critical thinking

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chpt 15

1. Which of the following best reflects the philosophy of critical thinking as taught by a nurse educator to a nursing student?
1. "Think about several interventions that you could use with this client."
2. "Don't draw subjective inferences about your client—be more objective."
3. "Please think harder—there is a single solution for which I am looking."
4. "Trust your feelings—don't be concerned about trying to find a rationale to support your decision."

"Think about several interventions that you could use with this client."

2. The second component of critical thinking in the "critical thinking model" is:
1. Experience
2. Competencies
3. Specific knowledge
4. Diagnostic reasoning

Experience

3. The nurse enters the room of a client who has a history of heart disease. On looking at the client, the nurse feels that something is "not right" with the client and proceeds to take the vital signs. This is the nurse acting on:
1. Intuition
2. Reflection
3. Knowledge
4. Scientific methodology

Intuition

4. The nurse manager has developed a staff protocol for peer evaluation. The nurses on her surgical unit are nervous about using her instrument. If the nurse manager continues to implement the new strategy, which of the following critical thinking attitudes is she portraying?
1. Humility
2. Risk-taking
3. Accountability
4. Independent thinking

Risk-taking

5. The nurse is working with a client who has recently had a colostomy and is having difficulty using the provided supplies. The nurse works with the client to see which alternative supplies are easier for the client to use. This is an example of the critical thinking strategy of:
1. Inference
2. Management
3. Problem-solving
4. Diagnostic reasoning

Problem-solving

6. Which of the following is an example of a nurse's statement that reflects using the scientific method in the nursing process?
1. "I believe that this client is getting depressed."
2. "The client doesn't look right to me; I think something is wrong."
3. "The client's husband told me that she is feeling very uncomfortable."
4. "The client reports more pain than yesterday and her blood pressure is elevated."

"The client reports more pain than yesterday and her blood pressure is elevated."

7. The nurse decides to administer tablets of Tylenol instead of the intramuscular Demerol she has previously been providing her orthopedic client. Which step of the nursing process does this address?
1. Assessment
2. Nursing diagnosis
3. Planning
4. Implementation

Implementation

8. The nurse has a multiple client assignment on the surgical unit. On beginning the shift, the nurse needs to determine which postoperative client should be seen first. Of the following, the nurse should go to see the client who:
1. Has a documented blood pressure of 90/50
2. Was medicated for back pain 10 minutes ago
3. Has an order to be out of bed and ambulated
4. Requires instructions for wound care before discharge

Has a documented blood pressure of 90/50

9. There are a variety of levels of critical thinking. An example of critical thinking at the complex level is:
1. Giving medication at the time ordered
2. Following a procedure for catheterization step-by-step
3. Reviewing all clients' medical records thoroughly
4. Discussing various alternative pain management techniques

Discussing various alternative pain management techniques

10. The nurse is deciding on the type of dressing to use for a client. Which step of the decision-making process is being used when the nurse observes the absorbency of different dressing brands?
1. Defining the problem
2. Making final decisions
3. Testing possible options
4. Considering consequences

Testing possible options

11. Which one of the following examples demonstrates the critical thinking attitude of responsibility and authority?
1. Reporting client difficulties
2. Offering an alternative approach
3. Looking for a different treatment option
4. Sharing ideas about nursing interventions

Reporting client difficulties

12. Use of the intellectual standard of critical thinking implies that the nurse:
1. Questions the physician's order
2. Recognizes conflicts of interest
3. Listens to both sides of the story
4. Approaches assessment logically

Approaches assessment logically

13. A client requires urinary catheterization but has difficulty keeping her legs in the usual position needed for this procedure. The nurse has worked for many years and adapts the procedure to allow the client to lie on her side. This action is based on the critical thinking element of:
1. Curiosity
2. Experience
3. Perseverance
4. Scientific knowledge

Experience

14. Which of the following statements made by a nursing student concerning the use of critical thinking and client care requires follow-up by the nursing instructor?
1. "I feel it's good practice to always have alternative interventions in mind."
2. "I trust my feelings about a client's needs since I work hard at knowing my client."
3. "I always try to keep an open mind about what interventions my client will require."
4. "I will wait until my assessment is completed before determining the client's needs."

"I trust my feelings about a client's needs since I work hard at knowing my client."

15. Which of the following is the best example of a nurse's use of reflection?
1. The nurse places a client experiencing respiratory difficulties in a high-Fowler's position.
2. The nurse calls the provider when a client reports feeling "chilled and achy" while having an oral temperature of 100.2° F.
3. While caring for a client with a history of asthma, the nurse assesses the client's pulse oximetry reading when he "doesn't sound right."
4. A nurse tells a client; "When you refused to go to physical therapy earlier today I believe you were upset about something else besides the appointment time."

A nurse tells a client; "When you refused to go to physical therapy earlier today I believe you were upset about something else besides the appointment time."

16. Which of the following nursing situations best reflects accountability?
1. The nurse takes the oncology nursing certification examination.
2. The nurse files an incident report regarding a medication error.
3. The nurse assesses the client for the possible cause of his pain.
4. The nurse tells the client, "I don't know but I will find out for you."

The nurse files an incident report regarding a medication error.

