Question 1

The nurse is administering medications to a patient with high blood pressure. The patient states, "This pill made me so sick yesterday. Are you sure I have to take it now?" The nurse should:

Accepted Answer

People cannot think critically about something without having knowledge about it. Knowledge deficit can cause errors in thinking. Illogical thinking is characterized by a failure to follow rational, systematic processes when approaching an issue or problem. Often making hasty generalizations and assumptions that do not consider the evidence, the illogical thinker may jump to conclusions. Errors in thinking and decision making can result from intentionally overlooking alternatives suggested by others. When relevant information from patients or experts is ignored because of closed-mindedness, nursing care can be compromised. Closed-minded individuals often believe that their way is the best and preferred way. Assumptions are beliefs that are taken for granted and assumed to be true. Assumptions can be unjustified or justified, depending on whether there are good reasons for them. Erroneous assumptions can lead to safety issues in the clinical setting.

Question 2

The nurse is preparing to restart a patient's intravenous line and discovers that the patient has no usable veins in either arm. To solve this problem, the nurse should:

Accepted Answer

Whether in an academic setting or in the clinical area, discussion of a problem, issue, or situation with colleagues may improve critical thinking. Through dialogue with others who have expertise or experience with the issue being faced, knowledge gaps can be filled, erroneous assumptions exposed, and unconscious biases addressed. Not starting the intravenous line is not an option at this point. A literature review to gain published information about intravenous complications may be appropriate after the patient's concern has been addressed. Initially contacting the physician without fully exploring the options for alternate insertion sites is neither wise nor recommended.

Question 3

The nurse is caring for a patient who is suspected of having early stages of dementia. The nurse observes mild confusion, short-term memory loss, and restlessness. The nurse conducts a mini-mental status exam. The nurse is using which of the following components of critical thinking?

Accepted Answer

Validation is the process of gathering information to determine whether the information or data collected are factual and true. Examining how information is organized and given meaning guides the interpretation of the information. Interpretations must be differentiated from facts and evidence because they are based on personal conceptions, experiences, and perspective. Intuition is the feeling that you know something without specific evidence. The terms thinking and reasoning are often used synonymously, although reasoning is more formal because it usually is aimed at finding answers, providing explanations, and forming conclusions.

Question 4

The nurse is taking an advanced cardiac life support (ACLS) recertification class. As part of that class, the nurse, and other nurses in the group, rotates responsibilities during multiple mock code exercises simulating cardiac arrest scenarios. The process of assigning nurses to different responsibilities is known as:

Accepted Answer

A role-play strategy involves assigning learners to different roles based on expected outcomes in a particular setting. Other learners and facilitators observe the role playing, and then all are involved in the debriefing or discussion of the scenario. As with simulation, this approach allows learners to interact in a safe, controlled environment. The concept map is a way to organize and visualize data to identify relationships and solve problems. Simulated experiences enable the student to apply previously learned content in a safe and realistic environment that allows time for questioning, clarifying, and feedback. Students develop confidence in providing direct nursing care. Because critical thinking cannot occur about subjects that are unknown, a review of literature may foster this type of thinking by addressing knowledge deficits.

Question 5

The nursing student is observing a staff nurse demonstrating a subcutaneous injection during a skills competency fair. The student tells the nurse that nursing textbooks indicate that aspirating for blood is not necessary. The nurse replies, "I prefer to check for blood, just in case. This is the way I learned to give shots and it works for me." The nurse's response is most likely related to:

Accepted Answer

When relevant information from patients or experts is ignored due to closed-mindedness, nursing care can be compromised. Closed-minded individuals often believe that their way is the best and preferred way. Illogical thinking is characterized by a failure to follow rational, systematic processes when approaching an issue or problem. Often making hasty generalizations and assumptions that do not consider the evidence, the illogical thinker may jump to conclusions. Decisions may be unduly influenced by bias, which is an inclination or tendency to favoritism or partiality. Bias may be related to a preconceived notion or prejudice such as believing that "these people seek their medication." It is important for nurses to examine personal biases because they can negatively impact care. Errors in thinking and decision making can result from intentionally overlooking alternatives suggested by others. Assumptions are beliefs that are taken for granted and assumed to be true. Assumptions can be unjustified or justified, depending on whether there are good reasons for them. Erroneous assumptions can lead to safety issues in the clinical setting.

