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(Download PDF) LPN To RN Transitions 4th Edition Claywell Test Bank Full Chapter
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Chapter 07: Critical and Diagnostic Thinking for Better Clinical Judgment
Claywell: LPN to RN Transitions, 4th Edition
MULTIPLE CHOICE
1. The nurse is listening to a lecture on critical thinking. Which statement indicates that teaching
has been effective?
a. “Critical thinking involves making inferences, solving problems, arriving at
decisions.”
b. “Critical thinking involves persuading others, inducing debate, using intuition.”
c. “Critical thinking involves making inferences, reducing fractions, making
decisions.”
d. “Critical thinking involves solving problems, elevating issues, reflecting actions.”
ANS: A
Although critical thinking may play a part in many processes, the primary uses are to make
inferences, solve problems, and arrive at decisions.
2. The nursing is listening to a lecture on reasoned thought. Which statement indicates that
teaching has been effective?
a. “Reasoned thought is reflection.”
b. “Reasoned thought is emotion.”
c. “Reasoned thought is parity.”
d. “Reasoned thought is contrast.”
ANS: B
Reasoned thought is discriminating and prudent and does not allow emotion, feelings, or
prejudices to skew decisions. Individuals who practice reasoned thought recognize when
negative factors may be interfering with their ability to think clearly.
3. Using clinical judgment, the nurse makes decisions on whether to proceed with or revise a
course of action. When providing this education to a nursing student, which statement
indicates that the teaching has been effective?
a. “The inquiry (investigational or exploratory) subprocess necessary for sound
clinical judgment is reflective thinking.”
b. “The inquiry (investigational or exploratory) subprocess necessary for sound
clinical judgment is persuasive thinking.”
c. “The inquiry (investigational or exploratory) subprocess necessary for sound
clinical judgment is critical thinking.”
d. “The inquiry (investigational or exploratory) subprocess necessary for sound
clinical judgment is intuitive thinking.”
ANS: C
Through clinical judgment, the nurse makes decisions on whether to proceed with or revise a
course of action. The inquiry (investigational or exploratory) subprocess necessary for sound
clinical judgment is critical thinking.
4. The nurse is listening to a lecture on critical thought. Which statement indicates that the
teaching has been effective?
a. “Critical thought is a disciplined, rational, and self-directed activity that uses
standards and criteria.”
b. “Critical thought is an intuitive process that relies only on the nurse’s experience.”
c. “Critical thought is a persuasive process leading to sound decisions.”
d. “Critical thought is a reactive process after an intervention is completed.”
ANS: A
Critical thought is a disciplined, rational, and self-directed activity that uses standards and
criteria. Critical thought assists the nurse in making more effective clinical decisions. The
nurse who engages in critical thought will meet more of the patient’s needs and effect positive
patient outcomes.
5. A patient has a problem that prevents him from shaving himself, tying his shoes, or fixing his
meals. He is not physically able to compensate for the problem, so he is in need of assistance.
Data support the nursing diagnosis “impaired physical mobility” by what mode of reasoning?
a. Induction
b. Deduction
c. Reduction
d. Reflection
ANS: B
Taking general assessment data, drawing conclusions, identifying problems or needs, and
formulating a plan of care are components of a deductive reasoning process. The nursing
process is an example of deductive reasoning because it involves taking data and deducing a
plan of care.
DIF: Cognitive Level: Analysis OBJ: Compare inductive and deductive reasoning.
TOP: Inductive and Deductive Reasoning MSC: NCLEX: Nursing Process
6. An RN has been working with a patient on the nursing unit for a 12-hour shift. The nurse
recognizes that each time the patient is turned to the left, the blood pressure drops 15 mm Hg.
The same RN has seen this phenomenon in several other patients and makes the connection
that patients with right-sided heart failure (the medical diagnosis) will experience a blood
pressure drop if they are turned to their left side. This type of reasoning is called
a. inductive.
b. deductive.
c. reductive.
d. reflective.
