Question 1

A patient has been admitted for a complex operation that will require complicated home care,including dressing changes.The primary nurse should begin the process of teaching and discharge planning

Accepted Answer

Initial discharge planning begins upon admission.The assessment phase is a time to establish the nurse-client and nurse-family relationships and begin the discharge planning process.
After the operation has been completed is too late to begin the discharge planning process.
The day before discharge is too late for the nurse to gather all pertinent information and begin teaching and coordinating resources.
After a complicated operation,the patient may well be discharged on narcotic analgesics.Waiting for the patient to not need them anymore might mean the patient gets discharged without teaching being done.

Question 2

The nursing student understands that being willing to listen and examine all ideas,even if they cause a negative reaction when considering them,describes the critical thinking characteristic known as intellectual

Accepted Answer

Intellectual courage is a willingness to listen and examine all ideas,including those that trigger a negative response.
Intellectual autonomy means having rational control of one's beliefs,values,and inferences.
Intellectual humility is an awareness of the limits of one's knowledge and sensitivity to the possibility of self-deception.
Intellectual integrity is the application of rigorous and consistent standards of evidence and the admission of errors when they occur.

Question 3

A nurse has designed an individualized nursing care plan for a patient,but the patient is not meeting the goals.Further assessment reveals that the patient is not following through on many items.Which action by the nurse would be best for determining the cause of the problem?

Accepted Answer

Having patient or family input to the care plan is vital in order to gain support for the plan of action.
The actions may have been too difficult for the patient,but this is a very narrow item to focus on.
The nurse might want to find out the rationale for the patient not following through,but instead of directly questioning the patient,which can sound accusatory,it would be best to offer some possible motives.
Reevaluation should be an ongoing process,but the more likely cause of the patient's failure to follow through is that the patient did not participate in making the plan of care.

Question 4

A unit has a continuous problem with a certain complication in a specific patient population.One nurse has read extensively about this issue and thinks the problem lies mainly in the unit's failure to follow one or two particular best practices because they use a standardized order set preferred by their physician group.Using the disposition of critical thinking known as analyticity,the best action for this nurse to take is to

Accepted Answer

When using the characteristic of analyticity,the nurse uses reasoning and evidence to solve problems but also is able to anticipate difficulties.In this case,getting the manager "on board" is a great first step.By anticipating possible resistance from the physicians,the nurse gets assistance in the best way to approach them so that his or her message is most likely to be heard.
To collectively stop implementing specific orders would tend to alienate the physicians and is not a good example of professional communication or collaboration.
Going directly to the physician group's meeting and asking them to change the orders might work,but more likely,it would have the effect of alienating the physicians.If that occurred,the end result would not be beneficial to patients.
A policy and procedures committee is a valuable resource in hospitals (and in other settings as well),but going directly to them without speaking to the physicians first might well antagonize them.

Question 5

A preceptor nurse is critiquing the student nurse's outcome statements on a patient's care plan.The preceptor tells the student the most well-written outcome statement is "The patient will

Accepted Answer

To ambulate 50 feet with a walker by Tuesday is a patient-centered,specific,realistic,and measurable goal,and it includes a time frame.It is the most well-written goal statement listed.
"Dress self with correct assistive devices" is not specific (what assistive devices? dress what part of self?).Also,it does not have a time frame.
"Majority of meals" is not measurable (what portion? 75%? 90%?).
"Give self insulin injections as instructed" does not indicate a time frame.

Question 6

A nurse has committed a serious medication error.The manager is a firm believer in developing critical thinking skills.From this standpoint,what action by the manager would best nurture this ability in the nurse who made the error?

Accepted Answer

Nurturing critical thinking skills is done in part by turning errors into learning opportunities.If the nurse presents an in-service on the cause and prevention of the type of error committed,not only will the nurse learn something,but many others nurses on the unit will learn from it to.This is the best example of developing critical thinking skills.
This option would allow the nurse to learn from the mistake,which is a method of developing critical thinking skills,but the paper would benefit only the nurse,so this option is not the best choice.
Letting the nurse work with more experienced nurses might be a good option in a very limited setting,for example,if the nurse is relatively new and the manager discovers a deficiency in the nurse's orientation or training on giving medications in that system.Otherwise,this option would not really be beneficial.
Sending the nurse to refresher courses might be a solution,but it is directed at the nurse's learning,not critical thinking.The nurse might feel resentful at having to attend such classes,but even if they were helpful,only this one nurse is learning.Going to generic classes also does not address the specific reason this error occurred and thus might be irrelevant.Critical thinking and learning can be enhanced by a presentation to the staff on the causes of the error.