Question 6

The patient is complaining of severe incisional pain 2 days after surgery. The patient has Morphine ordered intravenously or by mouth. The nurse chooses to give the medication orally. This is an example of:

Accepted Answer

Decision making requires choosing a solution to a problem. Reasoning is the process by which a nurse determines a patient's health status after gathering data and applying meaning to behaviors and physical signs and symptoms. A systematic approach in finding solutions is termed problem solving, and judgment is the process of forming an opinion by comparing solutions through reasoning.

Question 7

The nurse has received advanced orders for a patient that she is expecting to be admitted from the emergency room (ER). The patient's name is Mr. Herman Goldstein. Trying to get ahead on her task, the nurse changes the patient's diet from "Regular" to "Kosher." When the patient reaches the unit, the nurse discovers that the patient is Catholic even though his father is Jewish. The nurse is guilty of giving in to:

Accepted Answer

Assumptions are beliefs that are taken for granted and assumed to be true. Assumptions can be unjustified or justified, depending on whether there are good reasons for them. Erroneous assumptions can lead to safety issues in the clinical setting. Illogical thinking is characterized by a failure to follow rational, systematic processes when approaching an issue or problem. Often making hasty generalizations and assumptions that do not consider the evidence, the illogical thinker may jump to conclusions. Decisions may be unduly influenced by bias, which is an inclination or tendency to favoritism or partiality. Bias may be related to a preconceived notion or prejudice such as believing that "these people seek their medication." It is important for nurses to examine personal biases because they can negatively impact care. Errors in thinking and decision making can result from intentionally overlooking alternatives suggested by others. When relevant information from patients or experts is ignored due to closed-mindedness, nursing care can be compromised. Closed-minded individuals often believe that their way is the best and preferred way.

Question 8

A patient has been instructed in self-administration of insulin injections. The nurse observes the patient attempting to recap the needle and realizes that further teaching is needed. The nurse is applying which critical-thinking skill of the nursing process?

Accepted Answer

Nurses use critical-thinking skills to guide decision making and to solve problems. The scientific method, one approach to problem resolution, is systematic, logical, and based on data collection and hypothesis testing. The steps include (1) identification of the problem, (2) definition or clarification of the problem, (3) statement of the problem, (4) determination of criteria for evaluation, (5) data collection, (6) generation of solutions, and (7) hypothesis testing (Wilkinson, 2011). Interpretation is used to understand and explain the meaning of data. Analysis includes investigating plans of action on the basis of examination of subjective and objective data. Evaluation occurs when information, including the reliability, credibility, and bias of the source, is assessed. Nurses also evaluate when determining whether the desired outcome for an intervention was achieved. Recapping the needle is not part of the desired outcome. Inference leads to accurate conclusions that are based on sound reasoning.

Question 9

The nurse has been hired for her first job and is nervous about making errors in clinical judgment. It is important for the nurse to realize that clinical reasoning and the ability to make decisions in a clinical setting:

Accepted Answer

Clinical reasoning uses critical thinking, knowledge, and experience to develop solutions to problems and make decisions in a clinical setting. A nurse's clinical-reasoning skills develop over time with increased knowledge and expertise.

Question 10

The nurse is planning care for a group of patients. Which of the following activities may be delegated to unlicensed assistive personnel?