ANS: A
The nurse uses inductive reasoning when a patient has symptoms or problems the nurse has
seen before. From the assessment data gathered, the nurse makes inferences (conclusions or
assumptions), asks further questions, and makes decisions. The nurse, using inductive
reasoning, goes from specifics to generalities and infers the likely outcomes based on
supporting data.
DIF: Cognitive Level: Analysis OBJ: Compare inductive and deductive reasoning.
TOP: Inductive and Deductive Reasoning MSC: NCLEX: Nursing Process
7. Each element of the nursing process involves critical thinking. Which definition of assessment
reflects critical thinking?
a. Correctly and completely documenting the assessment data on a form
b. A process of discovery and decision-making about the nature of the patient’s needs
c. Using a systematic approach to ensure comprehensive collection of assessment
data
d. Selecting the most accurate NANDA-I nursing diagnosis for the patient
ANS: B
Assessment is a process of discovering and making decisions about the nature of the patient’s
nursing problems or needs. It involves purposeful and systematic data gathering about the
patient’s present illness or situation and past health history (subjective data), data gathering by
physical examination (objective data), and review of functional health patterns for both
subjective and objective data.
8. A novice RN is caring for a patient who is saying that something is wrong. Vital signs are
normal and there are no new specific findings. The novice RN calls another, more experienced
RN who briefly talks with the patient, calls the health care provider, and initiates a transfer to
the ICU. Which statement is most likely true of the more experienced RN?
a. The experienced RN is an advanced beginner with better assessment skills than the
novice nurse.
b. The experienced RN is proficient in assessment and the use of hospital protocol.
c. The experienced RN is an expert nurse with intuitive judgment that the
experienced nurse cannot quite explain.
d. The experienced RN is arrogant, foolish, and likely to get in trouble for her
assertive behavior.
ANS: C
The expert RN is able to connect the understanding of a situation with an appropriate action.
The expert RN has an intuitive grasp of each situation and zeroes in on the accurate region of
the problem without wasteful consideration of alternative actions. The strength of inference by
the expert RN is based on the extent of the RN’s knowledge and experience. The RN with
limited experience and with developing knowledge may rely on the proven and look to others
for validation of decisions. Practice at this stage demonstrates the highest level of critical
thinking in that the expert RN knows holistically what to do without consciously thinking
through the process of critical thinking.
9. An RN has collected extensive data on a patient with attention deficit disorder. When
weighing potential actions to help the patient and considering alternative solutions, which of
the attributes of the critical thinker is the RN demonstrating?
a. Creativity
b. Rational thought
c. Reflection
d. Curiosity
ANS: A
Creativity is the ability to be innovative, resourceful, and inventive in finding solutions.
Rational thought is fueled by knowledge gained through study and experience. Reflection
allows the critical thinker to look back and review ideas, thoughts, and actions. Curiosity is
the desire to understand what something is or how something works.
10. A nurse manager is designing orientation processes for new graduate nurses by using the work
of Hansten and Washburn as a model. All of the new graduates are instructed in the model
during orientation. The manager knows that a graduate nurse needs more instruction if which
comment is made during the evaluation interview?
a. “I think I need more mentoring to continue to build my thinking skill.”
b. “Improving my critical thinking will assist in decreasing the risk of sentinel events
for my patients.”
c. “Using my improving thinking skills will help improve patient care.”
d. “If my thinking skills are what they should be, fewer errors will happen in patient
care.”
ANS: A
Hansten and Washburn (1999) indicated that the nurse must be able to think critically as a
way to decrease errors and sentinel events and assist in cultivating an improved patient care
system. Mentoring new employees is not discussed.
11. The nurse has received a shift report. Which patient should the nurse assess first?
a. The patient diagnosed with type 2 diabetes mellitus who is complaining of
dizziness with a glucose level of 120.
b. The patient diagnosed with sleep apnea who is complaining of a morning
headache.
c. The patient diagnosed with diverticulitis who has a hard, rigid, abdomen and a
temperature of 101.3F.
d. The patient diagnosed with a stomach virus who vomited three times during the
previous shift.
