Problem Solving Revision..

Professional Enquiry Skills (Problem Solving)
1 - Introduction to Critical Thinking ( Terminology )

Word MEANING EXPLAINATION
Critical Critical means requiring careful judgment. The scientist does not jump to a conclusion he bases his
judgement on fact and reliable information
Thinking Means to have an opinion, to reflect on or The activity of using your mind to consider something.
ponder, to call to mind to form a mental picture
of (image), to reason.
Critical thinking An active, organized cognitive process & is the Critical thinking comprises of two basic skills that are crucial in
rational examination of ideas, inferences, the nursing career, which are problem solving and decision-
assumptions, principles, arguments, conclusions, making, and in this course, problem-solving skills will be the
issues, statements, beliefs & actions. main subject to handle and master.
Critical thinking in The core of being a good nurse. Nurses give critical care 24/7, so the critical thinking skills of
Nursing nurses can really mean the difference between someone living
or dying.
Ambiguous Doubtful, uncertain ,unclear in meaning A sentence having two or more possible meanings
Problem Any question or matter involving doubt, A situation, person, or thing that needs attention and needs to
uncertainty, or difficulty. be dealt with or solved
Analyze To look more deeply into an issue or situation To break up a whole into its parts, to examine in detail so as to
determine the nature of it.
Argument Is a series of statements typically used to A reason or reasons offered for or against something. This
persuade someone of something or to present term refers to a discussion in which there is disagreement and
reasons for accepting a conclusion suggests the use of logic and the bringing forth of facts to
support or refute a point
Assumption Something that you accept as true without A statement accepted or supposed as true without proof or
question or proof demonstration; an unstated premise or belief. Something
taken for granted.
Critique An objective judging, analysis, or evaluation of The purpose of critique is the same as the purpose of critical
something. thinking: to appreciate strengths as well as weaknesses,
virtues as well as failings.
Concept A general notion or idea An idea or thought, especially a generalized idea of a thing or
of a class of things. An abstract idea representing the
fundamental characteristics of what it represents
Empirical Relying or based on experiment, observation, or The knowledge or source of knowledge acquired by means of
experience rather than on theory or meaning. the senses, particularly by observation and experimentation.
Fallacy/fallacious Fallacies are defects that weaken arguments. An error in reasoning; flaw or defect in argument; an
argument which doesn't conform to rules of good reasoning
Imply/implication A claim or truth which follows from other claims One of the most important skills of critical thinking is the
or truths ability to distinguish between what is actually implied by a
statement or people may carelessly infer situation from what.
EX : She implied that she was in hurry
EX: his fine clothes implied he was wealthy
Justify/justification A good reason or explanation for something The act of showing a belief, opinion, action, or policy to be in
accord with reason and evidence, to be ethically acceptable,
or both.
Logic A particular way of thinking, especially one that Logic does not just deal with "thinking" in general. Logic deals
is reasonable and based on good judgment. with "correct thinking."
Training in logic should enable us to develop the skills
necessary to think correctly, that is, logically.
Prejudice Is prejudgment an unfair and unreasonable A judgment, belief, opinion, point of view formed before the
opinion or feeling, especially when formed facts are known, resistant to evidence and reason, or in
without enough thought or knowledge disregard of facts, which contradict it.
Theory A systematic statement of principles involved in Is a contemplative and rational type of abstract or generalizing
a subject; a formulation of apparent thinking, or the results of such thinking. Depending on the
relationships or underlying principles of certain context, the results might for example include generalized
observed phenomena, which has been verified explanations of how nature works.
to some degree.
Barriers to Critical Thinking

Egocentricity Thinking only about yourself and what is good A tendency to view everything in relationship to oneself; to
for you confuse immediate perception (how things seem) with reality.
One's desires, values, and beliefs
Sociocentrism Tending to regard one's own social group as Persons who conforms, especially unquestioningly, to the
superior to others. usual practices or standards of a group, society, etc.
Unwarranted Assumptions based on insufficient
assumption evidence/reasoning.
Wishful thinking Believing that something is true or that Ex: she is going to get a big raise, but that is wishful thinking.
something will happen just because one wishes Her boss is so tight with money.
that it were true or would happen. Ex: hoping for a car as a birthday present is just wishful
thinking. Your parents cannot afford it. Mary thinks that
Relativistic thinking The belief that different things are true, right, Ex. Women are accepted in schools and in business in the
etc., for different people or at different times USA, but not in Afghanistan.
Ex. It is okay to eat beef in England, but not in India.
Facts and Opinions
Facts are realities; opinions are beliefs or judgments. Opinions may fit the facts or be in error.
I think your room is the messiest I have ever Opinion
seen.
The hardest thing to learn in school is Science Opinion
Last year there was a horrible outbreak of flu. Opinion
The capital of Egypt is Cairo Fact
Babies generally start to talk between 18 and 24 Fact
months of age.
Italian is an easier language to learn than Opinion
Spanish
Many nutritionists believe a low-carbohydrate, Fact
high-protein diet is the healthiest diet.
Thousands of people die each year from the Fact
interaction of their prescription drugs.
Cell phones should be banned in all public Opinion
school classrooms.
Children should not be allowed to watch more Opinion
than five hours of television per week.
2- Critical thinking
Abstract thinking Thinking past what your senses tell you
Four Aspects of Critical Communicative thinking Being precise in giving your ideas to others
Thinking Systematic thinking Organizing your thoughts into logical steps
Creative thinking Thinking “out of the box,” innovating
Question What is being asked?
Critical Thinking Is Purpose Why do I want the answer?
involved Point of View Where do I stand to look at the question?
Information What data do I have?
Concepts What ideas are involved?
Assumptions What am I taking for granted?
Inferences What conclusions am I drawing?
Consequences What are the implications of my question?
Importance of Critical Purposeful, goal-directed thinking aiming to 1.Critical thinking is the key to resolving problems.
Thinking In Nursing make judgments based on evidence rather than 2. Nurses must make complex decisions, adapt to new
conjecture. situations & continuously update their knowledge & skills.
It is based on principles of science & the Critical thinking is integral to all of these.
scientific method & develops strategies that
maximize human potential & compensates for
problems caused by human nature
Reasonable and rational. Critical thinkers do not jump to conclusions. As nurses, we are
trained to collect data (vital signs, for example), weigh the
facts (blood pressure high, patient complaining of headache)
Characteristics Of and think the matter through (check for orders for blood
Critical Thinking pressure medications or call physician and request treatment
options).
Reflective We're back to thinking the matter through, weighing the facts
and evidence (does the patient have a history of high blood
pressure, did he get his medications today, or was he off the
unit when he normally would have taken them?) Things to
consider.
Inspires an attitude of inquiry. A nurse who thinks critically wants to know how the body
works and why it responds the way it does to disease,
treatment and medications.
Autonomous thinking. Critical thinkers are not easily manipulated. The patient in the
emergency room demands medication for pain. The nurse
needs specifics: how much pain, where, for how long? How
often and does the client have a history with pain
medications? Is it drug seeking behavior? Every ER nurse
worth their salt has investigated the answers to these
questions.
Creative thinking Nurses come up with original ideas for day-to-day problems.
As mentioned in previous articles about medical mission work,
the nursing team invented catheter collection containers out
of water bottles and personal belonging bags out of used
surgical gown sleeves. More inventions that are mundane
happen daily in your local hospital. For example, where i work,
scrub nurses use 3ml syringes as containers for their micro
needle holders. Keeps the needle loaded and safely out of the
way until the surgeon needs it.
Fair thinking. It is not biased or one-sided. Frequently this is about setting