Accepted Answer

When a patient is initially interviewed and assessed, the nurse must complete a thorough analysis of the patient's physical, emotional, spiritual, and psychomotor status. Several tools are available to guide the nurse in conducting detailed, complete assessments, including Gordon's Functional Health Patterns. The nurse often works with unlicensed assistive personnel (UAP) to collect relevant data on height and weight, intake and output, and vital signs.

Question 11

The nurse is preparing to administer an anticoagulant when the patient says, "Why do I have these bruises on my arms?" The nurse reviews the patient's blood tests and notes an abnormal bleeding time. Based on the findings, the nurse decides to hold the medication and notifies the health care provider. This action, by the nurse, is an example of:

Accepted Answer

Nursing practice is based on the application of knowledge to address patient problems. Nurses may "think aloud" as an inner dialogue to examine their thinking. The literature review is used to address knowledge gaps through the review of scholarly journals. A role-play strategy involves assigning learners to different roles based on expected outcomes in a particular setting. Other learners and facilitators observe the role playing, and then all are involved in the debriefing or discussion of the scenario. As with simulation, this approach allows learners to interact in a safe, controlled environment.

Question 12

The nurse is caring for a patient scheduled for a heart catheterization. During shift report, the nurse describes an overheard telephone conversation regarding the patient's HIV-positive son-in-law. This information should be evaluated for:

Accepted Answer

Relevance is focusing on facts and ideas directly related and pertinent to a topic-how is this related to the question? The son-in-law's HIV status has no bearing on the patient's care. Accuracy involves representing something in a true and correct way. Depth is getting beneath the surface of the topic or problem to identify and manage related complexities, whereas breadth involves considering a topic, problem, or issue from every relevant viewpoint.

Question 13

The nurse is reviewing the last 3 days of a patient's pain history and notes that the pain level has remained constant. The nurse validates the pain level with the patient and decides to contact the physician for further orders. In this scenario the nurse is using the process of:

Accepted Answer

Processes dependent on critical thinking include problem solving, decision making, reasoning, and judgment. Judgment is the process of forming an opinion by comparing solutions through reasoning. The nurse observes that the patient's pain level is not decreasing and further assesses the pain level through discussions with the patient. The nurse concludes that the patient's pain should be further addressed and contacts the physician. Decision making requires choosing a solution to a problem. The student is making a decision by reviewing two pertinent resources related to the removal of staples. Reasoning is the process by which a nurse determines a patient's health status after gathering data and applying meaning to behaviors and physical signs and symptoms. A systematic approach in finding solutions is termed problem solving.

Question 14

The nurse is preparing to teach Foley insertion techniques to a group of graduate nurses. Which of the following teaching-learning strategies would the nurse find most useful in teaching this skill?

Accepted Answer

Simulated experiences enable the student to apply previously learned content in a safe and realistic environment that allows time for questioning, clarifying, and feedback. Students develop confidence in providing direct nursing care. The concept map as a way to organize and visualize data to identify relationships and solve problems. Role-play strategies involve assigning learners to different roles based on expected outcomes in a particular setting. Other learners and facilitators observe the role playing, and then all are involved in the debriefing or discussion of the scenario. As with simulation, this approach allows learners to interact in a safe, controlled environment. Because critical thinking cannot occur about subjects that are unknown, a review of literature may foster this type of thinking by addressing knowledge deficits.

Question 15

The nursing student is admitting a patient with abdominal distention and severe nausea. The physician orders the insertion of a nasogastric tube. The student reviews the procedure, gathers the supplies, and tells the instructor, "I'm ready to begin." Which of the following critical thinking traits suggest that the student is prepared for the task?