ANS: C
Clinical judgment is perceptive understanding of a situation based on knowledge, empirical
data (data that can be observed or experienced), theory, and scientific inquiry. Clinical
judgment requires a series of decisions based on changing observations and collected data. A
hard, rigid abdomen and elevated temperature are abnormal in any circumstance, and the
nurse should assess this patient first. These are clinical manifestations of peritonitis, a
potentially life-threatening condition. A glucose level of 120 is normal for a patient with type
2 diabetes. The patient complaining of a headache is the least urgent compared with the other
patients. The patient who vomited three times is an urgent patient requiring monitoring of
hydration, but less urgent than a patient with a potentially life-threatening condition.
12. The nurse has received a change-of-shift report about these four patients. Which one should
the nurse plan to assess first?
a. A 23-year-old patient with cystic fibrosis who has pulmonary function testing
scheduled in 30 minutes.
b. A 35-year-old patient who was admitted the previous day with bacterial
pneumonia and has a temperature of 100.2F.
c. A 46-year-old patient who is complaining of dyspnea after having a thoracentesis 1
hour previously.
d. A 77-year-old patient with TB who has four antitubercular medications due in 15
minutes.
ANS: C
Clinical judgment is perceptive understanding of a situation based on knowledge, empirical
data (data that can be observed or experienced), theory, and scientific inquiry. Clinical
judgment requires a series of decisions based on changing observations and collected data.
Dyspnea after a thoracentesis may indicate pneumothorax or hemothorax and requires
immediate evaluation by the nurse. The other patients should also be assessed as soon as
possible, but there is no indication that they may need immediate action to prevent
deterioration.
13. As elements of reasoning and critical thought, why are implications or consequences of
outcomes important to consider?
a. They can help the nurse make confident clinical decisions.
b. They help the nurse understand complex ideas and events.
c. They help the nurse understand how the patient is responding to the demands of
the treatment.
d. They can be expected or unexpected and affect the completion of a nursing
intervention.
ANS: D
Implications or consequences are defined through outcomes. Implications or consequences
can be expected or unexpected, but each must be considered. For example, an expected
consequence of bathing is a clean patient with intact skin that can fight infection or
breakdown. An unexpected consequence is fatigue, which can cause stress on the patient’s
body and affect healing and recovery. Every action or nursing intervention has consequences,
so the nurse must critically think about the intervention and the consequences of performing
the intervention. Inferences help nurses make confident clinical decisions. Concepts can help
the nurse understand complex ideas, events, actions and entities, thereby defining and shaping
our thought processes. Gathering data helps the nurse understand how the patient is
responding to the demands of the treatment.
14. Which patient would the nurse see first at the start of the shift?
a. A patient admitted yesterday with osteomyelitis of the right arm with a T of
101.0F.
b. A patient with hepatic encephalopathy who is being rude to the nursing assistant.
c. A patient with lupus who has been on long-term corticosteroids and whose blood
sugar is 180.
d. A patient with circumferential burns of the right leg who is complaining of
numbness in the right foot.
ANS: D
People who engage in critical thought can be said to practice cultivated thinking, which is
organized, enlightened, and educated. By organizing the thought process, the individual is
able to make sense of information. Circumferential burns to the extremities can cause
circulatory compromise distal to the burn with subsequent neurologic impairment of the
affected extremity. The patient with a T of 101.0F, the patient being rude, and the patient
with a blood sugar of 180 are not exhibiting emergency conditions needing immediate
attention.
15. Which statement best assists the nurse in planning care for the patient who is not adhering to
the treatment regimen?
a. Patients’ health attitudes directly affect behavior and therefore influence
adherence.
b. Patients usually go to the hospital without preconceived ideas about what is wrong
with them.
c. Most patients adhere to the advice of health care providers even if they do not
believe that the treatment will work.
d. Noncompliance with prescribed treatment is irrational behavior.