rules. For example, everyone wants off sometime in the
winter holiday season. It is the charge of nurses and the nurse
managers to figure out a system for everyone to get some
time without jeopardizing patient safety. At many institutions,
this means turning in a preference for Thanksgiving, Christmas
or New Year's off and the staff settling individually for one of
the three.
Critical thinking focuses on deciding what to Critical thinking is used to decide on a course of action; make
believe or do. reliable observations; draw sound conclusions, solve
problems; and evaluate policies, claims, and actions. It is that
decision to call the physician even though it's the middle of
the night or the decision to put aside charting for a while and
sit with a patient who is anxious.
Curiosity Allow yourself to be curious. Great critical thinkers tune into
their desire to continue learning and understanding how
things work. Be inquisitive about anything and ask questions
others may have but don’t ask.
Objectivity. Great critical thinkers have the ability to remain objective.
They understand the goal, stay focused and don’t let their
emotions (or others’) cloud their judgment.
Active listening. Do not just hear what others have to say, engage in
conversation.
Ability to research. Don’t have an answer? Aren’t satisfied with an answer? Does
something sound a little off? The ability to research things and
bring in multiple resources will unveil a lot.
Humility. Great critical thinkers understand that their ideas may not be
the best and that they do not know everything. I once had a
fortune cookie that told me, “knowledge comes from being
humble” – that once you accept that you don’t know
everything you’re more likely to continue your search for
answers
Pretend to know more than they do. Pretend they know more than they do, ignore their
limitations, and assume their views are error free.
Get annoyed by problems. Regard problems and controversial issues as nuisances or
threats to their ego.
Are impatient. Are inpatient with complexity and thus would rather remain
Uncritical Thinkers confused than make the effort to understand.
Judge on first impressions and intuition. Base judgments on first impressions and gut reactions. They
are unconcerned about the amount or quality of evidence and
cling to their views steadfastly
Focus on their own opinions. Are preoccupied with themselves and their own opinions, and
so are unwilling to pay attention to others' views. At the first
sign of disagreement, they tend to think, "How can I refute
this?"
Look only for ideas like their own. Ignore the need for balance and give preference to views that
support their established views.
Are guided by feelings rather than thoughts. Tend to follow their feelings and act impulsively.
Claim that thinking gives them a headache.
Reasoning The process of forming conclusions, judgments, Which is a highly individualized, complex activity that involves
or inferences from facts or premises. distinct ideas, emotions & perceptions.
Deductive Reasoning – A process of reasoning Ex. Because all birds have wings, and a robin is a bird, then the
from known facts to conclusions. Sometimes it robin has wings.
can be thought of as starting from a general Broad Specific
statement that is accepted as true to a specific Generalizations Conclusions
statement that is “therefore” true. Example: All college My art history course
Courses are hard will be hard
Inductive Reasoning – A process of reasoning Ex. Mary is a grandmother and has gray hair; therefore, all
that moves from making observations to grandmothers must have gray hair
Types of Reasoning forming conclusions. It can also be thought of as Specific Reasoning Broad Principles
starting from specific examples and moving Example: My history All college courses
toward a general statement. This is also called Class requires a lot of have a lot of reading
inference.
3- LOGICAL FALLACIES Fallacies are defects that weaken arguments.
Hasty Generalization Making assumptions about a whole group or Ex. My roommate said her philosophy class was hard, and the
range of cases based on a sample that is one I'm in is hard, too. All philosophy classes must be hard!"
inadequate (usually because it is atypical or just o Two people's experiences are, in this case, not enough on
too small). which to base a conclusion.
- Stereotypes about people
Post hoc (false cause) This fallacy gets its name from the Latin phrase Ex: "President Jones raised taxes, and then the rate of violent
"post hoc, ergo propter hoc," which translates as crime went up. Jones is responsible for the rise in crime.“
"after this, therefore because of this." - The increase in taxes might or might not be one factor in the
• Definition: Assuming that because B rising crime rates, but the argument hasn't shown us that
comes after A, A caused B. one caused the other.
– Of course, sometimes one event really
does cause another one that comes later
Slippery Slope • Definition: The arguer claims that a sort of • Ex: "Animal experimentation reduces our respect for life. If
chain reaction, usually ending in some dire we don't respect life, we are likely to be more and more
consequence, will take place, but there is tolerant of violent acts like war and murder. Soon our
really not enough evidence for that society will become a battlefield in which everyone
assumption. constantly fears for their lives. It will be the end of
– The arguer asserts that if we take even one- civilization. To prevent this terrible consequence, we should
step onto the "slippery slope," we will end up make animal experimentation illegal right now."
sliding all the way to the bottom. – Since animal experimentation has been legal for some time
and civilization has not yet ended, it seems particularly clear
that this chain of events will not necessarily take place.
Appeal to Authority • Definition: Often we add strength to our • Ex: "Well, Isaac Newton believed in Alchemy, do you think
arguments by referring to respected sources you know more than Isaac Newton?”
or authorities and explaining their positions
on the issues we're discussing.
• If, however, we try to get readers to agree
with us simply by impressing them with a
famous name or by appealing to a supposed
authority who really isn't much of an expert,
we commit the fallacy of appeal to authority.
Red Herring • Definition: Partway through an argument, • Ex: "Grading this exam on a curve would be the most fair
the arguer goes off on a tangent, raising a thing to do. After all, classes go more smoothly when the
side issue that distracts the audience from students and the professor are getting along well." Let's
what's really at stake. Often, the arguer never try our premise-conclusion outlining to see what's wrong
returns to the original issue. with this argument:
• Premise: Classes go more smoothly when the students
and the professor are getting along well.
• Conclusion: Grading this exam on a curve would be the
fairest thing to do.
• When we lay it out this way, it's pretty obvious that the
arguer went off on a tangent--the fact that something
helps people get along doesn't necessarily make it more
fair; fairness and justice sometimes require us to do things
that cause conflict. But the audience may feel like the
issue of teachers and students agreeing is important and
be distracted from the fact that the arguer has not given
any evidence as to why a curve would be fair.
False Dichotomy • Definition: In false dichotomy, the arguer sets • Ex, the claim that “you’re either with me, or you’re against
up the situation so it looks like there are only me” is an example of a false dichotomy. This form of
two choices. The arguer then eliminates one of rhetoric is used to persuade or even threaten, but it ignores
the choices, so it seems that we are left with the fact that the individual or group addressed may have a
only one option: the one the arguer wanted us neutral opinion towards the speaker.
to pick in the first place.
Ad hominem • Definition: Fallacy focuses our attention on • Ad hominem arguments attack the person instead of the
people rather than on arguments or person's position. An example would be: "Only an evil
evidence. In both of these arguments, the person would say something like that." Note that the
conclusion is usually "You shouldn't believe speaker offers no rebuttal to whatever the "evil person"
So-and-So's argument." The reason for not said, but instead attacks the character of the person who
believing So-and-So is that So-and-So is a bad said it. Another example would be "You only say that
person (ad hominem). In an ad hominem because you want people to like you" (or anything that
argument, the arguer attacks his or her implies an ulterior motive that invalidates the argument in
opponent instead of the opponent's lieu of addressing the argument itself).
argument.
4- CRITICAL THINKING & NURSING PROCESS

