15. Critical thinking and clinical judgement

Question 1

Clinical decision making

Answer 1

Problem-solving approach that nurses use to define patient problems and select appropriate treatment.

Question 2

Clinical judgment

Answer 2

The observed outcome of critical thinking and decision making.

Question 3

Critical thinking

Answer 3

Active, purposeful, organized, cognitive process used to carefully examine one’s thinking and the thinking of other individuals.

Question 4

Deductive reasoning

Answer 4

Critically analyzing data to determine important information and ideas and then discards unnecessary data until a later time.

Question 5

Diagnostic reasoning

Answer 5

Process that enables an observer to assign meaning to and classify phenomena in clinical situations by integrating observations and critical thinking.

Question 6

Evidence-based knowledge

Answer 6

Knowledge that is derived from the integration of best research, clinical expertise, and patient values.

Question 7

Inductive reasoning

Answer 7

Making an inference by forming a conclusion about the related pieces of evidence. Previous experience with the evidence is also considered.

Question 8

Inference

Answer 8

Judgment or interpretation of informational cues. Taking one proposition as a given and guessing that another proposition follows.

Question 9

Intuition

Answer 9

Inner sensing that something is so.

Question 10

Knowing the patient

Answer 10

The patient’s typical pattern of responses, as well as engaging with patients about their concerns.

Question 11

Nursing process

Answer 11

Systematic problem-solving method by which nurses individualize care for each patient. The five steps of the nursing process are assessment, diagnosis, planning, implementation, and evaluation.

Question 12

Problem solving

Answer 12

Methodical, systematic approach to explore conditions and develop solutions, including analysis of data, determination of causative factors, and selection of appropriate actions to reserve or eliminate the problem.

Question 13

Reflection

Answer 13

Process of thinking back or recalling an event to discover the meaning and purpose of that event. Useful in critical thinking.

Question 14

A nurse enters a patient’s room at the beginning of a shift to assess his condition following a blood transfusion. The nurse cared for the patient on the previous day as well. The patient has several issues he wishes to share with the nurse, who takes time to explore each issue. The nurse also assesses the patient and finds no signs or symptoms of a reaction to the blood product. The nurse observed the patient the prior day and saw a change in his behavior—a reluctance to get out of bed and ambulate. Which of the following actions improves the nurse’s ability to make clinical decisions about this patient? (Select all that apply.)

1. Working the same shift each day
2. Spending time during the patient assessment
3. Knowing the early mobility protocol guidelines
4. Caring for the patient on consecutive days
5. Knowing the pattern of patient behavior about ambulation

Answer 14

2. Spending time during the patient assessment
3. Caring for the patient on consecutive days
4. Knowing the pattern of patient behavior about ambulation

Question 15

The concept for Critical Thinkers:
Matching Term Application:

___ 1. Truth-seeking

Answer 15

Matching Term Application:

c. Be objective in asking patient questions.

Question 16

Concepts for Critical Thinkers Term Application:

___ 2. Open-mindedness

Answer 16

Matching Term Application:

d. Be tolerant of the patient’s views and beliefs.

Question 17

Concepts for Critical Thinkers Term Application:

___ 3. Analyticity

Answer 17

Matching Term Application:

a. Anticipate how a patient might respond to a treatment.

Question 18

Concepts for Critical Thinkers Term Application:

___ 4. Systematicity

Answer 18

Matching Term Application:

b. Organize assessment on the basis of patient priorities.

