Unit B - Chapter 8 - Critical Thinking and Clinical Judgment

Question 1

Nursing practice requires the application of

Answer 1

knowledge from biological, social, and physical sciences; knowledge of pathophysiology;
knowledge of nursing procedures and skills.

Question 2

Nurses also must use multiple thinking skills—including. (6)

to make clinical judgments about problems in nursing practice.

Answer 2

critical thinking skills
interpretation,
analysis,
evaluation,
inference, and
explanation)—

Question 3

Clinical judgments lead the nurse to choosing

Through a process called

Answer 3

actions or intervention

clinical reasoning.

Question 4

A nursing knowledge base with foundational thinking skills, including recall and comprehension, is a prerequisite to

Answer 4

critical thinking in nursing.

Question 5

In nursing, critical thinking is an 

Answer 5

active,
orderly,
well‐thought‐out
reasoning process
guides a nurse in various approaches to
making a nursing judgment

Question 6

In critical thinking a nursing judgement is made by

Answer 6

applying knowledge
experience,
problem‐solving,
logic,
reasoning, and
decision‐making.

Question 7

A critical thinker

Answer 7

prioritizes,
explores various courses of action,
keeps ethics in mind, and
determines appropriate outcomes.

Question 8

To have a positive effect on a client’s health status, a nurse must be able to

Answer 8

think critically,
correctly identify problems, and
both devise and implement best solutions (interventions).

Question 9

Critical thinking discourages

Answer 9

quick judgments that lead to single‐focused solutions.

Question 10

Critical thinking requires

Answer 10

• lifelong learning
• ability to acquire relevant experiences that can be reflected on continuously to improve nursing judgment.

Question 11

The components of critical thinking include

Answer 11

knowledge,
experience,
critical thinking competencies,
attitudes, and
intellectual and
professional standards.

Question 12

Critical thinking is facilitated by

Answer 12

seeking truth
open-minded manner and
inquisitive why something is effective or ineffective.

Question 13

Critical thinking follows a.

Answer 13

systematic process or pattern,
not jumping to conclusions but using reason to guide decisions

Question 14

Nurses make inferences when making clinical decisions by

Answer 14

pulling pieces of information together to determine a relationship between the data

Question 15

Critical thinking incorporates

Answer 15

reflection,
language,
intuition, .

Question 16

Critical thinking evolves through how many levels

Answer 16

three distinct levels
as a nurse gains knowledge and experience while maturing into a competent nursing professional

Question 17

Critical thinking involves reflection

Answer 17

Purposefully thinking back or recalling a situation to discover its meaning and gain insight into the event.

Question 18

A nurse should reflect on the following:


Answer 18

● “Why did I say that or do this?”
● “Did the original plan of care achieve optimal client
outcomes?”
◯ If so: “Which interventions were successful?”
◯ If not: “Which interventions were unsuccessful?”

Question 19

Two components of critical thinking

Answer 19

Language

Intuition

Question 20

Language

Answer 20

Precise,
clear language
demonstrating focused thinking and
communicating unambiguous messages and expectations to clients and other health care team members.
A nurse should ask the following:
● “Did I use language appropriate for the client?”
● “Did I communicate the message clearly to the provider?”

Question 21

Intuition

Answer 21

An inner sensing that facts do not currently support somethi ng.
Intuition should spark nurse to search data to confirm or disprove the feeling.
The nurse should ask the following:
● “Did the vital signs reflect any changes that account for
the client’s present status?”
● “When the client’s status changed in this way last
month, there was a specific reason for it. Is that what is happening here?”

Question 22

LEVELS OF CRITICAL THINKING

Answer 22

Basic critical thinking

Complex critical thinking

Commitment

Question 23

Basic Critical Thinking

Answer 23

● A nurse trusts the experts and thinks concretely based on the rules.
● Basic critical thinking results from limited nursing knowledge and experience, as well as inadequate critical thinking experience.
Example: A client reports pain 1 hr after receiving a pain medication. Instead of reassessing the client’s pain, the nurse tells the client he must wait two more hours before he can receive another dose.

Question 24

Complex critical thinking

Answer 24

● The nurse begins to express autonomy by analyzing and examining data to determine the best alternative.
● Complex critical thinking results from an increase in nursing knowledge, experience, intuition, and more flexible attitudes.
Example: A nurse realizes that a client is not ambulating as often as prescribed because of a fear of missing her daughter’s phone call. The nurse assures the client that the staff will listen for and answer her phone when she is out of her room.

Question 25

Commitment

Answer 25

The nurse expects to make choices without help
from others and fully assumes the responsibility for those choices.
Commitment results from an expert level of knowledge, experience, developed intuition, and reflective,
flexible attitudes.
Example: A nurse increases the rate of an Iv fluid infusion when a client’s blood pressure indicates hypovolemic shock 24 hr after surgery.

Question 26

COMPONENTS OF CRITICAL THINKING

Answer 26

Knowledge

Experience

Competence

Attitudes

Standards

Question 27

Competence

Answer 27

Cognitive processes a nurse uses to make nursing judgments.

Question 28

General critical thinking

Answer 28

● Scientific method
● Problem-solving
● Decision-making
● Diagnostic reasoning and inference
● Clinical decision-making; collaboration

Question 29

Specific critical thinking in nursing:

Answer 29

The nursing process

Question 30

Attitudes

Answer 30

Mindsets that affect how a nurse approaches a problem.

Question 31

Attitudes of critical thinkers include:

Answer 31

● Confidence:.
● Independence:.
● Fairness:
● Responsibility:.
● Risk-taking
● Discipline:
● Perseverance:
● Creativity:.
● Curiosity:
● Integrity:
● Humility:.