(CRITICAL THINKING IN PRACTICE)
• Critical thinking is essential in nursing practice. Critical thinking applies to nearly every aspect of your patient care and patient assessment.
Components of critical Six cognitive skills used in critical thinking

thinking include: Exploring Encourages you to identify all the variables within a situation.
Analyzing Is the process of studying each variable to understand its
meaning and its relationship to the other variables.
Prioritizing Requires you to weigh the relative importance of each
variable to the others, at a given point in time.
Explaining The variables involves the exercise of amplifying each variable
to understand its meaning in the situation and to the involved
parties.
decision making Means to choose a specific course of action.
Evaluating Requires the thinker to assess how correct the thinking
process was, and if further action is needed.
Nursing process mirrors They are both processes developed to gather information, look ahead, plan, and evaluate processes.
a lot of the critical
thinking process
Nursing Process Critical Thinking
Assessment Exploring
Diagnosis Analyzing
Planning Prioritizing &Explaining
Implementation Deciding
Evaluation Evaluating
Case study 1
• Mrs. wafaa, a 42-year old wife and mother, has just returned to your nursing unit from the recovery room after a gastric She has
orders for pain medication, continuous gastric suction, incision monitoring, and NPO status.
• Eight hours postoperatively she develops sudden dyspnea and decreasing oxygen saturations. resection for a malignant stomach
tumor.
On each of the 6 components of critical thinking, write down what could be going on with your patient.
Exploring: what could be causing this woman to be so suddenly Pneumothorax – Hemothorax – Pneumonia -Pleural Effusions
dyspneic and hypoxic? (Assessment) Electrolyte Disorders
Analyzing: what other information can I gather to help me narrow down the possible causes of her dyspnea/hypoxia?
(Diagnosis)
 Breath Sounds
 ABG
 Blood Chemistry
After listening to her breath sounds, you determine that breath sounds are absent on the left side.
Prioritizing: is this change significant to this patient, and do I need to even look further? (Planning)
This also includes the decision that is made whether to inform the physician of the change in their patient’s status.
Deciding / Evaluating: after reporting the alteration to the patient’s Physician, he orders the following:
(Evaluation)
 ABG Arterial blood gas & Portable CXR
 Equipment for chest tube insertion to be at bedside .
 When the chest x-ray comes back, there is a large pneumothorax on the left, as well as diffuse atelectasis. Anesthesia is called to place a
chest tube.
 Once the chest tube was placed, Mrs. Wafaa had an immediate improvement of her oxygen saturations, and her dyspnea resolved.
Case study 2
• Mr. Mahmoud , a 67-year old patient who suffers from COPD (chronic obstructive pulmonary disease) has been admitted to your
unit from another facility.
• Upon admission you note her to be alert, oriented and appropriate. She provides you with information to complete her history.
• After completing & charting your assessment, you leave him to see to your other patients.
• An hour later when you return, you note that Mr.Mhmoud does not seem as alert, and appears to be confused.
Exploring: what could be causing this previously alert MAN to be Hypoxia- Hypotension –Fatigue –Infection- Medications -
so suddenly confused? Unfamiliar Surroundings -Stroke
Analyzing: what other information can I gather to help me narrow down the possible causes of her confusion?
 Vital Signs
 Oxygen Saturation/ ABG
 Medications taken & last dose time
 Further assessment of confusion level
 Previous history of confusion?
 Potential infection sites & their appearance
Prioritizing/Deciding: is this change significant to this patient, and do I need to even look further?
This also includes the decision that is made whether to inform the physician of the change in their patient’s status. What would you say?
Considering that Mr . Mahmoud is a new patient, and that this is a sudden change, it is potentially clinically significant, and should be
investigated thoroughly, and reported to the Physician right away.
Evaluating: after reporting the alteration to the patient’s Physician, he orders the following:
 STAT ABG & STAT Portable CXR
 Blood Cultures
 Urine & Sputum Cultures
 Head CT in the morning if confusion doesn’t resolve
 Discontinue all medications that could cause confusion
 At this point, the Physician’s orders indicate to you that he is thinking along the same lines as you did, and your thinking process
was complete
Now the next time you have a patient who suddenly presents with confusion, you have a “history” with that
experience, and have a knowledge base to draw from.
Case study 3
Mr. Mansour is your patient. He is an 18-year-old young man thrown from the van in which he was riding, when it was hit head on by an
oncoming car. He is unconscious and has a cervical fracture. He has no movement of his extremities. Suddenly during the middle of the
night, his legs begin to move. On each of the 5 components of critical thinking, write down what could be going on with your patient.
Exploring: what could be causing the movement in Mr. Mansour Spinal Reflexes - Purposeful movement -Muscular spasms
legs?
Analyzing: what other information can I gather to help me  Are the movements purposeful?
narrow down the possible causes of his movement?  Can the movements be duplicated?
 How much movement is possible?
 Does the patient report any changes in sensation?
Prioritizing/Deciding: is this change significant to this patient, and do I need to even look further? This also includes the decision
That is made whether to inform the physician of the change in their patient’s status. What would you say?
With the patient having a stable overall status, it would most likely be best to report this to the physician first thing in the morning.
Evaluating: after reporting the alteration to the patient’s Physician, he orders the following:
• Spine CT
• Neurological Consult
• Every 4 hour neurological checks
• At this point, the Physician’s orders indicate to you that he is thinking along the same lines as you did, and your thinking process
was complete
Critical Thinking Model

Your assessment and actions with the patient who was experiencing hypoglycemic diabetic patient can be described in terms of a model of
critical thinking. The model highlights the importance of Critical Reflection
You brought knowledge into the situation: • Patient is self-administering Insulin
• Insulin causes lowing blood sugar .
• Hypoglycemia occurs when the level of glucose present in the
blood falls below a set point: Below (72mg/dL))
• Facility policy for managing hypoglycemia
You gathered further information: Patient’s blood sugar is 60mg/dL

•
He is difficult to arouse
•
You reflected critically on what you already knew and Patient is experiencing hypoglycemia probably due to Taking
•
what you assessed to identify a problem: too much medication, skipping meals, eating less than normal,
or exercising more than usual can lead to low blood sugar
You took action and reflected critically on the results of • Per facility policy, administer glucose
your action by continued monitoring: • Monitor patient response
• Identify and address cause of hypoglycemia
• (Eating less than normal)
• Order change needed? Further patient teaching?
The outcome of your action joins with other experiences in your knowledge base.
You may have learned something new in this situation or you may have simply validated your previous knowledge.
• Regardless, the experience adds to the knowledge you will bring to new situations.
The Process of Critical Reflection: • You brought the knowledge into the situation
• You gathered further information
• You reflected critically on what you already knew and what you
assessed to identify a problem
• You took action and reflected critically on the results of your
action by continued monitoring
• The outcome of your action joins with other experiences in your
knowledge base
The process of critical reflect includes the following steps • Review existing knowledge, gather additional knowledge,
in the correct order of occurrence: Summarized manner reflect on the problem, and identify course of action.
Why Critical thinking in nursing is outcome-focused 1. Is guided by standards, policies and procedures, ethics, and laws.
thinking? 2. Is based on principles of nursing process, problem solving, and
the scientific method.
3. Carefully identifies the key problems, issues, and risks involved.
4. Applies logic, intuition, and creativity.
5. Is driven by patient, family, and community needs.
6. Is constantly re-evaluating, self-correcting, and striving to
improve.
7. Calls for strategies that make the most of human potential
Tools for Critical Thinking • Ask questions! Sometimes people hesitate to ask questions
because they fear that asking a question may be interpreted as a
lack of knowledge on their part.
• However, the question is a key element of critical thinking.
• Questions serve many purposes, and only serve to broaden your
knowledge base, and expand your options.
• Questioning begins the information-seeking process.
• All questioning is about seeking information, re-formulating
information to new situations, and solving nursing practice
dilemmas.
Some examples of information seeking: • Looking up lab values
• Reviewing a policy or procedure
• Reading instructions about how to operate a piece of
equipment
• Reviewing a patient’s chart
• Asking a resource person.
Exercise 1
You’re doing a routine reassessment on your patient, Mr. ALI . You notice that his vital signs are as follows:
• Temp: 40.
• Pulse: 144
• Resp: 26
• BP: 90/42
None of these values are within Mr. ALI’s normal range. What are you thinking could be going on? Write down
everything that comes to mind.
Did you consider that there may be an underlying infection, causing the elevated temperature, heart rate, and decreased blood
pressure?
Or is the elevated heart rate the reason for the low blood pressure?
The limited information you have should make you want to get more information, to help solve the problem.
Assessment
You determine that these vital signs warrant further assessment of his condition.
What questions do you want to answer with your reassessment?
What potential routes for infection does he have? An IV, a foley catheter, NG-tube, a surgical site, a wound?
How do these areas look?
What are his lung sounds like?
Is his heart rate regular or irregular?
What medications is he on?
What is his fluid volume status? What are his I & O’s like?
Is he diaphoretic?
Does he complain of pain?
What color is his urine?
What were some of the potential causes?
• Infection
• Dehydration
• Heart Problem
• Pain
• By searching for more information, you could narrow down the potential causes!
100
BUE -MMNF
Degree Year 1
Module Title: Professional inquiry skills (problem solving) Module Code: N2369
Date: 00/00/2018 Time : 2 hrs

