Chapter 15: Critical Thinking in Nursing Practice

Question 1

1. Critical thinking characteristics include
   a.
   Considering what is important in a given situation.
   b.
   Accepting one, established way to provide patient care.
   c.
   Making decisions based on intuition.
   d.
   Being able to read and follow physician’s orders.

Answer 1

ANS: A
Critical thinking involves being able to decipher what is relevant and important in a given situation and to make a clinical decision based on that importance. Patient care can be provided in many ways. Clinical decisions should be based on evidence and research. Following physician’s orders is not considered a critical thinking skill.

Question 2

2. Which of these patient scenarios is most indicative of critical thinking?
   a.
   Administering pain relief medication according to what was given last shift
   b.
   Asking a patient what pain relief methods, pharmacological and nonpharmacological, have worked in the past
   c.
   Offering pain relief medication based on physician orders
   d.
   Explaining to the patient that his reports of severe pain are not consistent with the minor procedure that was performed

Answer 2

ANS: B
Asking the patient what pain relief methods have worked in the past is an example of exploring many options for pain relief. Administering medication based on a previous assessment is not practicing according to standards of care. The nurse is to conduct an assessment each shift on his/her patient and intervene accordingly. Nonpharmacological pain relief methods are available, as are medications for pain. Pain is subjective. The nurse should offer pain relief methods based on the patient’s reports without being judgmental.

Question 3

3. Professional nurses are responsible for making clinical decisions to
   a.
   Prove traditional methods of providing nursing care to patients.
   b.
   Take immediate action when a patient’s condition worsens.
   c.
   Apply clear textbook solutions to patients’ problems.
   d.
   Formulate standardized care plans for groups of patients.

Answer 3

ANS: B
Professional nurses are responsible for making clinical decisions to take immediate action when a patient’s condition worsens. Patient care should be based on evidence-based practice, not on tradition. Clear textbooks solutions to patient problems are not always available. Care plans should be individualized.

Question 4

4. The nurse needs a reminder of professional responsibility when performing which of these actions?
   a.
   Making an informed clinical decision
   b.
   Making an ethical clinical decision
   c.
   Making a clinical decision in the patient’s best interest
   d.
   Making a clinical decision based on previous shift assessments

Answer 4

ANS: D
The professional nurse is responsible for assessing patients each shift. Making informed, ethical decisions in the patient’s best interest is practicing responsibly.

Question 5

5. Which of the following demonstrates a nurse utilizing self-reflection to improve clinical decision making?
   a.
   Uses an objective approach in all situations
   b.
   Obtains data in an orderly fashion
   c.
   Improves a plan of care while thinking back on interventions performed
   d.
   Provides evidence-based explanations for all nursing interventions

Answer 5

ANS: C
Self-reflection utilizes critical thinking when thinking back on the effectiveness of interventions and how they were performed. The other options are not the best examples of self-reflection but do represent good nursing practice. Using an objective approach and obtaining data in an orderly fashion does not involve purposefully thinking back to discover the meaning or purpose of a situation. Providing evidence-based explanations for nursing interventions does not always involve thinking back to discover the meaning of a situation.

Question 6

6.	A nursing instructor needs to evaluate students’ abilities to synthesize data and identify relationships between nursing diagnoses. Which learning assignment is best suited for this instructor’s needs?
a.
Concept mapping
b.
Reflective journaling
c.
Reading assignment with a written summary
d.
Lecture and discussion

Answer 6

ANS: A
Concept maps challenge the student to synthesize data and identify relationships between nursing diagnoses. Reflective journaling involves thinking back to clarify concepts. Reading assignments and lecture do not best provide an instructor the ability to evaluate students’ abilities to synthesize data.

Question 7

7.	What is the first component of the critical thinking model for clinical decision making?
a.
Experience
b.
Nursing process
c.
Attitude
d.
A scientific knowledge base

Answer 7

ANS: D
A scientific knowledge base is the first component for clinical decision making. After acquiring a sound knowledge base, the nurse can then apply knowledge to different clinical situations using the nursing process to gain valuable experience. A critical thinking attitude is a guideline for how to approach a problem and apply knowledge to make a clinical decision.