Question 19

A nurse has seen many cancer patients struggle with pain management because they are afraid of becoming addicted to the medicine. Pain control is a priority for cancer care. By helping patients focus on their values and beliefs about pain control, a nurse can best make clinical decisions. This is an example of:


1. Creativity

2. Fairness

3. Clinical reasoning

4. Applying ethical criteria

Answer 19

4. Applying ethical criteria

Question 20

The REFLECT model can improve learning after providing patient care. Place the steps of this model in the correct order:


1. Think about your thoughts and actions at the time of a situation.

2. Review the knowledge you gained from the experience.

3. Review the facts of the situation.

4. Set a schedule for completing your plan of action.

5. Consider options for handling a similar situation in the future.

6. Recall any feelings you had at the time of the situation.

7. Create a plan for future situations.


Answer 20

3. Review the facts of the situation.

4. Think about your thoughts and actions at the time of a situation.

5. Recall any feelings you had at the time of the situation.

6. Review the knowledge you gained from the experience.
7. Consider options for handling a similar situation in the future.

8. Create a plan for future situations.


9. Set a schedule for completing your plan of action.

Question 21

One element of clinical decision making is knowing the patient. Which of the following activities affect a nurse’s ability to know patients better? (Select all that apply.)


1. Caring for similar groups of patients over time

2. Reading the evidence-based practices appropriate to patients

3. Learning how patients typically respond to their clinical situations

4. Observing patients

5. Engaging with patients experiencing illness


Answer 21

1. Caring for similar groups of patients over time

2. Learning how patients typically respond to their clinical situations

3. Observing patients

4. Engaging with patients experiencing illness


Question 22

A nurse is preparing medications for a patient. The nurse checks the name of the medication on the label with the name of the medication on the health care provider’s order. At the bedside, the nurse checks the patient’s name against the medication order as well. The nurse is following which critical thinking attitude?


1. Responsibility

2. Humility

3. Accuracy

4. Fairness


Answer 22

1. Responsibility

Question 23

A nurse has been caring for a patient with a chronic wound that has not been healing. The nurse talks with a nurse specialist in wound care to find alternative approaches from what the health care provider ordered for dressing the wound. The two decide that because of the patient’s allergy to tape, a nonallergenic dressing will be used. The nurse obtains an order from the health care provider for the new dressing. After 2 days there is improvement in the wound. This is an example of which critical thinking standards? (Select all that apply.)


1. Clarity

2. Broadness

3. Relevance

4. Risk taking

5. Creativity


Answer 23

3. Relevance

4. Risk-taking

5. Creativity


Question 24

A nurse is assigned to care for a woman who is expecting her first child. The nurse organizes herself and plans to gather data about the patient by applying Pender’s health promotion model, including the patient’s characteristics and experiences and situational influences. She plans to observe patient behavior and consider the patient’s psychosocial issues. Such data will offer a clear understanding to help the nurse identify the patient’s needs. This is an example of which of the following concepts? (Select all that apply.)


1. Diagnostic reasoning

2. Deductive reasoning

3. Inductive reasoning

4. Assessment

5. Problem solving


Answer 24

2. Deductive reasoning

   

3. Assessment



Question 25

A nurse is caring for a patient who has poor pain control. The patient has a history of opioid abuse. During the day, the patient made frequent requests for a pain medication. To make an effective clinical decision about this patient, the nurse needs to ask questions about the data available on the patient to make a thorough and thoughtful decision. The nurse asks herself, “How does my view about the patient’s pain tolerance compare with the patient’s, and does that pose a problem?” This is an example of:


1. A question about assumptions

2. A question about evidence

3. A question about procedure

4. A question about perspective

Answer 25

4. A question about perspective

Question 26

A nurse is giving a patient a medication and notices the dosage. From the nurse’s experience, the dosage is higher than what is normally given. Which of the following steps should the nurse take to ensure a safe outcome for the patient? (Select all that apply.)


1. Wait until end of shift when there is time to check dosage with pharmacy reference.

2. Recognize how the nursing team communicates problems, and consult with charge nurse.

3. Hold the dose and confer with the ordering health care provider now.

4. Assess patient knowledge of what has been the routine dose for this medication.

5. Administer the medication and closely monitor patient response.


Answer 26

2. Recognize how the nursing team communicates problems, and consult with charge nurse.

3. Hold the dose and confer with the ordering health care provider now.

4. Assess patient knowledge of what has been the routine dose for this medication.