Total mark: 100 marks
Part I: Multiple Choice Questions
(Total 50 marks, each question = 2 marks)
Choose the correct answer:

1) The second component of the critical thinking model is:
a) Competencies.
b) Experience
c) Specific knowledge
d) Diagnostic reasoning
2) The nurse is working with a patient who recently had a colostomy. The patient
is having difficulty using the supplies that are provided for ostomy care. The
nurse investigates with the patient to see which ones are the best. This is an
example of a critical thinking strategy of:
a) Inference
b) Problem solving
c) Management
3) The nurse decides to administer tablets of acetaminophen ( Tylenol) instead of

the intramuscular meperidine ( Demerol) she has been giving to one of her
orthopaedic patients, in accordance with the prescription order. Which step of
the nursing process does this address?
a) Assessment
b) Nursing diagnosis
c) Planning
d) Implementation
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4) The nurse has a multiple patient's assignment on the surgical unit. When
beginning the shift, the nurse needs to determine which postoperative patient
should be seen first. From the following, the nurse should go to see the patient
who:
a) Is reported as having a BP of 90\ 50
b) Received medication for pain 10 minutes ago
c) Needs to be out of bed and ambulating
d) Requires instructions for wound care
5) 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 standardize care plans for groups of patients.
6) 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 will be back in 30 minutes.
b) Set a box of tissues papers 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.
7) A patient who is in pain refuses to be repositioned. In making a decision about

what to do, what should the nurse consider first?
a) Why a decision is needed.
b) When a decision is needed
c) Who actually can make the decision
d) What are the alternatives
8) A new nurse is transferred 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.
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9) A nursing diagnosis includes:
a) The identified problem.
b) The identified problem and related cause
c) A review of the objective data.
d) The physician’s diagnosis.
10) The nursing process is utilized to :

a) Provide a systemic, organized and comprehensive approach to meeting the
needs of patients.
b) Encourage the family to make decisions regarding patient’s care.
c) Increase involvement of allied healthcare professionals in decision-making.
d) None of the above.
11) The process of critical thinking includes:

a) Intellectual skills.
b) Imitating skills
c) Manual Skills
d) Personal Behavioral
12) The nursing student can develop critical skills by doing which of the following:
a) Studying 3 hours more nursing in general each night.
b) Actively participating in all clinical experiences.
c) Interviewing staff nurses about their expectation on nursing profession.
d) Attending all open skills lab opportunities.
13) The nurse is deciding on the type of dressing to use for a patient. Which step
of the decision making process is being used when the nurse observes the
absorbency of different dressing brands?
a) Defining the problem
b) Considering consequences
c) Testing possible options.
d) Making final decisions
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14) The patient, who has shortness of breathing, will get benefits from the head of
the bed being elevated. Because this position can result in skin breakdown in
the sacral area, the nurse decides to search literature evidence on the amount
of sacral pressure occurring in other positions. This decision is an example of
a) The research method.
b) The trial-and-error method.
c) Intuition.
d) The nursing process.
15) Why a nurse cannot apply the 8D approach to all problems?

a) The 8D approach takes several weeks to several months in order to solve a
problem.
b) It takes a minimum of (4) people from at least four different organizational
areas to effectively apply the 8D team problem solving approach.
c) The 8D team requires senior management support for allocated
time/resources and the authority to make the appropriate and required
changes.
d) All of above.
16) Describing the problem starts with a well-thought-out problem statement, so

The problem statement will:
a) Communicate the scope of the problem with the team.
b) Clarify the role the team should play
c) Provide information if it is relevant to the problem or not.
d) Lays down expectations from the team.
17) Characteristics of an effective problem solver include all the following Except :
a) Have confidence.
b) Know the difference between fact and opinion and understand the need for
valid evidence.
c) seek win-lose solutions
d) are not fast in solving problems.
18) The purpose of problem solving includes all of the following Except:
a) Makes you stand out
b) Increases confidence
c) Makes the impossible possible.
d) Depends on the trial-and-error method
4|Page
19) In the assessment phase, critical thinking is used to help:
a) Writing guidelines for patient care.
b) Obtaining knowledge from biological, physical and social sciences as basis for
the nurse to ask relevant questions.
c) Complicate the planning process.
d) Invading the patient’s privacy.
20) The steps of the nursing process include:

a) Problem identification, care giving, collaboration and goal setting.
b) Planning intervention, re-evaluation, renewal and revision.
c) Assessment, diagnosis, planning, implementation and evaluation.
d) Assessment, analysis and planning.
21) Which reasoning process describes the nurse’s actions when the nurse
evaluates possible solutions for care of an infected wound for optimal patient
outcomes?
a) Intuition
b) Research process
c) Trial and error
d) Problem solving
22) A patient with diarrhoea also has a primary care provider’s order for a bulk
laxative daily. The nurse, not realizing that bulk laxative can help solidify
certain types of diarrhea, concludes,” the primary care provider does not know
the patient has diarrhea.” What type of statement is this?
a) A fact
b) An inference
c) A judgment
d) An opinion
23) In the decision-making process, the nurse sets and weights the criteria,
examines alternatives, and performs which of the following before
implementing the plan?
a) The purpose for making the decision
b) Consults the client and family members to determine their view of the criteria
c) Identifies and considers various means for reaching the outcomes
d) Determines the logical course of action should intervening problems arise.
5|Page
24) The nurse enters the room of a patient who has a history of heart disease. On
looking at the patient, the nurse proceeds to take the vital signs. This is the
nurse acting on:
a) Intuition
b) Reflection
c) Knowledge
d) Scientific method
25) The nurse manager has developed a staff protocol for peer evaluation. The
nurses on the surgical unit are nervous about using instrument. If the nurse
manager continues to implement the new strategy, which of the following
critical thinking attitudes is she portraying?
a) Accountability
b) Thinking independently
c) Risk taking
d) Humility
Part II: Opinion or Fact Questions:

(Total 10 marks, each question = 1 mark )
Read each statement and then write (F) if it is a fact or (O) if it is an opinion.
S. Statement Fact Opinion