17. Which of the following nursing actions is the best example of problem solving?
1. Requesting the IV team to start an antibiotic drip on a client with a history of being a difficult stick
2. Offering to call the kitchen to provide an alternate breakfast for a client who does not like cooked cereal
3. Trying several difficult wound dressings to determine which one the client can apply the most effectively
4. Calling for another pain medication order when the current drug results in the client experiencing nausea

Trying several difficult wound dressings to determine which one the client can apply the most effectively

18. Which of the following clients should be prioritized with the most urgent need for a nursing assessment?
1. A new admission admitted for swelling in the right ankle and knee
2. A second day postoperative client who received pain medication 30 minutes ago
3. A client who the nursing assistant found crying in the bathroom
4. A client ready for discharge who requires a final assessment and documentation

A client who the nursing assistant found crying in the bathroom

19. Which of the following nursing interventions is the best example of the implementation step of the nursing process?
1. Determining that the client's ankle edema is worse after he ambulates
2. Asking the client to rate his ankle pain after receiving oral pain medication
3. Arranging for the client to receive pain medication 30 minutes before his ordered ambulation
4. Crushing the client's pain medication to facilitate easier swallowing and thus minimize the risk of choking

Crushing the client's pain medication to facilitate easier swallowing and thus minimize the risk of choking

20. Which of the following nursing actions best reflects the consequence stage of the decision-making process?
1. Being physically present when a client is given the results of a tissue biopsy
2. Witnessing the client sign consent for surgery forms before cardiac surgery
3. The client is informed of the various treatments available for his condition.
4. The nurse explains to the client the risks of leaving the hospital against medical advice.

The nurse explains to the client the risks of leaving the hospital against medical advice.

21. The concept of nursing responsibility is best reflected in which of the following nursing actions?
1. Providing accurate and timely documentation regarding an incident resulting in a client fall
2. Suggesting that a client might prefer taking a particular medication at bedtime instead of in the morning
3. Posting a note on the unit Kardex how to best apply a dressing to a skin wound on a particular client
4. Referring to the institution's policy manual when unsure of how to handle a client's complaint regarding a social services consult

Referring to the institution's policy manual when unsure of how to handle a client's complaint regarding a social services consult

22. Which of the following situations is the best example of a nurse using intellectual standards as a critical thinking tool?
1. Performing a head-to-toe assessment on a new admission
2. Placing a client experiencing shortness of breath on oxygen
3. Arbitrating a complaint between roommates over the television
4. Notifying a provider of a client's allergy to an ordered medication

Placing a client experiencing shortness of breath on oxygen

23. The nurse is best demonstrating perseverance by:
1. Having a perfect attendance record
2. Completing a lengthy course on current chemotherapies
3. Repeatedly irrigating the nasogastric tube until it is patent
4. Sitting with a client until she is ready to discuss why she is crying

Sitting with a client until she is ready to discuss why she is crying

24. With regards to client care, the most likely reason that a veteran nurse tends to be a more skillful critical thinker than a new graduate nurse is because:
1. The veteran nurse has a varied history of client care experiences
2. Critical thinking improves with experience, longevity, and interest
3. Today's short hospital stays minimize the opportunity to develop critical thinking skills
4. New graduates often lack the self-confidence to take the risks often required of critical decision making

Critical thinking improves with experience, longevity, and interest

25. The primary factor that distinguishes a professional nurse's care from care provided by ancillary nursing staff is:
1. Critical thinking
2. Years of education
3. Professional licensure
4. Complexity of the task

Critical thinking

26. A clinical nursing instructor asks the nursing students to describe a critical thinker. Which of the following represents the best response?
1. "A person with the educational background to solve problems."
2. "A person who finds the problem and does what is best to fix it."
3. "It's someone who uses the scientific method to solve problems."
4. "Someone who uses a system to work through and solve a problem."

"A person who finds the problem and does what is best to fix it."

27. Which of the following statements made by a new graduate nurse regarding a client's care needs requires follow-up by the mentor?
1. "No one really enjoys being hospitalized."
2. "Every client is offered a back rub at bedtime."
3. "All post surgery clients are reluctant to ambulate."
4. "I always spend extra time with new clients to help them relax."

"All post surgery clients are reluctant to ambulate."

28. A nurse is caring for an immobile client with a large pressure ulcer on her left ankle. Which of the following statements by the nurse best reflects critical thinking regarding client care?
1. "I'm sure that friction and pressure have caused this problem."
2. "Please be sure that her ankles are well padded when you place her in bed."
3. "Do you have any suggestions on how we can minimize the pressure to her ankles?"
4. "It was an ineffective turning schedule that allowed this to happen so now we will reposition every hour."

"Do you have any suggestions on how we can minimize the pressure to her ankles?"

29. A nurse is caring for a 35-year-old client who is 12 hours post mastectomy. The care assistant reports that the client is crying. Which of the following responses by the nurse best reflects the use of analysis regarding this client's care needs?
1. "That surgery is painful. I'll get her pain medication ready."
2. "She was sleeping when I checked 15 minutes ago. I'll go back in right now."
3. "I'll be responsible for her PM care so I can spend some uninterrupted time with her."
4. "A mastectomy is a blow to a woman's self image. I'll notify her provider that she is depressed."

"She was sleeping when I checked 15 minutes ago. I'll go back in right now."

30. Which of the following statements made by a nurse regarding personal reflection related to client care requires follow-up by the unit's nurse manager?
1. "Mary and I were comparing foot wound dressing techniques."
2. "I've been caring for orthopedic clients for 10 years and I think I've seen it all."
3. "I can't believe that my client isn't improving after 2 weeks of physical therapy."
4. "I always wean my orthopedic surgery clients onto oral pain medication on postoperative day 4."

"I always wean my orthopedic surgery clients onto oral pain medication on postoperative day 4."

1. The scope of a client's health problem is a result of which of the following factors? (Select all that apply.)
1. Religious beliefs
2. Life experiences
3. Lifestyle choices
4. Work environment
5. Family relationships
6. Educational background

2. Life experiences
3. Lifestyle choices
4. Work environment
5. Family relationships

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