Question 8

8. A new graduate nurse will make the best clinical decisions by applying the components of the nursing critical thinking model and which of the following?
   a.
   Drawing on past clinical experiences to formulate standardized care plans
   b.
   Relying on recall of information from past lectures and textbooks
   c.
   Depending on the charge nurse to determine priorities of care
   d.
   Using the nursing process

Answer 8

ANS: D
Using the nursing process along with applying components of the nursing critical thinking model will help the new graduate nurse make the most appropriate clinical decisions. Care plans should be individualized, and recalling facts does not utilize critical thinking skills to make clinical decisions. The new nurse should not rely on the charge nurse to determine priorities of care.

Question 9

9. The critical thinking skill of evaluation in nursing practice can be best described as
   a.
   Examining the meaning of data.
   b.
   Reviewing the effectiveness of nursing actions.
   c.
   Supporting findings and conclusions.
   d.
   Searching for links between data and the nurse’s assumptions.

Answer 9

ANS: B
Reviewing the effectiveness of interventions best describes evaluation. Examining the meaning of data is inference. Supporting findings and conclusions provides explanations. Searching for links between the data and the nurse’s assumptions describes analysis.

Question 10

10.	The patient appears to be in no apparent distress, but vital signs taken by assistive personnel reveal an extremely low pulse. The nurse then auscultates an apical pulse and asks the patient whether he has any complaints or a history of heart problems. The nurse is utilizing which critical thinking skill?
a.
Interpretation
b.
Evaluation
c.
Self-regulation
d.
Explanation

Answer 10

ANS: A
Interpretation involves being orderly in data collection, looking for patterns to categorize data, and clarifying uncertain data. This nurse is clarifying the data in this situation. Evaluation involves determining the effectiveness of interventions. The nurse in this scenario is assessing the patient, not evaluating interventions. Self-regulation is reflecting on experiences. Explanation is supporting findings and conclusions. The nurse in this question is clarifying uncertain data (determining cause of the low pulse), not supporting the finding of a low pulse.

Question 11

11. A patient continues to report postsurgical incision pain at a level of 9 out of 10 after pain medicine is given. The next dose of pain medicine is not due for another hour. What should the critically thinking nurse do first?
    a.
    Explain to the patient that nothing else has been ordered.
    b.
    Explore other options for pain relief.
    c.
    Offer to notify the health care provider after morning rounds are completed.
    d.
    Discuss the surgical procedure and reason for the pain.

Answer 11

ANS: B
The critically thinking nurse should explore all options for pain relief first. The nurse should use critical thinking to determine the cause of the pain and determine various options for pain, not just ordered pain medications. The nurse can act independently to determine all options for pain relief and does not have to wait until after the health care provider rounds are completed. Explaining the cause of the pain does not address options for pain relief.

Question 12

12. The nursing student can best develop critical thinking skills by doing which of the following?
    a.
    Studying 3 hours more each night
    b.
    Actively participating in all clinical experiences
    c.
    Interviewing staff nurses about their nursing experiences
    d.
    Attending all open skills lab opportunities

Answer 12

ANS: B
Nursing is an applied science, and to apply knowledge learned and develop critical thinking skills to make clinical decisions, the student should actively participate in all clinical experiences. Studying for longer hours, interviewing nurses, and attending skills labs do not provide opportunities for clinical decision making, as do actual clinical experiences.

Question 13

13. While caring for a hospitalized older adult female post hip surgery, the new graduate nurse is faced with the task of inserting an indwelling urinary catheter, which involves rotating the hip into a contraindicated position. The nurse exhibits critical thinking to perform this task by
    a.
    Following textbook procedure.
    b.
    Notifying the physician of the need for a urologist consult.
    c.
    Adapting the positioning technique to the situation.
    d.
    Postponing catheter insertion until the next shift.

Answer 13

ANS: C
The nurse must use critical thinking skills in this situation to adapt positioning technique. In practice, patient procedures are not always presented as in a textbook, but they are individualized. A urologist consult is not warranted for position, but perhaps instead for difficulty in insertion. Postponing insertion of the catheter is not an appropriate action

Question 14

14. The nurse enters a room to find the patient sitting up in bed crying. How would the nurse display a critical thinking attitude in this situation?
    a.
    Tell the patient she’ll be back in 30 minutes.
    b.
    Set a box of tissues at the patient’s bedside before leaving the room.
    c.
    Ask the patient why she is crying.
    d.
    Limit visitors while the patient is upset

Answer 14

ANS: C
The nurse should try to find out why the patient is crying to intervene appropriately. Telling the patient that she will return, providing tissues, and limiting visitors may be appropriate actions but do not address the reason why the patient is crying.