Question 7

A new graduate nurse is working with an experienced nurse to chart assessment findings.The experienced nurse warns that charting assessment data can be difficult.The best explanation for this statement is that assessment data

Accepted Answer

It is important that the nurse records only what is assessed without adding judgments or interpretations to the record.
Data do indeed change (and need to be charted)as the patient's condition changes,but this would not be the best answer to this question.
Assessment data may at times be difficult to obtain,but that would not occur often enough to warrant a warning about the difficulty in charting it.Also,obtaining data is a clearly different activity than charting it.
Charting can be time consuming and tedious,but this is not the most complete answer to this question.

Question 8

A nurse is thought of as being difficult to work with because of the attitude that his answers are always correct (even in differing situations)and that no other options can work.The nurse manager should counsel this nurse on developing the critical thinking disposition of

Accepted Answer

Maturity means judicious decision making in light of understanding that some situations will have several different options and that judgments need to be made in light of professional standards and individual contexts.This nurse does not display this disposition.
Open-mindedness is the disposition that allows people to realize their opinions may be biased and to be tolerant of divergent views.
Self-confidence is trust in one's own reasoning and decision-making processes and the ability to take a leadership stand in resolving problems.
Systematicity is an orderly approach toward inquiry.

Question 9

A patient has not met goals on the care plan.The nurse assesses that the patient is in full agreement with the plan and has the motivation to carry it out.The diagnoses are supported by data,and the outcome statements are well written.The nurse concludes that

Accepted Answer

Each outcome toward attaining a goal should have accompanying interventions that are based on scientific rationale and that are aimed at helping the patient meet the goal.If appropriate outcomes are not met,then the nurse must look to the interventions to ascertain whether they were appropriate to meet the outcome(s)and the overall goal.
It is certainly possible that delegated activities were not done or were done incorrectly,but this probably would not apply to every activity on the care plan directed toward meeting a certain goal.
Accurate assessment and input from the patient should have prevented the nurse from establishing outcomes the patient could not meet.
Good care planning takes into account the patient's unique personal attributes and the characteristics of the health alteration to formulate outcomes with a reasonable time frame.Inadequate time would not be the most likely cause of the failure.

Question 10

A faculty member explains to a class of nursing students that the primary goal of critical thinking in clinical practice is to

Accepted Answer

Critical thinking in nursing is used to make sound clinical judgments and,after considering all plausible alternatives,to determine course of action most likely to be effective.
Critical thinking aids the patient,whether that patient (client)is a person,a family,or a group.It is used to meet the patient's needs,not to compete with other health care professionals.
Critical thinking may be used when theorists examine the components of a theory in progress,but this is not the primary goal.
Judging the value of actions,or evaluation,is part of the critical thinking process,but this is not the goal.

Question 11

When applying the nursing process to patients,the nurse knows that the goal of data analysis is

Accepted Answer

Data analysis is used to formulate sound nursing diagnoses.
Assessment should be an ongoing process.
Ensuring adequate data collection is a good practice,but that is not the goal of analysis.
Analyzing data can reveal discrepancies in the data set,but that is not the goal of analysis.

Question 12

A student is confused about the need to answer questions in a clinical journal about what happened during the day that could have been handled differently and what the possible outcomes might have been.The nursing instructor explains that this kind of questioning

Accepted Answer

To use critical thinking skills effectively,one must dig deeper than the surface attributes of a given situation and examine the assumptions held that led to certain actions.In patient care settings,these assumptions may be right or they may be erroneous,and actions taken as a result will have corresponding results.
A discussion of possible actions in clinical could include a review of the theories behind possible actions,but it does not necessarily include this aspect.
If the student writes specifically about a clinical situation that includes interdisciplinary collaboration,then this statement could be correct,but not all journal entries will include this activity.
If students had several options and the chosen course of action was a good one,journaling about the experience could "cement" the action in the students' minds as appropriate,which would be good if they realized that all actions need to be context driven,and what worked in this situation might not be beneficial in another setting.Regardless,this is not the best choice.

