to the patients family for more information.

ANS: C

Feedback

A

The statement and behaviors observed indicate that the patient is experiencing pain.

B

One can make a conclusion because there is sufficient information available.

C

The patient states he/she is in pain and the rigid positioning and shallow breathing are behaviors found when individuals experience pain.

D

The subjective nature of pain requires obtaining the information from the patient if at all possible. The family can be an excellent source of information if the patient is unable to cooperate with the nurses assessment.

DIF: Cognitive Level: Analysis REF: p. 158

9. A nurse is admitting a non-English speaking patient to the hospital unit. Which is the best method of obtaining data from the patient?

a.

Asking the other family members to help interpret

b.

Performing a physical examination on the patient

c.

Interviewing the patient using a professional interpreter

d.

Attempting to obtain past medical records for this patient

ANS: C

Feedback

A

While tempting, the nurse should not use family members to interpret. They may insert cultural biases, may be embarrassed to translate certain topics, or may misunderstand the nurses question. Professional interpreters must be used.

B

A physical examination yields important data, but the patient interview is the primary method of obtaining information. The nurse needs to use an interpreter to gain this information from the patient.

C

A professional interpreter has been trained to convey medical information without cultural biases and in an objective fashion.

D

Past medical records may provide useful information but obtaining them does not replace the need to conduct a patient interview with the assistance of a professional interpreter.

DIF: Cognitive Level: Application REF: p. 161

10. What is the primary method of obtaining patient data?

a.

Medical record

b.

Speaking with family

c.

Interview with patient

d.

Physical examination

ANS: C

Feedback

A

The medical record is the third source, along with consultation.

B

The presence of others, even family, can obstruct the interview process.

C

The patient interview is the primary method of obtaining information.

D

The examination is the second process.

DIF: Cognitive Level: Knowledge REF: p. 158

11. What does the process of analysis of patient data directly result in?

a.

Validating actual problems or diagnoses

b.

Determining the nursing interventions of importance

c.

Identifying actual or potential problems amenable to nursing intervention

d.

Confirming the medical diagnosis

ANS: C

Feedback

A

Analysis identifies both actual and potential problems.

B

Analysis identifies problems. The most important interventions are determined by identifying the most important problems and the interventions related to them.

C

Analysis will identify both actual and potential problems. These problems can be addressed through nursing interventions.

D

The identification of patient problems that nursing can intervene with is not related only to the medical diagnosis.

DIF: Cognitive Level: Knowledge | Cognitive Level: Comprehension

REF: p. 159

12. Which of the following describes the primary difference between nursing diagnoses and medical diagnoses?

a.

Nursing diagnoses identify simple instead of complex problems.

b.

Nursing diagnoses must be verified by a physician.

c.

Nursing diagnoses, like medical diagnoses, identify medical diseases.

d.

Nursing diagnoses identify problems that can be treated with independent nursing actions.

ANS: D

Feedback

A

Nursing diagnoses are not simple versus complex problems but the human response to disease.

B

Nursing diagnoses are identified by nurses and do not need to be verified by any other professional.

C

Nursing diagnoses identify the human effect of disease on the person.

D

Nursing diagnoses identify problems that nurses can treat within their scope of practice.

DIF: Cognitive Level: Knowledge REF: p. 159

13. Which of the following is a correctly stated nursing diagnosis?

a.

Fluid volume deficit

b.

Hypovolemia related to vomiting

c.

Fluid volume deficit related to vomiting as evidenced by increased heart rate and decreased urine output

d.

Hypovolemia related to nausea as evidenced by restlessness and anxiety

ANS: C

Feedback

A

Fluid volume deficit is incomplete; it contains only the diagnostic label.

B

Hypovolemia related to vomiting is incomplete; it contains only the diagnostic label and the etiology.

C

Fluid volume deficit related to vomiting as evidenced by increased heart rate and decreased urine output contains the diagnostic label, the etiology, and the defining characteristics.