ANS: A
Understanding the patient’s health attitudes helps the nurse to understand the patient’s point of
view about the treatment regimen. All thinking stems from a point of view. An enlightened
thinker is able to interpret data and clarify meaning from several points of view, that is, to
explain or illustrate how the data can be understood from multiple positions. The RN can
recognize that a routine treatment may seem strange and frightening from the patient’s point
of view. In gathering data to support this assumption, the nurse will ask questions to better
understand how the patient is responding to the demands of the treatment. An unenlightened
nurse may make erroneous assumptions that label the patient as problematic and
noncompliant. All the other answer choices have nothing to do with understanding the
patient’s point of view.
16. Select the hospital patient who has the best chance of avoiding a hospital-acquired infection.
a. A 42-year-old patient who had abdominal surgery
b. A 35-year-old patient with a closed leg fracture
c. A 5-month-old non-breastfed infant
d. A 75-year-old patient receiving chemotherapy
ANS: B
Clinical judgment is perceptive understanding of a situation based on knowledge, empirical
data (data that can be observed or experienced), theory, and scientific inquiry. Clinical
judgment requires a series of decisions based on changing observations and collected data.
The patient with the closed leg fracture is the patient with the best chance of avoiding a
hospital-acquired infection. The patient with abdominal surgery is at risk for contracting a
hospital-acquired infection because of healing surgical wounds. The non-breastfed infant and
the patient receiving chemotherapy are patients with compromised immune systems that put
them at risk for a hospital-acquired infection.
17. The nurse is caring for a 19-year-old trauma patient paralyzed from the neck down. He is alert
and oriented, requires assistance with ADLs, and keeps his spirits up with frequent visitors. A
priority for the nurse is
a. rounding hourly to assess the patient’s support system and acceptance of his
condition.
b. feeding the patient to maintain his nutritional status.
c. ensuring the patient has constant stimuli through his friends because teenagers are
peer-focused.
d. watching and preventing skin breakdown as a result of immobility.
ANS: D
Clinical judgment is perceptive understanding of a situation based on knowledge, empirical
data (data that can be observed or experienced), theory, and scientific inquiry. Clinical
judgment requires a series of decisions based on changing observations and collected data.
Patient safety is a nurse’s priority. Watching and preventing skin breakdown are the priorities
for an immobile patient. Hourly rounding, nutritional status, and ensuring that the patient is
kept busy are important but of lower priority.
18. Which of the following is the best example of an open-ended question regarding a patient’s
pain?
a. “For how many weeks have you been having this pain?”
b. “Does it feel like a burning pain?”
c. “Where on your body does the pain begin and end?”
d. “Can you describe your pain for me?”
ANS: D
Curiosity, an element of reasoning, stimulates the RN to apply all available facts, principles,
and theories, as well as specific knowledge of the situation, to formulate the plan of care.
Open-ended questions such as “Can you describe your pain for me?” allow the patient to think
and express thoughts freely without limitations. The other answer choices are limiting and
draw specific responses.
MULTIPLE RESPONSE
1. The nurse who can think critically will make more effective clinical decisions, meet more of
the patient’s needs, and affect positive patient outcomes. How this is accomplished? (Select
all that apply.)
a. Committing to test one’s own thought process for clarity, accuracy, and logic
b. Accepting an individual’s responsibility to develop critical thinking skills
c. Joining nursing organizations to keep current on nursing policies affecting patient
care
d. Constantly seeking out others for answers to difficult clinical questions and
problems
e. Requesting that health care organizations adopt and foster a culture of critical
thinking
f. Maintaining the required amount of continued education units for license renewal
ANS: A, B, E
Committing to test one’s own thought process for clarity, accuracy, and logic; accepting
individual responsibility to develop critical thinking skills; and requesting that health care
organizations adopt and foster a culture of critical thinking are all ways to foster critical
thinking. Joining nursing organizations to keep current on nursing policies affecting patient
care is not discussed. Constantly seeking out others for answers to difficult clinical questions
and problems is incorrect because critical thinkers demonstrate specific attributes that support
the process, including curiosity, diligence in the pursuit of evidence and information, rational
thought, reflection, and creativity. Maintaining the required amount of continued education
units for license renewal is not discussed.
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