Chapter 15 Critical Thinking in Nursing Practice Flashcards
1. While assessing a patient, the nurse observes that the patient's intravenous (IV) line is not infusing at the ordered rate. The nurse assesses the patient for pain at the IV site, checks the flow regulator on the tubing, looks to see if the patient is lying on the tubing, checks the point of connection between the tubing and the IV catheter, and then checks the condition of the site where the intravenous catheter enters the patient's skin. After the nurse readjusts the flow rate, the infusion begins at the correct rate. This is an example of: A. Inference. B. Diagnostic reasoning. C. Competency. D. Problem solving.
D
Rationale:
This is an example of problem solving. The nurse collects information and tries options until she is able to find a solution to the slowed infusion rate. The focus is on solving the problem with the patient’s IV and not on solving the patient’s health problem; thus this is not the diagnostic reasoning process.
- The nurse sits down to talk with a patient who lost her sister 2 weeks ago. The patient reports she is unable to sleep, feels very fatigued during the day, and is having trouble at work. The nurse asks her to clarify the type of trouble. The patient explains she can’t concentrate or even solve simple problems. The nurse records the results of the assessment, describing the patient as having ineffective coping. This is an example of:
A. Diagnostic reasoning.
B. Competency.
C. Inference.
D. Problem solving.
A.
Rationale:
In this example the nurse collects information about the patient, sees patterns in the data collected, and makes a nursing diagnosis. This is an example of the diagnostic process.
- A patient on a surgical unit develops sudden shortness of breath and a drop in blood pressure. The staff respond, but the patient dies 30 minutes later. The manager on the nursing unit calls the staff involved in the emergency response together. The staff discusses what occurred over the 30-minute time frame, the actions taken, and whether other steps should have been implemented. The nurses in this situation are:
A. Problem solving.
B. Showing humility.
C. Conducting reflective practice.
D. Exercising responsibility.
C.
Rationale:
Reflective practice is a conscious process of thinking, analyzing, and learning from previous work situations. The staff may discuss problems that occurred, but in this case they are reflecting on them to learn for future patient situations.
- A nurse has worked on an oncology unit for 3 years. One patient has become visibly weaker and states, “I feel funny.” The nurse knows how patients often have behavior changes before developing sepsis when they have cancer. The nurse asks the patient questions to assess thinking skills and notices the patient shivering. The nurse goes to the phone, calls the physician, and begins the conversation by saying, “I believe that your patient is developing sepsis. I want to report symptoms I’m seeing.” What examples of critical thinking concepts does the nurse show? (Select all that apply.)
A. Experience B. Ethical C. Analyticity D. Self-confidence E. Risk taking
C & D
Rationale:
Among critical thinking concepts, the nurse shows analyticity (analyzing information, gathering additional findings, and sensing a problem), and self-confidence (calling the physician, which shows trust in his own reasoning). The nurse’s experience would have influenced the familiarity of patient symptoms, but in this text experience is considered a component of the critical thinking model and not a concept. Acting ethically is a critical thinking standard.
- A nurse who is working on a surgical unit is caring for four different patients. Patient A will be discharged home and is in need of instruction about wound care. Patients B and C have returned from the operating room within an hour of each other, and both require vital signs and monitoring of their intravenous (IV) lines. Patient D is resting following a visit by physical therapy. Which of the following activities by the nurse represent(s) use of clinical decision making for groups of patients? (Select all that apply.)
A. Consider how to involve patient A in deciding whether to involve the family caregiver in wound care instruction.
B. Think about past experience with patients who develop postoperative complications.
C. Decide which activities can be combined for patients B and C.
D. Carefully gather any assessment information and identify patient problems.
C & A
Rationale:
Considering how to involve patients in decisions and how to combine nursing activities to be more organized and allow for resolving more than one problem at a time are examples of clinical decision making for groups of patients. Thinking about past experience with patients is an example of reflection, an approach to strengthen critical thinking skills. Gathering assessment information is part of the process of diagnostic reasoning, which should be applied to each patient.
6. The surgical unit has initiated the use of a pain-rating scale to assess patients' pain severity during their postoperative recovery. The registered nurse (RN) looks at the pain flow sheet to see the pain scores recorded for a patient over the last 24 hours. Use of the pain scale is an example of which intellectual standard? A. Deep B. Relevant C. Consistent D. Significant
C
Rationale:
Use of the same pain scale for assessing pain acuity is an example of being consistent.
- During a home health visit the nurse prepares to instruct a patient in how to perform range-of-motion (ROM) exercises for an injured shoulder. The nurse verifies that the patient took an analgesic 30 minutes before arrival at the patient’s home. After discussing the purpose for the exercises and demonstrating each one, the nurse has the patient perform them. After two attempts with only the second of three exercises, the patient stops and says, “This hurts too much. I don’t see why I have to do this so many times.” The nurse applies the critical thinking attitude of integrity in which of the following actions?
A. “I understand your reluctance, but the exercises are necessary for you to regain function in your shoulder. Let’s go a bit more slowly and try to relax.”
B. “I see that you’re uncomfortable. I’ll call your doctor to decide the next step.”
C. “Show me exactly where your pain is and rate it for me on a scale of 0 to 10.”
D. “Is anything else bothering you? Other than the pain, is there any other reason you might not want to do the exercises?”