(F) (O)
1. The sun rises in the east and sets in the west.
2. Sunflowers are the prettiest flowers.
3. Ostriches are unable to fly, but they can run very fast.
4. Bicycling is a truly enjoyable form of exercise
5. Last year there was a horrible outbreak of flu.
6. The capital of Egypt is Cairo
7. Insects and spiders are invertebrates.
8. Staying up late is a lot of fun.
9. Babies generally start to talk between 18 and 24 months of age.
10. The nursing profession is a Female based profession.
6|Page
Part III: Give detailed answers on the following questions:
( Total 40 marks)
1) Discuss the purpose of 8D approach. ( 5 marks)
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2) List four Aspects of Critical Thinking and define briefly each one. ( 8 marks)
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3) Explain the importance of Critical Thinking in nursing clinical practices. ( 2 marks)
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4) Name 10 out 18 of attributes of Critical Thinkers. ( 5 marks)
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5) Explain the synonym of critical thinking and list the types. ( 6 marks)
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6) Explain the four styles of decision-making in nursing. ( 4 marks)
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7) Draw a fishbone diagram in which you faced a critical problem in your life. ( 10
marks)
Prof. Gehan Mohamed
9|Page
100
BUE -MMNF
Degree Year 1
Module Title: Professional inquiry skills (problem solving) Module Code: N2369
Date: 00/00/2018 Time : 2 hrs

Total mark: 100 marks
Part I: Multiple Choice Questions

(Total 50 marks, each question = 2 marks)
Choose the correct answer:
1) The second component of the critical thinking model is:

a) Competencies.
b) Experience
c) Specific knowledge
2) The nurse is working with a patient who recently had a colostomy. The patient
is having difficulty using the supplies that are provided for ostomy care. The
nurse investigates with the patient to see which ones are the best. This is an
example of a critical thinking strategy of:
a) Inference
b) Problem solving
c) Management
3) The nurse decides to administer tablets of acetaminophen (Tylenol) instead of

the intramuscular meperidine (Demerol) she has been giving to one of her
orthopaedic patients, in accordance with the prescription order. Which step of
the nursing process does this address?
a) Assessment
b) Nursing diagnosis
c) Planning
d) Implementation
1|Page
4) The nurse has a multiple patient's assignment on the surgical unit. When
beginning the shift, the nurse needs to determine which postoperative patient
should be seen first. From the following, the nurse should go to see the patient
who:
a) Is reported as having a BP of 90\ 50
b) Received medication for pain 10 minutes ago
c) Needs to be out of bed and ambulating
d) Requires instructions for wound care
5) Professional nurses are responsible for making clinical decisions to:

b) Take immediate action when a patient’s condition worsens.
c) Apply clear textbook solutions to patients’ problems.
d) Formulate standardize care plans for groups of patients.
6) 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 will be back in 30 minutes.
b) Set a box of tissues papers 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.
7) A patient who is in pain refuses to be repositioned. In making a decision about

what to do, what should the nurse consider first?
a) Why a decision is needed.
b) When a decision is needed
c) Who actually gets to make the decision
d) What are the alternatives
8) A new nurse is transferred 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.
2|Page
9) A nursing diagnosis includes:
b) The identified problem and related cause
d) The physician’s diagnosis.
10) The nursing process is utilized to :

a) Provide a systemic, organized and comprehensive approach to meeting the
needs of clients.
b) Encourage the family to make decisions regarding patient’s care.
c) Increase involvement of allied healthcare professionals in decision-making.
d) None of the above.
11) The process of critical thinking includes:

b) Imitating skills.
c) Manual Skills
12) The nursing student can develop critical skills by doing which of the following:
a) Studying 3 hours more in general nursing subjects each night.
b) Actively participating in all clinical experiences.
c) Interviewing staff nurses about their expectation on nursing profession.
d) Attending all open skills lab opportunities.
13) The nurse is deciding on the type of dressing to use for a patient. Which step of
decision making process is being used when the nurse observes the
3|Page
14) The patient who has shortness of breathing, will get benefits from the head of
the bed being elevated. Because this position can result in skin breakdown in
the sacral area, the nurse decides to study the amount of sacral pressure
occurring in other positions. This decision is an example of
c) Intuition.
15) Why a nurse cannot apply the 8D to all problems?

a) The 8D approach takes several weeks to several months in order to solve a
problem.
b) It takes a minimum of (4) people from at least four different organizational
areas to effectively apply the 8D team problem solving approach.
c) The 8D team requires senior management support for allocated
time/resources and the authority to make the appropriate and required
changes.
d) All of above.
16) Describing the problem starts with a well-thought-out problem statement, so

The problem statement will:
17) Characteristics of an effective problem solver include all the following Except :
a) Have confidence.
b) Know the difference between fact and opinion and understand the need for
valid evidence.
c) seek win-lose solutions
d) are not fast in solving problems.
18) The purpose of problem solving includes all of the following Except:
a) Makes you a stand out
b) Increased confidence
c) Make the impossible possible.
d) Depend on trial-and-error method
4|Page
19) In the assessment phase, critical thinking is used to help:
a) Writing guidelines for patient care.
b) Obtaining knowledge from biological, physical and social sciences as basis for
the nurse to ask relevant questions.
c) Complicate the planning process.
d) Invading the patient’s privacy.
20) The steps of the nursing process include:

a) Problem identification, care giving, collaboration and goal setting.
c) Assessment, diagnosis, planning, implementation and evaluation.
21) Which reasoning process describes the nurse’s actions when the nurse evaluates
possible solutions for care of an infected wound for optimal patient outcomes?
a) Intuition
b) Research process
c) Trial and error
d) Problem solving
22) A client with diarrhoea also has a primary care provider’s order for a bulk
laxative daily. The nurse, not realizing that bulk laxative can help solidify certain
types of diarrhea, concludes,” the primary care provider does not know the
patient has diarrhea.” What type of statement is this?
a) A fact
b) An inference
c) A judgment
d) An opinion
23) In the decision-making process, the nurse sets and weights the criteria,
b) Consults the client and family members to determine their view of the criteria
d) Determines the logical course of action should intervening problems arise.
5|Page
24) The nurse enters the room of a patient who has a history of heart disease. On
looking at the patient and proceeds to take the vital signs. This is the nurse
acting on:
a) Intuition
b) Reflection
c) Knowledge
d) Scientific method
25) The nurse manager has developed a staff protocol for peer evaluation. The
nurses on her surgical unit are nervous about using her instrument. If the nurse
manager continues to implement the new strategy, which of the following critical
thinking attitudes is she portraying?
a) Accountability
b) Thinking independently
c) Risk taking
d) Humility
Part II: Opinion or Fact Questions:

(Total 10 marks, each question = 1 mark )
S. Statement Fact Opinion

(F) (O)
1. The sun rises in the east and sets in the west. (F)
2. Sunflowers are the prettiest flowers. (O)
3. Ostriches are unable to fly, but they can run very fast. (F)
4. Bicycling is a truly enjoyable form of exercise (O)
5. Last year there was a horrible outbreak of flu. (F)
6. The capital of Egypt is Cairo (F)
7. Insects and spiders are invertebrates. (F)
8. Staying up late is a lot of fun. (O)
9. Babies generally start to talk between 18 and 24 months of age. (F)
10. The nursing profession is a Female based profession. (O)
6|Page
Part III: Give detail answer on the following questions:
( Total 40 marks)
1) Discuss the purpose of 8D approach: ( 5 marks)
Answer:
 Isolates and contains the most basic causes of any undesirable condition.
 Identifies the factors that contribute to the problem.
 Eliminates systemic factors that cause the condition
 Keeps teams from jumping to conclusions too early.
 Prevents problem recurrence
2) List four Aspects of Critical Thinking and define each one. ( 8 marks)
Answer:
• Abstract Thinking:
thinking past what your senses tell you
• Creative Thinking:
thinking “out of the box,” innovating
• Systematic Thinking:
organizing your thoughts into logical steps
• Communicative Thinking:
being precise in giving your ideas to others.
3) Explain the importance of Critical Thinking in nursing clinical practices. ( 2marks)