D

The etiology of hypovolemia related to nausea as evidenced by restlessness and anxiety is incorrect.

DIF: Cognitive Level: Comprehension REF: p. 160

14. A patient is admitted with the diagnosis of bronchitis, congestive heart failure, and fever. The nurses assessment finds a temperature of 101 F, peripheral edema, and rhonchi. Which of the following is the best etiology to support the nursing diagnosis of ineffective airway clearance?

a.

Peripheral edema

b.

Retained secretions

c.

Bronchitis

d.

Congestive heart failure

ANS: B

Feedback

A

Peripheral edema is related to the accumulation of fluid in the feet and legs but has nothing to do with the airway.

B

The nursing diagnosis indicates that something may be blocking the airway. Respiratory secretions are the only choice that could block the airway.

C

Bronchitis is a medical diagnosis.

D

Congestive heart failure is a medical diagnosis.

DIF: Cognitive Level: Analysis REF: p. 160

15. Why is the etiology of the nursing diagnosis statement important?

a.

If the etiology is incorrect, the nursing interventions are likely to be ineffective.

b.

The etiology will be the same each time the nursing diagnosis is identified.

c.

The etiology is necessary to identify the defining characteristics.

d.

The etiology determines whether the problem can be solved.

ANS: A

Feedback

A

On the basis of the etiology, different interventions would be selected; for example, anxiety versus fatigue.

B

The etiology can vary although the same diagnosis is identified. For example, the etiology of the nursing diagnosis of ineffective breathing pattern could be either fatigue or anxiety.

C

The etiology is not necessary to identify the defining characteristics that are the signs and symptoms of the nursing diagnosis.

D

The resolution of the problem is not determined by the etiology.

DIF: Cognitive Level: Comprehension REF: p. 160

16. A patient is admitted with asthma. The nurses assessment finds a temperature of 99 F, wheezing, speaking in three-word phrases, and respiratory rate of 16 breaths per minute. Which of the following are the best defining characteristics to support the diagnosis of ineffective airway clearance related to inflammation and constriction of the bronchial tree?

a.

Elevated temperature and respiratory rate

b.

Diagnosis of asthma with wheezing

c.

Wheezing and speaking in three-word phrases

d.

Limited vocalization and fever

ANS: C

Feedback

A

Neither the temperature nor the respiratory rate is outside of the norms of an adult.

B

The medical diagnosis is not a defining characteristic.

C

The constriction causes wheezing and difficulty vocalizing.

D

There is no fever.

DIF: Cognitive Level: Analysis REF: p. 160

17. Which of the following patient problems is given the highest priority by the nurse?

a.

Anxiety related to hospitalization as manifested by hyperactive state

b.

Impaired tissue perfusion, cerebral, related to hypoxia as manifested by decreased level of consciousness

c.

Impaired skin integrity related to surgical incision

d.

Risk for fluid volume overload related to imbalance in antidiuretic hormone as manifested by peripheral edema and decreased sodium

ANS: B

Feedback

A

Anxiety is a psychological, not a physical or life-threatening, problem.

B

Impaired tissue perfusion, cerebral, is life threatening and would take priority.

C

Impaired skin integrity has a potential for harm but does not take priority over cerebral tissue perfusion problems.

D

Risk for fluid volume overload related to imbalance in antidiuretic hormone as manifested by peripheral edema and decreased sodium is a potential problem and does not take priority over actual problems.

DIF: Cognitive Level: Analysis REF: p. 160

18. Which of the following patient problems is given the highest priority by the nurse using Maslows hierarchy of needs?

a.

Anxiety related to fear of the hospital

b.

Ineffective airway clearance related to retained secretions

c.

Fluid volume excess related to third spacing of fluid (edema)

d.

Ineffective thermoregulation related to fever

ANS: B

Feedback

A

Psychological safety is a not higher level need than oxygenation.

B

The need for oxygen is one of the most basic needs according to Maslows hierarchy.