A
Rationale:
The nurse reviews the position of requiring exercises to restore function and decides to try a different approach to proceed, which is an example of integrity. In calling the doctor for the next step, the nurse does not reinforce the importance of exercises, which is likely the standard of care for this type of patient. In asking the location and strength of the pain the nurse is interpreting further to determine if any other physical problems are developing. In attempting to learn if any other underlying problems exist, the nurse is showing curiosity.
- The nurse cared for a 14-year-old with renal failure who died near the end of the work shift. The health care team tried for 45 minutes to resuscitate the child with no success. The family was devastated by the loss, and, when the nurse tried to talk with them, the mother said, “You can’t make me feel better; you don’t know what it’s like to lose a child.” Which of the following examples of journal entries might best help the nurse reflect and think about this clinical experience? (Select all that apply.)
A. Data entry of time of day, who was present, and condition of the child
B. Description of the efforts to restore the child’s blood pressure, what was used, and questions about the child’s response
C. The meaning the experience had for the nurse with respect to her understanding of dealing with a patient’s death
D. A description of what the nurse said to the mother, the mother’s response, and how the nurse might approach the situation differently in the future
B, C & D
Rationale
The nurse can reflect on the effects of the treatment and what was difficult or confusing about the outcome. The nurse reviews the meaning of the experience to help improve understanding of personal comfort and competence in dealing with death and how to respond in the future. The nurse reflects on the communication approach used with the mother to consider if it was appropriate.
9. A nurse has been working on a surgical unit for 3 weeks. A patient requires a Foley catheter to be inserted, so the nurse reads the procedure manual for the institution to review how to insert it. The level of critical thinking the nurse is using is: A. Commitment. B. Scientific method. C. Basic critical thinking. D. Complex critical thinking.
C
Rationale:
This is an example of basic critical thinking, in which the nurse trusts that experts have the right answers for how to insert the Foley catheter and thus goes to the procedure manual. Thinking is concrete and based on a set of rules or principles.
10. A patient had hip surgery 16 hours ago. During the previous shift the patient had 40 mL of drainage in the surgical drainage collection device for an 8-hour period. The nurse refers to the written plan of care, noting that the health care provider is to be notified when drainage in the device exceeds 100 mL for the day. On entering the room, the nurse looks at the device and carefully notes the amount of drainage currently in it. This is an example of: A. Planning B. Evaluation. C. Intervention. D. Diagnosis.
B
Rationale:
The patient’s baseline for wound drainage was 40 mL, representing the initial assessment of the patient’s wound condition. In this example the nurse is evaluating to determine if there is a change in the amount of drainage, which indicates the progress of wound healing.
11. The nurse asks a patient how she feels about her impending surgery for breast cancer. Before the discussion the nurse reviewed the description of loss and grief and therapeutic communication principles in his textbook. The critical thinking component involved in the nurse's review of the literature is: A. Experience. B. Problem solving. C. Knowledge application. D. Clinical decision making.
C
Rationale:
The nurse reviewed knowledge that pertained to the patient’s clinical situation, allowing him to apply critical thinking in the patient’s care.
- A nurse is working with a nursing assistive personnel (NAP) on a busy oncology unit. The nurse has instructed the NAP on the tasks that need to be performed, including getting patient A out of bed, collecting a urine specimen from patient B, and checking vital signs on patient C, who is scheduled to go home. Which of the following represent(s) successful delegation? (Select all that apply.)
A. A nurse explains to the NAP the approach to use in getting the patient up and why the patient has activity limitations.
B. A nurse is asked by a patient to help her to the bathroom; the nurse leaves the room and directs the NAP to assist the patient instead.
C. The nurse sees the NAP preparing to help a patient out of bed, goes to assist, and thanks the NAP for her efforts to get the patient up early.
D. The nurse is in patient B’s room to check an intravenous (IV) line and collects the urine specimen while in the room.
E. The nurse offers support to the NAP when needed but allows her to complete patient care tasks without constant oversight.
A, C, D
Rationale:
Successful delegation is represented by good communication, showing respect, and showing initiative. The example in answer 2 shows a lack of initiative on the part of the nurse.
- Which of the following is unique to the commitment level of critical thinking?
A. Weighs benefits and risks when making a decision.
B. Analyzes and examine choices more independently.
C. Concrete thinking.
D. Anticipates when to make choices without others’ assistance.
D
Rationale:
Anticipating when to make choices during decision making is unique to the commitment level of critical thinking. Thinking concretely is basic critical thinking. Analyzing and examining choices and weighing benefits and risks are characteristic of complex critical thinking.
- In which of the following examples is the nurse not applying critical thinking skills in practice?
A. The nurse considers personnel experience in performing intravenous (IV) line insertion and ways to improve performance.
B. The nurse uses a fall risk inventory scale to determine a patient’s fall risk.
C. The nurse observes a change in a patient’s behavior and considers which problem is likely developing.
D. The nurse explains the procedure for giving a tube feeding to a second nurse who has floated to the unit to assist with care.
D
Rationale:
The nurse is explaining how to provide care on the basis of knowledge. Considering personal experience is self-regulation through reflection. Determining a patient’s fall risk is evaluation, using a criteria-based screening scale. Observing a change in the patient’s behavior and considering likely developments is inference, in which the nurse looks for a relationship in findings.