Question 13

A new nurse is always asking questions,even when there does not seem to be a problem,much to the annoyance of some of the new nurse's co-workers.The nurse manager's best response to this situation is to

Accepted Answer

Inquisitiveness is a characteristic of critical thinking and reflects a desire to learn even when the knowledge may not appear readily useful.The manager should promote this.
Suggesting the nurse work more closely with a preceptor implies that the manager thinks that the nurse needs to learn more and increase confidence.In reality,this nurse is demonstrating a characteristic of critical thinking.
Suggesting that the nurse ask fewer questions would hamper the development of the nurse as a critical thinker.
All new nurses do go through a phase of asking more questions at one time,but dismissing the nurse's behavior with this explanation is simplistic and will discourage critical thinking.

Question 14

Some nursing students are complaining about having to write "so many journals." Which statement by the nursing instructor provides the best explanation for this? "Journaling

Accepted Answer

Critical thinking requires reflection on what occurred,how data were processed,and how decisions were made.Journaling is one method of developing critical thinking skills.
Journaling does give nurses time to review what happened in their clinical,but this statement does not go far enough in explaining the importance of the journal-writing process.
Journaling may be a way to organize thoughts about one's experiences,but this statement is too narrow an explanation and does not account for the critical aspect of reflection.
Open-mindedness is a critical thinking disposition that allows one to be tolerant of divergent views.Journaling can assist with developing this disposition but only if what is written reflects that specific topic.

Question 15

When the nurse is assessing a patient,the best action by the nurse is to

Accepted Answer

To collect a complete database,the nurse needs to use both primary and secondary sources of information.
Physical assessment data are collected through the nurse's five senses,but limiting data to this severely restricts the database.
Significant others,including friends and family,are important secondary sources of information about the patient.
Neither primary nor secondary sources of data should be considered solely to guide further assessments.They are both valuable sources of complete information about the patient.

Question 16

A recent graduate nurse charts the following entry: "1200: Ambulated patient 25 feet with walker." The preceptor nurse critiques the entry.Which statement by the preceptor nurse is most accurate? "This charting

Accepted Answer

The chart entry needs to include the specific response of the patient to the intervention.
Something is missing,but this option is vague and not the best choice.
The chart entry is not accurate.
The charting does need to show how the patient responded,but nurses should avoid subjective words such as "well," "fair," or "poorly," so this answer is not the best choice.

Question 17

The student nurse learning to write nursing care plans learns that evaluation

Accepted Answer

Evaluation should occur at each step of the nursing process to ensure that appropriate actions were taken.It may be done to judge whether assessment data were accurate or whether planned interventions were effective.
An evaluation should occur at the end of an episode of care,but this is not the only time it should occur;thus,this is not the best answer.
Evaluation after the patient has met goals does not really help the nursing process for that patient.
Evaluation should occur more frequently than every few days;it should also occur on a less rigid schedule.

Question 18

The nursing student knows that critical thinking is

Accepted Answer

The goals of critical thinking are unique to nursing,but the process can be applied to many disciplines and professions.
Critical thinking is a skill requiring certain knowledge and practice.Although some people may be naturally better at it than others,all nurses can and should learn to use critical thinking in practice.
The goals of critical thinking are unique to nursing,but the process can be applied to many disciplines and professions.
All nurses need to use critical thinking skills in every position.

Question 19

A student nurse asks how the nursing process is different from critical thinking.The best reply by the faculty member is that the nursing process is

Accepted Answer

The nursing process is the tool nurses use to operationalize their critical thinking judgments about patient care.
Saying that the nursing process is merely the way nurses articulate patient care needs does not differentiate between the two concepts,nor does it show any relationship between them.
Critical thinking can be used in many different ways,including systematically and without the use of the nursing process.
Nursing process and critical thinking,although related,are not synonymous.

Question 20

A nurse studying critical thinking theories can generalize the process as

Accepted Answer

Looking across theories and definitions of critical thinking,they all have in common the ability to reflect on data and choose actions.Reflection also considers evaluating the result of the actions to determine whether they were effective.
Although critiquing ideas and establishing goal-oriented care could be considered as part of a generalized statement of critical thinking,this is not broad enough without the reflection and evaluation.
Critical thinking would most likely be used to create care paths derived from best-care literature,but this is not a generalized statement covering all definitions and theories of critical thinking.
Critical thinking is used when engaging in the nursing process,but this is too narrow in focus to capture the essence of critical thinking definitions and theories.Critical thinking is not synonymous with the nursing process.

Quiz 9: Think Like a Nurse: Essential Thinking Skills for Professional Nurses