Chapter-015 test bank PDF

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Potter & Perry: Fundamentals of Nursing, 7th Edition Test Bank Chapter 15: Critical Thinking in Nursing Practice MULTIPLE CHOICE 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.” ANS: 1 The nurse educator is asking the student to synthesize critical thinking skills by encouraging the student to examine alternatives to meet the client’s unique needs within the context of the nursing process. Drawing inferences is a specific critical thinking competency used in diagnostic reasoning. The educator who tells the student not to draw inferences is not allowing the student to practice competencies necessary for specific critical thinking in clinical situations. The critical thinker will look beyond a single solution to a problem. Intuition develops as one’s clinical experience increases. The nursing student should examine rationales in order to make good decisions. DIF: C REF: 216 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Safe, Effective Care Environment 2. The second component of critical thinking in the “critical thinking model” is: 1. Experience 2. Competencies 3. Specific knowledge 4. Diagnostic reasoning ANS: 1 Experience is the second component of critical thinking in the “critical thinking model.” The third component of the “critical thinking model” is competencies. Specific knowledge base is the first component of the “critical thinking model.” Diagnostic reasoning is a specific critical thinking competency in clinical situations. DIF: A REF: 222 OBJ: Knowledge TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Safe, Effective Care Environment

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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 ANS: 1 Intuition is an inner sensing that something is so, as in this example. Reflection is the process of purposefully thinking back or recalling a situation to discover its purpose or meaning. Knowledge of the nurse includes information and theory from the basic sciences, humanities, behavioral sciences, and nursing. Scientific methodology is an approach to seeking the truth or verifying that a set of facts agrees with reality. DIF: A OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Safe, Effective Care Environment 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 ANS: 2 This is an example of the critical thinking attitude of risk-taking. A critical thinker is willing to take risks in trying different approaches to solving problems. Humility is a critical thinking attitude in which a person admits what they do not know and tries to acquire the knowledge needed to make proper decisions. To be accountable means to be answerable for the outcomes of your actions. To think independently, one questions others’ ways of interpreting knowledge and looks for rational and logical answers to problems. DIF: A REF: 224 OBJ: Comprehension TOP: Nursing Process: Planning MSC: NCLEX® test plan designation: Safe, Effective Care Environment 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

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3. Problem-solving 4. Diagnostic reasoning ANS: 3 This is an example of the critical thinking strategy of problem-solving. The nurse gathers information from the client and combines that information with what the nurse already knows about ostomy care to find a solution. Effective problem-solving involves the examination of alternatives. Inference is the process of drawing conclusions. Management is not a critical thinking strategy. Diagnostic reasoning is a process of determining a client’s health status after the nurse assigns meaning to the behaviors, physical signs, and symptoms presented by the client. DIF: A REF: 219 OBJ: Comprehension TOP: Nursing Process: Assessment/Implementation MSC: NCLEX® test plan designation: Safe, Effective Care Environment 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.” ANS: 4 Reporting more pain than yesterday and elevated blood pressure reflects using the scientific method in the nursing process. The nurse identified a problem of pain, hypothesized that it was greater than the day before, and collected data to evaluate its reality. Believing the client is depressed or thinking something is wrong reflect intuition. Speaking with the husband reflects information gathering, which may be used in diagnostic reasoning. DIF: A REF: 218 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Safe, Effective Care Environment 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 ANS: 4

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Taking appropriate action demonstrates the implementation step of the nursing process. Assessment involves the gathering of data. When formulating a nursing diagnosis, the nurse critically examines and analyzes the data, and identifies the client’s response to a problem. The nurse may then determine priorities. Planning involves establishing goals and expected outcomes of care. DIF: A REF: 221 OBJ: Comprehension TOP: Nursing Process: Implementation MSC: NCLEX® test plan designation: Safe, Effective Care Environment 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 ANS: 1 The nurse prioritizes actions and determines to see this client first because of a lower than normal blood pressure for a postoperative patient. This nurse is using scientifically and practice-based criteria for making clinical judgment. This is an example of following standards. The nurse uses criteria such as the clinical condition of the client, Maslow’s hierarchy of needs, and risks involved in treatment delays to determine which clients have the greatest priority for care. In answers 2 through 4, the client is not reported to be having any problems and therefore is not the priority. DIF: C REF: 221 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Safe, Effective Care Environment/Coordination/Setting Priorities 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 ANS: 4 Discussing alternative pain management techniques is an example of critical thinking at the complex level. The nurse analyzes and examines alternatives more independently. Giving medication at the time ordered is an example of the basic level of critical thinking. Following a procedure step-by-step is an example of the basic level of critical thinking. Reviewing the client’s medical records thoroughly is an example of gathering data and may be used in evaluation of a client’s care.

Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

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DIF: C REF: 218 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Safe, Effective Care Environment 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 ANS: 3 The nurse who observes the absorbency of different brands of dressing is demonstrating testing of possible options. This is not an example of defining the problem. The nurse has not yet made a final decision. The nurse is not examining pros and cons, and therefore is not considering consequences. DIF: A REF: 219 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Safe, Effective Care Environment 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 ANS: 1 Reporting client difficulties demonstrates the critical thinking attitude of responsibility and authority. Asking for help if uncertain and following standards of practice also demonstrate the critical thinking attitudes of responsibility and authority. Offering an alternative approach would demonstrate the critical thinking attitude of risk-taking. Looking for a different treatment option demonstrates the critical thinking attitude of creativity. Sharing ideas about nursing interventions demonstrates the critical thinking attitude of thinking independently. DIF: A REF: 223 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Safe, Effective Care Environment 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

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4. Approaches assessment logically ANS: 4 Use of the intellectual standard of critical thinking implies that the nurse approaches assessment logically and consistently. Questioning the physician’s order is an example of the critical thinking attitude of risk-taking. Recognizing conflicts of interest demonstrates the critical thinking attitude of integrity. Listening to both sides of the story demonstrates the critical thinking attitude of fairness. DIF: A REF: 225 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Safe, Effective Care Environment 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 ANS: 2 Having worked for many years and being able to adapt a procedure to meet the client’s needs is an example of the second component of the critical thinking model—experience. Curiosity is a critical thinking attitude where the nurse asks why, and continues to learn more about the client to make appropriate clinical judgments. Perseverance is a critical thinking attitude where the nurse does not readily accept the easy answer but does look further to find necessary information and appropriate solutions. Scientific knowledge is knowledge acquired from the study of science. It may be acquired through education, such as coursework, or by reading nursing literature to remain current in nursing science. DIF: A REF: 222 OBJ: Comprehension TOP: Nursing Process: Implementation MSC: NCLEX® test plan designation: Safe, Effective Care Environment 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.” ANS: 2

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Intuition develops as one’s clinical experience increases. The nursing instructor should instruct the student to examine rationales in order to make good decisions regarding client needs. The instructor would encourage the student to examine alternatives to meet the client’s unique needs, so this statement would not require follow-up. Basing client care on identified client needs is the appropriate use of critical thinking, and so would not require follow-up. Basing client care on client needs identified by thorough nursing assessments is the appropriate use of critical thinking, and so would not require followup. DIF: C OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Safe, Effective Care Environment 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.” ANS: 4 Reflection is the process of purposefully thinking back or recalling a situation to discover its purpose or meaning. Knowledge of the nurse includes information and theory from the basic sciences, humanities, behavioral sciences, and nursing. Scientific methodology is an approach to seeking the truth or verifying that a set of facts agrees with reality. Intuition is an inner sensing that something is so, as in this example. DIF: C REF: 226 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Safe, Effective Care Environment 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.” ANS: 2 To be accountable means to be answerable for the outcomes of your actions. Answer 2 is an example of the critical thinking attitude of risk-taking. A critical thinker is willing to take risks in trying different approaches to solving problems. To think independently, one questions others’ ways of interpreting knowledge and looks for rational and logical answers to problems. Humility is a critical thinking attitude where a person admits what they do not know and tries to acquire the knowledge needed to make proper decisions.

Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

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DIF: C REF: 224 OBJ: Analysis TOP: Nursing Process: Planning MSC: NCLEX® test plan designation: Safe, Effective Care Environment 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 ANS: 3 This is an example of the critical thinking strategy of problem solving. The nurse gathers information by using several different products and then uses this information to determine which will work best for the client. Effective problem solving involves the examination of alternatives. While requesting the IV team solves a problem, there is little critical thinking needed because it would be understood that the IV team would be called under these circumstances. Although calling the kitchen solves a problem, there is little critical thinking needed because it would be understood that the kitchen would be called under these circumstances. Calling for another pain medication order solves a problem, but there is little critical thinking needed because it would be understood that the provider would be called for a new drug order under these circumstances. DIF: C REF: 219 OBJ: Analysis TOP: Nursing Process: Assessment/Implementation MSC: NCLEX® test plan designation: Safe, Effective Care Environment 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 ANS: 3 This client has an acute need that requires the nurse’s attention. The facility has a policy regarding the amount of time available in which to complete such an assessment and this client is in no acute distress, so the assessment does not have priority. While a pain assessment is required to evaluate the effectiveness of pain medication, it does not the have the priority of the other presented options. This client has no acute problems and so the assessment does not have the priority of some of the other options. DIF: C REF: 221 TOP: Nursing Process: Assessment

OBJ: Analysis

Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

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MSC: NCLEX® test plan designation: Safe, Effective Care Environment 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 ANS: 4 Taking appropriate action dem...