C

Although fluid volume excess related to third spacing of fluid (edema) concerns a basic need, it is not as life threatening as lack of oxygen.

D

Although ineffective thermoregulation related to fever concerns a basic need, it is not as life threatening as lack of oxygen.

DIF: Cognitive Level: Analysis REF: p. 160

19. The identification of nursing diagnosis and goal setting should ideally be a collaborative process between the nurse and which other party?

a.

Physician

b.

Nurse manager

c.

Patients family

d.

Patient

ANS: D

Feedback

A

The physician does not set nursing goals.

B

The nurse manager does not set nursing goals.

C

The family does not set goals for the patient.

D

Nursing goals should be agreed on jointly by the nurse and the patient.

DIF: Cognitive Level: Knowledge REF: p. 161

20. Which of the following statements has all of the necessary criteria for a well-written outcome?

a.

Patient will consume 50% of meals with no nausea and vomiting by 24 hours postsurgery.

b.

Therapist will report improvement in patients range of motion on a daily basis.

c.

Patient will ambulate in the halls a little today.

d.

Patients condition will improve before discharge.

ANS: A

Feedback

A

Patient will consume 50% of meals with no nausea and vomiting by 24 hours postsurgery is specific, measurable, and has a specific time frame.

B

Outcomes should be patient focused.

C

Patient will ambulate in the halls a little today is nonspecific and not measurable.

D

Patients condition will improve before discharge is nonspecific, is nonmeasurable, and has no time frame.

DIF: Cognitive Level: Application REF: p. 162

21. A patient is in respiratory distress and placed on oxygen. Which is the most appropriate short-term goal?

a.

Nasal cannula remains in place.

b.

Patient completes morning care and eats breakfast.

c.

Patient verbalizes that he is breathing better after lunch.

d.

Patient maintains an oxygen saturation of 90% during the shift.

ANS: D

Feedback

A

Nasal cannula remains in place is not a patient goal, and there is no time frame.

B

Patient completes morning care and eats breakfast is broad, and there is no time frame.

C

Although there is a short time frame, the goal patient verbalizes that he is breathing better after lunch lacks specificity.

D

Patient maintains an oxygen saturation of 90% during the shift involves a specific goal for the patient in a short time frame.

DIF: Cognitive Level: Application REF: p. 162

22. Which of the following is an appropriate long-term goal to measure diabetes control for a patient in whom diabetes has been newly diagnosed?

a.

Patient will inject insulin twice daily.

b.

Patient will keep appointments with physician over the next 6 months.

c.

Patients A1c will be 5% at 1 year postdiagnosis.

d.

Patients recorded blood glucose will be between 60 and 120 mg/dL each day.

ANS: C

Feedback

A

Taking the insulin is important but does not indicate how well blood glucose was controlled.

B

Although keeping appointments is important for diabetes management, this does not indicate blood glucose control.

C

Patients A1c will be 5% at 1 year postdiagnosis reflects the best indicator of long-term control of blood glucose level and therefore diabetes management. This goal is specific and easily measurable.

D

Patients recorded blood glucose will be between 60 and 120 mg/dL each day is a short-term measure of blood glucose control.

DIF: Cognitive Level: Application REF: p. 162

23. Which of the following is an independent nursing intervention?

a.

Teaching a patient with congestive heart failure to weigh herself daily

b.

Recommending an extra dose of diuretic to the patient whose weight has increased 2 pounds overnight

c.

Changing the first surgical dressing on a patient after surgery

d.

Transferring a patient out of the intensive care unit 2 days after vascular surgery

ANS: A

Feedback

A

Teaching requires no supervision, and nurses can carry out teaching interventions independently.

B

Prescribing medication is not a nursing intervention.

C

Changing the first surgical dressing on a patient after surgery is a dependent nursing action.

D

Transferring a patient out of the intensive care unit 2 days after vascular surgery is a dependent nursing intervention.