Answer:
1. Critical thinking is the key to resolving problems.
2. Nurses must make complex decisions, adapt to new situations & continuously update
their knowledge & skills. Critical thinking is integral to all of these.
4) Name 10 out 18 of attributes of Critical Thinkers. ( 5 marks)
Answer:
1. Active thinkers.
2. Knowledgeable of their biases & limitations.
3. Fair-minded.
4. Willing to exert a conscious effort to work in a planning manner.
5. Good communicators.
6. Empathetic.
7. Open-minded.
8. Independent thinkers.
9. Curious & insightful.
10. Humble.
7|Page
11. Proactive.
12. Honest with themselves & others, admitting when their thinking may be flawed or requires
more thought.
13. Organized & systematic in their approach.
14. Flexible.
15. Cognizant of rules of logic
16. Realistic
17. Team players.
18. Creative & committed to excellence.
5) Explain the Synonym for critical thinking, and list the types: ( 6 marks)
Answer:
Reasoning which is a highly individualized, complex activity that involves distinct ideas,
emotions & perceptions.
• Inductive reasoning: generalizations are formed from a set of facts or
observations. A process of reasoning that moves from making observations to
forming conclusions. It can also be thought of as starting from specific examples and
moving toward a general statement. This is also called inference
• Deductive reasoning: reasoning from the general to the specific. A process of
reasoning from known facts to conclusions. Sometimes it can be thought of as
starting from a general statement that is accepted as true to a specific statement that
is “therefore” true.
6) Explain the four styles of decision-making in nursing. ( 4 marks)

Answer:
1- Directive style:
a) Efficient, logical.
b) Use less information.
c) Few alternative.
d) Make decision fast.
e) focus on short-term
2- Analytical style:
a) Careful decision makers
b) Adapt to new situation
3- Conceptual style:
a) Broad outlook examine.
b) more alternative.
c) long range.
d) find creative solution
4- Behavioral style:
a) Work well with others Receptive to suggestions Avoid conflicts
8|Page
7) Draw a fishbone diagram in which you faced a critical problem in your life. ( 10 marks)
Good Luck
Prof. Gehan Mohamed
9|Page
MODEL A
Professional Enquiry Skills - Problem-Solving (Quiz II)
Module Code: N2369

Year: DY1S1 2018-2019
Date: 22 / 11 / 2019 Time 30 min. (Total Marks 20)
Part I Multiple Choice Questions: ( 2.5 Mark)
1-The nurse enters the room of a patient who has a history of heart disease. On looking at the
patient and proceeds to take the vital signs. This is the nurse acting on:
a) Intuition.
b) Reflection.
c) Knowledge.
d) Scientific method.
2-The nurse manger has developed a staff protocol for peer evaluation. The nurses on her
surgical unit are nervous about using her instrument. If the nurse manger continues to
implement the new strategy, which of the following critical thinking attitudes is she portraying?
a) Humility.
b) Thinking independence.
c) Risk taking.
d) Accountability.
3-Individual factor that impact nursing clinical decision making is:

a) Task complexity.
b) Area of specialty & professional autonomy.
c) Time pressure.
d) Knowledge and experience.
4-Importance of clinical decision- making are except:

a) Play an intimate role in the quality of care.
b) Influence nurses effectiveness in clinical practice.
c) Understands how nurses make decision.
d) Determines the logical action should intervening problems arise.
5. Assessment phase in critical thing includes collection of which of the following data.
a) Physiological and psychological.
b) Social and psychological.
c) Social and cultural information.
d) Biopsychosocial and cultural.
Part II- Fill in the blankets from a to f by choosing from the following words (4.5 Marks):
(Responses, Actions, Decisions, Legal, Satisfaction, Outcomes, Nature, Potential,

Strategies, Omissions, Falls, Mutual, Result, Process, Outside, Umbrella, Priority, Top,
Welfare, Caregiver, Patient).
a. Ensuring Legal and Patient safety and Welfare must be Priority in all nursing thinking.
b. Critical thinking is an Umbrella term that includes clinical reasoning, clinical judgment, and
reasoning Outcomes of the clinical setting.
c. Critical thinking and clinical reasoning are thinking Strategies Clinical judgment is the Decisions
of the thinking.
d. Critical thinking dependence on accuracy and Mutual exchange of information. Communication

problems are major cause of mistakes and adverse outcomes such as Falls and care Satisfaction
e. Critical thinking call for Actions that make the most of human Potential And compensate for
problems created by human Nature.
f. Critical thinking means more than fixing problems Outside it means fixing them in a way that gets
the best Result from cost, time, and patient Top perspective.
Part III: Opinion or Fact Questions: (2.5 Marks):
Statement Fact (F) Opinion (O)

1 Babies generally start to talk between 18 and 24 √
months
2 Insects and spiders are invertebrates. √

3 Sunflowers are the prettiest flower. √
4 The sun rises in the East and seat in the West. √
5 The nursing profession is a female-based profession. √
Part IV: Matching Questions: (Total 2: Grades)
Matching the type of decision (column I) with its description (column II).
Type description
1-Routine Decision a) Decision made when the problem and alternative solution
are somewhat unusual and only partially understood e,g,
changing working time, work pattern or method of
assessment.
2-Creative Decision b) Nurses are continually faced with demands to make
decisions of care, is a basic function of all nurse leaders.
3-Adaptive Decision c) Decision made when problems are relatively well defined
and common when established rules, polices procedures
can be used to solve them.
4- Clinical Decision d) Decision made when problems unusual and unclear and
creative solution are necessary
Answer:
1 2 3 4
C D A B
Part V: Answer the Flowing Questions: :
1. Mention 3 critical thinking attitudes? (1.5 Mark)
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2. List three types of decision-making and define each one? (3 Mark)
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3. List 4 characteristics of critical thinking? (4 Mark)
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Professional Enquiry Skills - Problem-Solving (Quiz I)
Module Code: N2369
Year: DY1S1 2019-2020

Part I: True and False Questions: (Total: 5 Grades):
Select (T) if the answer is true or select (F) if the answer is false and correct the false statement.
No Statement T F
1 Affinity is one methods of root cause analysis. 
2 Trial and Error one methods to solve problems. 
3 Nursing process is the heart of the clinical reasoning. 
4 Synergize means making the whole greater than the sum of 