Question 32

● Confidence:

Answer 32

Feels sure of abilities.

Question 33

● Independence:

Answer 33

Analyzes ideas for logical reasoning.

Question 34

● Fairness:

Answer 34

Is objective, nonjudgmental.

Question 35

● Responsibility:

Answer 35

Adheres to standards of practice.

Question 36

● Risk-taking:

Answer 36

Takes calculated chances in finding , better solutions to problems.

Question 37

● Discipline

Answer 37

Develops a systematic approach to thinking.

Question 38

● Perseverance:

Answer 38

Continues to work at a problem until there’s a resolution.

Question 39

● Creativity:

Answer 39

Uses imagination to find solutions to unique client problems.
.

Question 40

● Curiosity:

Answer 40

Requires more information about clients
and problems.

Question 41

● Integrity:

Answer 41

Practices truthfully and ethically.

Question 42

● Humility:

Answer 42

Acknowledges weaknesses

Question 43

Standards

Answer 43

Model for comparing care to determine acceptability, excellence, and appropriateness.

Question 44

● Intellectual standards ensure the

Answer 44

thorough application of critical thinking.

Question 45

● Professional standards

Answer 45

◯ Nursing judgment based on ethical criteria
◯ Evaluation that relies on evidence-based practice
◯ Demonstration of professional responsibility
◯ Promotes maximal level of nursing care

Question 46

● The nurse can improve their critical thinking and clinical reasoning ability through

Answer 46

tactics (concept mapping and reflective journaling)
which allow the nurse to recognize connections and patterns among data and outcomes.

Question 47

● Mentoring and peer relationships can

Answer 47

positively influence the nurse’s critical thinking ability, as nurses discuss client care and learn from each other’s experiences.

Question 48

List at least three critical thinking skills for each of the five steps of the nursing process.

Question 49

1. A nurse is caring for a client who is 24 hr postoperative following an inguinal hernia repair. The client is tolerating clear liquids well, has active bowel sounds, and is expressing a desire for “real food.” The nurse tells the client, “I will call the surgeon and ask for a change in diet.” The surgeon hears the nurse’s report and prescribes a full liquid diet. The nurse used which of the following levels of critical thinking?
   A. Basic
   B. Commitment
   C. Complex
   D. Integrity

Question 50

2. A nurse receives a prescription for an antibiotic for a client who has cellulitis. The nurse checks the client’s medical record, discovers that the client is allergic to the antibiotic, and calls the provider to request a prescription for a different antibiotic. Which of the following critical thinking attitudes did the nurse demonstrate?
   A. Fairness
   B. Responsibility
   C. Risk‐taking
   D. Creativity

Answer 50

2. A. Fairness is using a nonjudgmental, objective approach in looking at clients and situations. This attitude does not apply here.
   B. CORRECT: The nurse is responsible for administering medications in a safe manner and according to standards of practice. Checking the medical record for allergies helps ensure safety.
   C. Risk‐taking is a calculated approach to solving a problem that is not responding to traditional methods. This attitude does not apply here.
   D. Creativity is an approach that uses imagination to find solutions to unique client problems. This problem is not unique, and it requires a straightforward solution.

Question 51

3. A newly licensed nurse is considering strategies
   to improve critical thinking. Which of the following actions should the nurse take? (Select all that apply.)
   A. Find a mentor.
   B. Use a journal to write about the outcomes of clinical judgments.
   C. Review articles about evidence‐based practice.
   D. Limit consultations with other professionals involved in a client’s care.
   E. make quick decisions when unsure about a client’s needs.

Answer 51

3. A. CORRECT: Learning from the experience of peers can improve critical thinking.
   B. CORRECT: Journaling about decision‐making can assist the nurse with self‐reflections and improve critical thinking.
   C. CORRECT: Improving knowledge by learning new information about evidence‐based practice improves the nurse’s ability to think critically.
   D. Although nurses who have advanced critical thinking can do so independently, the nurse should talk to other professionals to share information and remain open‐minded and inquisitive.
   E. Quick decision‐making can lead to errors. A nurse’s intuition might cause feelings of uncertainty, which should lead the nurse to ask questions about whether the plan
   of care makes sense and to gather more information.

Question 52

4. A nurse is caring for a client who has a new prescription for antihypertensive medication. Prior to administering the medication, the nurse uses an electronic database to gather information about the medication and
   the effects it might have on this client. Which of the following components of critical thinking is the nurse using when he reviews the medication information?
   A. Knowledge
   B. Experience
   C. Intuition
   D. Competence

Answer 52

4. A. CORRECT: By using the electronic database, the nurse takes the initiative to increase their knowledge base, which is the first component of critical thinking.
   B. The nurse has had no prior experience with administering this medication to this client.
   C. Intuition requires experience, which the nurse lacks in administering this medication to this client.
   D. Competence involves making judgments, but no one can make a judgment about how the nurse handles researching and administering this medication to this client until they perform those tasks.

Question 53

5. A nurse uses a head‐to‐toe approach to conduct
   a physical assessment of a client who will undergo surgery the following week. Which of the following critical thinking attitudes did the nurse demonstrate?
   A. Confidence
   B. Perseverance
   C. Integrity
   D. Discipline

Answer 53

5. A. Confidence is feeling sure of one’s own abilities. The nurse might feel confident of their physical assessment skills, but choosing a particular method or sequence requires another attitude.
   B. Perseverance is continuing to work at a problem until the nurse resolves it. This attitude does not apply here.
   C. Integrity is a practicing truthfully and ethically. This specific attitude does not apply here.
   D. CORRECT: Discipline includes using a systematic approach to thinking. Using a head‐to‐toe approach ensures the nurse is thorough and calculated in getting information about the client’s physical status