DIF: Cognitive Level: Comprehension REF: p. 163

24. Which of the following represents an interdependent nursing action?

a.

Giving the patient an ordered medication

b.

Bathing the patient

c.

Inserting a Foley catheter

d.

Participating in a code (cardiac arrest response)

ANS: D

Feedback

A

Giving the patient an ordered medication is a dependent nursing action.

B

Bathing the patient is an independent nursing action.

C

Inserting a Foley catheter is a dependent nursing action.

D

Participating in a code (cardiac arrest response) is an example of an action that involves collaboration with other health care professionals before and during implementation. It requires a protocol.

DIF: Cognitive Level: Comprehension REF: p. 163

25. The use of standardized plans of care for different patient populations has

a.

facilitated the use of critical paths as interdisciplinary plans of care.

b.

required the nurse to individualize the plan of care to the patient.

c.

eliminated the need for the nurse to develop a plan of care for an individual.

d.

increased the time the nurse has to document the plan of care.

ANS: B

Feedback

A

Standardized plans of care are not always critical paths and/or interdisciplinary.

B

Although plans for frequent patient problems can be easily produced, the plan of care still may need to be modified to meet the needs of the patient.

C

The use of standardized plans of care has not eliminated the need for an individualized plan.

D

The use of the standardized plans of care has decreased the time required of the nurse to update and document the plan of care.

DIF: Cognitive Level: Comprehension REF: p. 163

26. The nurse instructs the patient about incentive spirometry as preoperative teaching. Which phase of the nursing process does this illustrate?

a.

Assessment

b.

Planning

c.

Implementation

d.

Evaluation

ANS: C

Feedback

A

The example in the question is an intervention, not an assessment.

B

The example in the question is an intervention, not a plan.

C

Implementation is the phase of the nursing process when interventions are carried out.

D

The example of incentive spirometry is not an evaluation.

DIF: Cognitive Level: Comprehension REF: p. 164

27. In the nursing process, the evaluation phase is used to determine the

a.

value of the nursing intervention.

b.

accuracy of problem identification.

c.

the quality of the plan of care.

d.

degree of outcome achievement.

ANS: D

Feedback

A

Evaluation does not measure the value of the intervention.

B

Evaluation does not measure the accuracy of problem identification.

C

While it is an indicator of the effectiveness of the plan of care, evaluation is far more than that.

D

The evaluation phase of the nursing process is used to evaluate patient progress related to goals and outcome achievement to determine whether a problem is resolved.

DIF: Cognitive Level: Knowledge REF: p. 164

28. A nurse reviewing a patients care plan notes a goal of Patient will ambulate 50 feet, three times in the hallway today. According to Bloom, what taxonomic category is this goal?

a.

Affective domain

b.

Physical domain

c.

Psychomotor domain

d.

Cognitive domain

ANS: C

Feedback

A

The affective domain involves feelings, emotions, values, and attitudes. This goal is not in the affective domain.

B

Blooms taxonomy does not include physical domain.

C

The psychomotor involves movement and motor skills. An ambulation goal would be part of this domain.

D

The cognitive domain includes knowledge and cognitive skills. Ambulating would not be part of the cognitive domain.

DIF: Cognitive Level: Comprehension REF: p. 161

MULTIPLE RESPONSE

1. A well-cultivated critical thinker is an individual who does which of the following? (Select all that apply.)

a.

Raises questions

b.

Recognizes alternative ways to see problems

c.

Uses only logic to determine relevance of information

d.

Implements solutions to complex problems only as an individual

e.

Criticizes solutions and alternatives suggested by others

ANS: A, B

Feedback

Correct

A critical thinker identifies clear and precise questions and is open-minded to alternative ways to see problems.

Incorrect

A critical thinker gathers and assesses all relevant information and will communicate with others as he or she formulates solutions. Critical thinking does not involve criticism of others solutions and ideas, although it does include questioning and arriving at ones own conclusions.