its parts.
5 Brainstorming is a team tool for quickly capturing diverse 

information, ideas, and perspectives.
Part II: Clinical Scenario: (Total:6 Grades):
Adam, a 55 year-old male is admitted to your hospital for an elective removal of his spleen.
The nurses, operating surgeon and anesthesiologist are all employed by the hospital, which is self-
insured for professional liability. The procedure is technically challenging due to the patient's
obesity but appears to go smoothly. Adam is discharged after 3 days and has mild, persistent
abdominal pain. The medical team attributes the pain to the surgical incision. When Adam returns
for his 2-week post-operative check at the surgeon's office, he reports increasing abdominal pain
and a 3-day history of a low-grade fever. An X-ray of the abdomen reveals a surgical sponge.
Adam undergoes another surgery to remove the sponge, at which time an abdominal infection is
discovered. The surgery is performed by a different surgical team at the same hospital. Treatment
of the abdominal infection requires a 4-day stay in the hospital followed by a 3-week course of
intravenous antibiotics at home. Adam, who is employed as an architect, misses a total of 8 weeks
of work. The sponge counts took place before and after the surgical procedure, and correct counts
were documented. The physician considered obesity to be a causative factor for the problem.
Answer the following questions based on the scenario (20 marks, 4 for each)
1- Identify the real problem of the patient
2- analyze the root cause/s of Mr. Adam’s problem
3- Identify the approach used to solve this problem.
ANSWER
Part II: Clinical Scenario: (Total 6 Grades):
1- Identify the real problem of the patient
The real problem of the Mr. Adam is post-operative infection.
2- Analyze the root cause/s of Mr. Adam’s problem
The root cause analysis reveals that the sponge counts took place before and after the
surgical procedure, and correct counts were documented.
3- Identify the approach used to solve this problem
Research process because it tackled the following steps, data collection , problem
identification searching the alternatives, selecting the solution, executing the solution,
reflecting on the problem (the sponge counts took place before and after the surgical procedure,
and correct counts were documented. The physician considered obesity to be a causative factor
for the problem.
Select the answer that is most appropriate for each of the following questions.
III-Multiple Choice Questions (MCQ 1 to10). (Total= 10 marks-each MCQ Question is
worth = 1 mark)
1. The advantage of heuristic for problem solving (six- step):
a) It provides an unjustifiable solution.
b) It makes the decision making process harder
c) It helps eliminate bias and preconceptions.
d) It ensures that each group work individually.
2. Habits of highly effective people are:
a) Think win/win.
b) Be proactive.
c) Discord
d) Practice renew
1) b,c,d. 3) a,b,d.
2) a,c,d. 4) a, b, c.
3. Which step of problem solving skills is being used when the nurse observes the
a) Defining the problem.
b) Testing possible options.
c) Considering consequences
d) Making final decision.
4. Which of the following is true about the defining characteristics of the nursing
process?
a) Static, Systematic and independent.
b) Dynamic, interrelated and independent.
c) Cyclic, static and interrelated.
d) Systematic, cyclic and dependent.
5. The nursing diagnosis includes:

b) The physician’s diagnosis.
d) The identified problem and related cause.
6. The importance of problem solving skills are:

a) Make the impossible possible. c) Depend on trial and error method.
b) Makes you a stand out. d) Increased confidence.
1. a,b,d. 2. a,b,c 3.b,c,d 4.a,d,c.
7. Characteristics of effective problem solvers are:
a) Have confidence.
b) Seek win- lose solutions.
c) Are not fast in solving problems.
d) Understand the need for valid evidence.
1) a,b,c. 3) a,b,d.
2) b,c,d. 4) a,c,d.
8. In which step of the nursing process would the nurse ask a patient if the medication
administered has relieved his pain?
a) Assessment.
b) Analysis.
c) Planning.
d) Evaluation.
9. Which reasoning process describes the nurse’s action when the nurse evaluates possible
solutions for care of an infected wound for optimal patient outcomes?
a) Intuition.
b) Trial and error.
c) Nursing process.
d) Research process.
10. The patient is complaining of shortness of breath. The nurse decided to study the effect
of sitting position on improving lung expansion and consequently the shortness of breath.
This decision is an example of
b) The nursing process.
c) The trial and error method.
d) Intuition.
Good Luck
Prof. Manal Ismail

Professional Enquiry Skills - Problem-Solving (Quiz II)
Answer
Module Code: N2369
Year: DY1S1 2018-2019
Part I Multiple Choice Questions: ( 2 Mark)
1-In which step of the nursing process would the nurse ask a patient if the medication
administered has relieved his pain?
a) Assessment.
b) Analysis.
c) Planning.
d) Evaluation.
2. Assessment phase in critical thing includes collection of which of the following data.
a) Physiological and psychological.
b) Social and psychological.
c) Social and cultural information.
d) Biopsychosocial and cultural.
3-The nurse enters the room of a patient who has a history of heart disease. On looking at the
patient and proceeds to take the vital signs. This is the nurse acting on:
a) Intuition.
b) Reflection.
c) Knowledge.
d) Scientific method.
4-The nurse manger has developed a staff protocol for peer evaluation. The nurses on her
surgical unit are nervous about using her instrument. If the nurse manger continues to
implement the new strategy, which of the following critical thinking attitudes is she portraying?
a) Humility.
b) Thinking independence.
c) Risk taking.
d) Accountability.
5- 8 hours following a hip surgery with a drainage device containing 40 ml, the nurse warned the
healthcare providers that the drainage amount should not exceed 100 ml. The nurse enters the
patient’s room to check the drainage amount. This is an example of:
a) Planning.
b) Diagnosis.
c) Intervention.
d) Evaluation
6-Importance of clinical decision- making are except:
a) Play an intimate role in the quality of care.
b) Influence nurses effectiveness in clinical practice.
c) Understands how nurses make decision.
d) Determines the logical action should intervening problems arise.
7-A nurse is caring for a 45-year-old married woman who has undergone hemicolectomy for
colon cancer. The woman has two children. Which concepts about families should the nurse
keep in mind when providing care for this client? Choose the appropriate.
1. Illness in one family member can affect all members.
2. Family roles do not change because of illness.
3. A family member may have more than one role at a time in a family.
4. The effects of an illness on a family depend on the stage of the family’s life cycle.
a) 1, 2, & 3. c) 1, 2, & 4.
b) 2, 3, & 4. d) 1, 3, & 4.
8- A client reports feeling hungry, but does not eat when food is served. Using critical
thinking skills, the nurse should perform which of the following?
A .Assess why the client is not ingesting the food provided.

B. Continue to leave the food at the bedside until the client is hungry enough to eat.
C. Notify the primary care provider that tube feeding may be indicated soon.
D. Believe the client is not hungry.
Answer question #8
A. Assess why the client is not ingesting the food provided.Rationale: The nurse recognizes that
many assumptions (beliefs) could interfere with the client eating—such as that the food presented is
not culturally appropriate. These assumptions must be clarified. Options 2 and 3 reach conclusions
not supported by the facts. In option 4, the nurse has made a judgment or has an opinion that may not
be accurate. Also, the nurse is acting without assessment. Implementation should be preceded by
assessment
9- 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
B. Take immediate action when a patient's condition worsens.

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.
10- The client who is short of breath benefits from the head of the bed being elevated. Because
this position can result in skin breakdown in the sacral area, the nurse decides to study the
amount of sacral pressure occurring in other positions. This decision is an example of
a) The research method
c) Intuition.
Answer
a) The research method.Rationale: The research method uses a research study-based approach to
problem solving.
•Trial and error (option 2) and intuition (option 3) would involve unstructured approaches resulting in
less predictable results.
•The nursing process generally uses application of known interventions, previously determined by the
scientific (research) process (option 4).
Part II: Opinion or Fact Questions: (5 Marks):
Statement Fact (F) Opinion

(O)
1 Babies generally start to talk between 18 and 24 months √
2 Insects and spiders are invertebrates. √
3 Sunflowers are the prettiest flower. √
4 The sun rises in the East and seat in the West. √
5 The nursing profession is a female-based profession. √
Part III: Matching Questions: (Total 5: Grades)
Matching the type of decision (column I) with its description (column II) .
No Statement T F
1 Adaptive Decision is decision made when problems are 

relatively well defined and common when established rules,
polices procedures can be used to solve them.
2 Intellectual curiosity is the ability to imagine yourself in the 

place of others in order to understand them and their actions or
beliefs.
3 Clinical decision –making will influence nurses’ effectiveness 

in clinical practice and make an impact on patients’ lives and
experiences with health care.
4 Ineffective problem solvers take great care to understand all 

the facts and relationships.
5 Emotion and perception is individual factor that impact 

nursing clinical decision making
Part V: Answer the Flowing Questions: :
1. Mention 3 critical thinking attitudes? (1.5 Mark)
 Independence
 Intellectual Humility
 Intellectual courage to challenge the status Quo and ritual
 Intellectual Empathy
 Intellectual Integrity
 Intellectual Perseverance
 Intellectual Curiosity
 Faith in reason
 Fair- mindedness
 Interest in exploring thoughts and feelings
2. List four types of decision-making ? ( 2 Mark)

