Deck 12: Critical and Diagnostic Thinking for Better Clinical Judgment

Question 1

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 patient's 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.

Answer 1

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 nurse's 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.

Question 2

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

Answer 2

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.

Question 3

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.

Answer 3

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 patient's 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.

Question 4

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.

Question 5

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

Question 6

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 nurse's experience.
C) persuasive process leading to sound decisions.
D) reactive process after an intervention is completed.

Question 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 patient's 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

Question 8

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.

Question 9

Which of the following is the best example of an open-ended question regarding a patient's 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?"

Question 10

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

Question 11

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.

Question 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 100.2°F
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

Question 13

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.

Question 14

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

Question 15

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."

Question 16

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

A) Committing to test one's 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

Question 17

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.

Question 18

Reasoned thought is characterized by the lack of:

A) reflection.
B) emotion.
C) parity.
D) contrast.

Question 19

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 101.0°F
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

Question 20

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 101.3°F
D) The patient diagnosed with a stomach virus who vomited three times during the previous shift