Question 15

15.	A patient is having trouble reaching the water fountain while holding on to crutches. The nurse suggests that the patient place the crutches against the wall while stabilizing himself with two hands on the water fountain. Which critical thinking attitude is utilized in this situation?
a.
Humility
b.
Confidence
c.
Risk taking
d.
Creativity

Answer 15

ANS: D
The nurse uses creativity in this situation to figure out how the patient can stabilize himself while getting a drink of water. Humility is recognizing when more information is needed to make a decision. Confidence is being well prepared to perform nursing care safely. This question best illustrates the attitude of creativity. Risk taking is demonstrating the courage to speak out or to question orders based on the nurse’s own knowledge base.

Question 16

16. A new nurse is pulled from the surgical unit to work on the oncology unit. The nurse displays the critical thinking attitudes of humility and responsibility by
    a.
    Refusing the assignment.
    b.
    Asking for an orientation to the unit.
    c.
    Assuming that patient care will be the same as on the other units.
    d.
    Admitting lack of knowledge and going home.

Answer 16

ANS: B
Humility and responsibility are displayed when the nurse realizes lack of knowledge and requests an orientation to the unit. The other answer choices represent inappropriate actions in this situation and are not examples of humility and responsibility. The nurse should explore all options before refusing an assignment. The nurse should not make assumptions. Assuming is not an example of critical thinking. Admitting lack of knowledge is an example of humility, but going home does not illustrate an example of responsibility.

Question 17

17. Professional standards influence a nurse’s clinical decisions by
    a.
    Bypassing the patient’s feelings to promote ethical standards.
    b.
    Establishing minimal passing standards for testing.
    c.
    Requiring the nurse to use critical thinking for the highest level of quality nursing care.
    d.
    Utilizing evidence-based practice based on nurses’ needs.

Answer 17

ANS: C
Upholding professional standards requires nurses to use critical thinking for the highest level of quality nursing care. Bypassing the patient’s feelings is not practicing according to professional standards. The primary purpose of professional standards is not to establish minimal passing standards for testing. Patient care should be based on patient needs, not on nurses’ needs.

Question 18

18.	A nurse who is caring for a patient with a pressure ulcer fails to apply the recommended dressing according to hospital policy. If the patient is harmed, the nurse could be subject to legal action for not adhering to
a.
Fairness.
b.
Intellectual standards.
c.
Independent reasoning.
d.
Institutional practice guidelines.

Answer 18

ANS: D
Institutional practice guidelines are established standards and policies that can be used in court to make judgments about nursing actions. Intellectual standards are guidelines or principles for rational thought. Fairness and independent reasoning are two examples of critical thinking attitudes that are designed to help nurses make clinical decisions.

Question 19

19. Which of these findings, if identified in a plan of care, should the registered nurse revise because it is not characteristic of critical thinking and the nursing process?
    a.
    Patient’s reactions to diagnostic testing
    b.
    Nurse’s assumptions about hospital discharge
    c.
    Identification of five different nursing diagnoses
    d.
    Documentation of patient’s ability to cope with loss

Answer 19

ANS: B
The nurse should not assume when a patient is going to be discharged and document this information in a plan of care. Making assumptions is not an example of a critical thinking skill. The patient’s reactions to testing, having several nursing diagnoses, and a description of the patient’s coping abilities are all appropriate to document in the nursing plan of care.

Question 20

1.	The nursing process involves which of the following steps in the clinical decision-making process? (Select all that apply.)
a.
Identifying patient needs
b.
Diagnosing the disease process
c.
Determining priorities of care
d.
Setting goals
e.
Performing nursing interventions
f.
Evaluating effectiveness of medical treatments

Answer 20

ANS: A, C, D, E
Diagnosing disease is not a nursing action. Evaluating the effectiveness of medical treatments is not a nursing action either. Nurses are to use the nursing process to evaluate the effectiveness of nursing interventions, not medical treatments. Identifying patient needs, determining priorities of care, setting realistic goals, and implementing nursing interventions are all steps in the clinical decision-making process.