3. Routine decision.
4. Adaptive decision.
5. Innovative decision.
6. Creative decision.
3- List three actions necessary for a successful career? ( 1.5 marks)
a) Enjoy
b) Learn
c) Communicate
d) Work Hard
e) Evolve
f) Plan
g) Share.
Revision
Q1
The steps of the nursing process include:
a) Problem identification, care giving, collaboration and goal-setting.
c) Assessment, analysis, planning, intervention and evaluation.
Answer Q1:
The steps of the nursing process include:
a) Problem identification, care giving, collaboration and goal-setting.
c) Assessment, analysis, planning, intervention and evaluation.
Q2
A coworker asserts: "men always seem to exaggerate pain," the nurse
who is thinking critically might ask:
a) "Where did you read that?"
b) "Who told you that?"
c) "What evidence do you have for that?"
d) "How many male patients have you had?"
Answer Q2:
• A coworker asserts: "men always seem to exaggerate pain," the
nurse who is thinking critically might ask:
a) "Where did you read that?"
b) "Who told you that?"
c) "What evidence do you have for that?"
d) "How many male patients have you had?"
Q3
The process of critical thinking includes:
b) Imitating skills
c) Manual Skills
Answer Q3
The process of critical thinking includes:
b) Imitating skills
c) Manual Skills
Q4
The nurse is deciding on the type of dressing to use for a patient.
Which step of the decision making process is being used when the
nurse observes the absorbency of different dressing brands?
Answer Q4
The nurse is deciding on the type of dressing to use for a patient.
Which step of the decision making process is being used when the
nurse observes the absorbency of different dressing brands?
Q5
The patient, who has shortness of breathing, will get benefits from
the head of the bed being elevated. Because this position can result
in skin breakdown in the sacral area, the nurse decides to search
literature evidence on the amount of sacral pressure occurring in
other positions. This decision is an example of
c) Intuition.
Aswer Q5
The patient, who has shortness of breathing, will get benefits from
the head of the bed being elevated. Because this position can result
in skin breakdown in the sacral area, the nurse decides to search
literature evidence on the amount of sacral pressure occurring in
other positions. This decision is an example of

c) Intuition.
Q6
Describing the problem starts with a well-thought-out problem
statement, so The problem statement will:
Answer Q6
Describing the problem starts with a well-thought-out problem
statement, so The problem statement will:
Q7
In the decision-making process, the nurse sets and weights the criteria,

b) Consults the client and family members to determine their view of the
criteria
d) Determines the logical course of action should intervening problems
arise.
Answer Q7
In the decision-making process, the nurse sets and weights the criteria,

b) Consults the client and family members to determine their view of the
criteria
d) Determines the logical course of action should intervening problems
arise.
Q8
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
non-pharmacological, 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 Q8
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
non-pharmacological, 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.
Q9
Professional nurses are responsible for making clinical decisions to:
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 Q 9
Professional nurses are responsible for making clinical decisions to:
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.
Q 10
• Discuss the purpose of 8D approach.
Answer Q 10
Discuss the purpose of 8D approach.
• Isolates and contains the most basic causes of any undesirable
condition.
• Identifies the factors that contribute to the problem.
• Eliminates systemic factors that cause the condition
• Keeps teams from jumping to conclusions too early.
• Prevents problem recurrence
Q11
• Styles of decision-making in nursing
Answer Q11
Styles of decision-making in nursing:
1. Directive style:
2. Analytical style:
3. Conceptual style:
4. Behavioral style:
Fish bone diagram scenario #1
• Mr. Brown asked Chris to write a report for his next column in the newspaper. “
The way people think nowadays”. It will be due next Sunday.
• Days have passed and Chris hasn’t touched his report due to many office
problems. Sunday was closing in on him as he didn’t know what to do.
• Till the day finally came and he was trembling from terror and when Mr. Brown
called in on him he ran
• How would you analyze the Problem using the Fishbone Diagram?
Fish bone diagram scenario #2
• Your friends invited you to go on a field trip with them to the forest.
They will camp there for two days, On your way you thought about
making a plan of how to have fun.
• What is your plan for fun using the Fishbone Diagram?

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Professional Enquiry Skills (Problem Solving)

1 - Introduction to Critical Thinking ( Terminology )

Barriers to Critical Thinking

Fair thinking. It is not biased or one-sided. Frequently this is about setting

Claim that thinking gives them a headache.

4- CRITICAL THINKING & NURSING PROCESS

Components of critical Six cognitive skills used in critical thinking

Critical Thinking Model

You gathered further information: Patient’s blood sugar is 60mg/dL

Date: 00/00/2018 Time : 2 hrs

Part I: Multiple Choice Questions

(Total 50 marks, each question = 2 marks)

Choose the correct answer:

3) The nurse decides to administer tablets of acetaminophen ( Tylenol) instead of

5) Professional nurses are responsible for making clinical decisions to:

7) A patient who is in pain refuses to be repositioned. In making a decision about

10) The nursing process is utilized to :

11) The process of critical thinking includes:

15) Why a nurse cannot apply the 8D approach to all problems?

16) Describing the problem starts with a well-thought-out problem statement, so

20) The steps of the nursing process include:

Part II: Opinion or Fact Questions:

S. Statement Fact Opinion

2. Sunflowers are the prettiest flowers.

4. Bicycling is a truly enjoyable form of exercise

5. Last year there was a horrible outbreak of flu.

6. The capital of Egypt is Cairo

7. Insects and spiders are invertebrates.

8. Staying up late is a lot of fun.

9. Babies generally start to talk between 18 and 24 months of age.

10. The nursing profession is a Female based profession.

3) Explain the importance of Critical Thinking in nursing clinical practices. ( 2 marks)

6) Explain the four styles of decision-making in nursing. ( 4 marks)

Prof. Gehan Mohamed

Date: 00/00/2018 Time : 2 hrs

Part I: Multiple Choice Questions

Choose the correct answer:

1) The second component of the critical thinking model is:

3) The nurse decides to administer tablets of acetaminophen (Tylenol) instead of

5) Professional nurses are responsible for making clinical decisions to:

7) A patient who is in pain refuses to be repositioned. In making a decision about

10) The nursing process is utilized to :

11) The process of critical thinking includes:

15) Why a nurse cannot apply the 8D to all problems?

16) Describing the problem starts with a well-thought-out problem statement, so

20) The steps of the nursing process include:

Part II: Opinion or Fact Questions:

S. Statement Fact Opinion

2. Sunflowers are the prettiest flowers. (O)

4. Bicycling is a truly enjoyable form of exercise (O)

5. Last year there was a horrible outbreak of flu. (F)

6. The capital of Egypt is Cairo (F)

7. Insects and spiders are invertebrates. (F)

8. Staying up late is a lot of fun. (O)

9. Babies generally start to talk between 18 and 24 months of age. (F)

10. The nursing profession is a Female based profession. (O)

3) Explain the importance of Critical Thinking in nursing clinical practices. ( 2marks)

6) Explain the four styles of decision-making in nursing. ( 4 marks)