Accepted Answer

Confidence is feeling certain about one's ability to accomplish a goal. The student stating "I'm ready" indicates this. Risk taking involves being willing to try new ideas. Curiosity is being motivated to achieve and asking why. Perseverance is staying determined to work until the goal is achieved

Question 16

To develop critical thinking, the nurse needs to develop a critical-thinking character that includes:

Accepted Answer

To develop critical thinking, the nurse needs to develop a critical-thinking character, which includes maintaining high standards and developing critical-thinking qualities such as honesty, fair-mindedness, creativity, patience, persistence, and confidence. The next step in the development of critical thinking includes taking responsibility for personal learning and seeking needed experiences that can provide the necessary knowledge on which to base the thinking. Fostering interpersonal skills, such as teamwork, conflict management, and advocacy, is important in the development of critical thinking. Self-evaluation and having thinking evaluated by others require the ability to accept and use constructive criticism.

Question 17

The nurse completes the health interview and physical exam on a patient admitted with an infection of the gallbladder. The nurse reviews the medical record and compares the abnormal lab results to the normal standards. Which critical thinking skill is the nurse using in this part of the nursing process?

Accepted Answer

Nurses use critical-thinking skills to guide decision making and to solve problems. The scientific method, one approach to problem resolution, is systematic, logical, and based on data collection and hypothesis testing. The steps include (1) identification of the problem, (2) definition or clarification of the problem, (3) statement of the problem, (4) determination of criteria for evaluation, (5) data collection, (6) generation of solutions, and (7) hypothesis testing. Interpretation is used to understand and explain the meaning of data. Analysis includes investigating plans of action on the basis of examination of subjective and objective data is an example of nursing analysis. Evaluation occurs when information, including the reliability, credibility, and bias of the source, is assessed. Nurses also evaluate when determining whether the desired outcome for an intervention was achieved. Recapping the needle is not part of the desired outcome. Inference leads to accurate conclusions that are based on sound reasoning.

Question 18

A patient arrives at the urgent care clinic and complains of vague pains in the legs. The nurse asks the patient to describe this pain. This type of question meets the intellectual standard of precision. As with any skill, critical thinking questions:

Accepted Answer

The ultimate goal is for these questions to become so spontaneous in thinking that they form a natural part of our inner voice, guiding us to better reasoning. As with any skill, critical thinking can be enhanced through practice. The routine use of these questions should promote critical thought.

Question 19

A patient, frequently admitted to the hospital for chronic back pain, asks the medication nurse for additional pain medication. The nurse has seen patients like this before, and "knows" that the only reason that these people come to the hospital is to get their pain medication. The nurse is demonstrating:

Accepted Answer

Decisions may be unduly influenced by bias, which is an inclination or tendency to favoritism or partiality. Bias may be related to a preconceived notion or prejudice such as believing that "these people seek their medication." It is important for nurses to examine personal biases because they can negatively impact care. Illogical thinking is characterized by a failure to follow rational, systematic processes when approaching an issue or problem. Often making hasty generalizations and assumptions that do not consider the evidence, the illogical thinker may jump to conclusions. Errors in thinking and decision making can result from intentionally overlooking alternatives suggested by others. When relevant information from patients or experts is ignored because of closed-mindedness, nursing care can be compromised. Closed-minded individuals often believe that their way is the best and preferred way. Assumptions are beliefs that are taken for granted and assumed to be true. Assumptions can be unjustified or justified, depending on whether there are good reasons for them. Erroneous assumptions can lead to safety issues in the clinical setting.

Question 20

The nurse has finished her shift and is on her way home. During the shift, one of the patients attempted to climb out of bed and fell. On her way home the nurse is thinking about what she could have done differently to prevent the fall. This is an example of using:

Accepted Answer

Reflection is an effective tool that enables students and nurses to think about how best to improve their future caregiving in similar situations. The results of deliberate thinking are used to guide further thinking. Identification and use of evidence is necessary to guide analysis of situations and decision making. Nursing practice must be based on evidence gained through research and review of findings. Some personal characteristics are associated with critical thinking. Critical thinking needs to be assessed and evaluated according to standards to ensure the quality of thinking. Nursing practice is based on standards established by the American Nurses Association in areas such as the nursing process, ethics, education, research, communication, leadership, and collaboration.

Quiz 4: Critical Thinking in Nursing