DIF: Cognitive Level: Comprehension REF: p. 154

2. The nurse is admitting a patient for surgery. The patient is twisting a handkerchief over and over while saying, Im going to have a little mole removed. Im not worried. The surgery will take only an hour, and then I will go home. Ive never been sick a day in my life, so Ill be fine. The nurse finds the following during her physical assessment: blood pressure is 150/90; temperature is 98.6 F; pulse is 88 beats per minute; respiration is 20 breaths per minute; black, brown, and red pigmented pea-sized raised area on her shoulder. Which of the above information would be considered objective data? (Select all that apply.)

a.

Twisting handkerchief

b.

Blood pressure 150/90

c.

Im having this little mole removed.

d.

Patient is worried.

e.

Patient is exhibiting denial.

ANS: A, B

Feedback

Correct

Twisting handkerchief and blood pressure 150/90 are measurable or observable data.

Incorrect

Patient is worried is subjective data, and Im having this little mole removed is the patients description of what is going to occur. Patient is worried is incorrect because this is a conclusion the nurse might make based on the subjective and objective data. Patient is exhibiting denial is incorrect because this is a conclusion or inference that the nurse might make based on the data.

DIF: Cognitive Level: Application REF: p. 157

3. The nurse is admitting a patient for surgery. The patient is twisting a handkerchief over and over while saying, Im going to have a little mole removed. Im not worried. The surgery will take only an hour, and then I will go home. Ive never been sick a day in my life, so Ill be fine. The nurse finds the following during her physical assessment: blood pressure is 150/90; temperature is 98.6 F; pulse is 88 beats per minute; respiration is 20 breaths per minute; black, brown, and red pigmented pea-sized raised area on her shoulder. Which of the above information would be considered subjective data? (Select all that apply.)

a.

Pigmented mole on shoulder

b.

Im not worried Ill be fine.

c.

Patient is anxious.

d.

Heart rate is increased.

e.

The surgery will take only an hour and then I will go home.

ANS: B, E

Feedback

Correct

Im not worried Ill be fine and The surgery will take only an hour and then I will go home are statements made by the patient describing feelings or events.

Incorrect

Pigmented mole on shoulder is a conclusion based on objective data. Patient is anxious is incorrect because this is a conclusion the nurse might make based on the subjective and objective data. Heart rate is increased is incorrect because this is a conclusion the nurse might make based on objective data.

DIF: Cognitive Level: Application REF: p. 157

4. Several methods have been developed to assist nurses in organizing patient data. They include (Select all that apply.)

a.

Hendersons 14 nursing problems.

b.

Gordons 11 functional health patterns.

c.

Nightingales ecological framework.

d.

Abdellahs 21 nursing problems.

ANS: A, B, D

Feedback

Correct

Hendersons 14 nursing problems, Gordons 11 functional health patterns, and Abdellahs 21 nursing problems help sort patient data into categories.

Incorrect

Nightingale did not provide a method of organizing patient data.

DIF: Cognitive Level: Comprehension REF: p. 158

5. Developing sound clinical judgment is a professional responsibility of the nurse. Which statements indicate behaviors that improve clinical judgment? (Select all that apply.)

a.

I always assess before acting and make changes as needed.

b.

I work the shifts I am assigned.

c.

I look for research findings to support my nursing actions.

d.

I believe that every patient deserves my very best efforts.

e.

I have read the professional nursing standards.

ANS: A, C, D, E

Feedback

Correct

I always assess before acting and make changes as needed,

I look for research findings to support my nursing actions, I believe that every patient deserves my very best efforts, and I have read the professional nursing standards are behaviors that demonstrate the use of resources and the nursing process to give the patient quality care. These activities facilitate the development of clinical judgment.

Incorrect

The nurse is not taking opportunities to extend herself or himself and potentially learn from other situations. This would not show sound clinical judgment.

DIF: Cognitive Level: Application REF: p. 165

Leave a Reply