CHAPTER 03 2026 CRITICAL
THINKING, ETHICAL DECISION
MAKING AND THE NURSING PROCESS
A nurse has been offered a position on an obstetric unit and has learned that the unit offers
therapeutic abortions, a procedure which contradicts the nurse’s personal beliefs. What is the
nurse’s ethical obligation to these client’s?
A) The nurse should adhere to professional standards of practice and offer service to these client’s.
B) The nurse should make the choice to decline this position and pursue a different nursing role.
C) The nurse should decline to care for the client’s considering abortion.
D) The nurse should express alternatives to women considering terminating their pregnancy.
1. A terminally ill client you are caring for is complaining of pain. The physician has ordered a
large dose of intravenous opioids by continuous infusion. You know that one of the adverse effects
of this medicine is respiratory depression. When you assess your client’s respiratory status, you
find that the rate has decreased from 16 breaths per minute to 10 breaths per minute. What action
should you take?
A) Decrease the rate of IV infusion.
B) Stimulate the client in order to increase respiratory rate.
C) Report the decreased respiratory rate to the physician.
D) Allow the client to rest comfortably.
2. An adult client has requested a do not resuscitate (DNR) order in light of his recent diagnosis
with late stage pancreatic cancer. The client’s son and daughter-in-law are strongly opposed to the
client’s request. What is the primary responsibility of the nurse in this situation?
A) Perform a slow code until a decision is made.
B) Honor the request of the client.
C) Contact a social worker or mediator to intervene.
D) Temporarily withhold nursing care until the physician talks to the family.
3. An elderly client is admitted to your unit with a diagnosis of community-acquired pneumonia.
During admission the client states, I have a living will. What implication of this should the nurse
recognize?
A) This document is always honored, regardless of circumstances.
B) This document specifies the client’s wishes before hospitalization.
1
,C) This document that is binding for the duration of the client’s life.
D) This document has been drawn up by the client’s family to determine DNR status.
4. A nurse has been providing ethical care for many years and is aware of the need to maintain the
ethical principle of nonmaleficence. Which of the following actions would be considered a
contradiction of this principle?
A) Discussing a DNR order with a terminally ill client
B) Assisting a semi-independent client with ADLs
C) Refusing to administer pain medication as ordered
D) Providing more care for one client than for another
5. A care conference has been organized for a client with complex medical and psychosocial needs.
When applying the principles of critical thinking to this client care planning, the nurse should most
exemplify what characteristic?
A) Willingness to observe behaviors
B) A desire to utilize the nursing scope of practice fully
C) An ability to base decisions on what has happened in the past
D) Openness to various viewpoints
6. Achieving adequate pain management for a postoperative client will require sophisticated
critical thinking skills by the nurse. What are the potential benefits of critical thinking in nursing?
Select all that apply.
A) Enhancing the nurse’s clinical decision making
B) Identifying the client’s individual preferences
C) Planning the best nursing actions to assist the client
D) Increasing the accuracy of the nurse’s judgments
E) Helping identify the client’s priority needs
7. A nurse is unsure how best to respond to a client’s vague complaint of feeling off. The nurse is
attempting to apply the principles of critical thinking, including metacognition. How can the nurse
best foster metacognition?
A) By eliciting input from a variety of trusted colleagues
B) By examining the way that she thinks and applies reason
C) By evaluating her responses to similar situations in the past
D) By thinking about the way that an ideal nurse would respond in this situation
8. The nursing instructor cites a list of skills that support critical thinking in clinical situations.
The nurse should describe skills in which of the following domains? Select all that apply.
A) Self-esteem
2
,B) Self-regulation
C) Inference
D) Autonomy
E) Interpretation
9. The nurse is providing care for a client with chronic obstructive pulmonary disease (COPD).
The nurse’s most recent assessment reveals an SaO2 of 89%. The nurse is aware that part of
critical thinking is determining the significance of data that have been gathered. What
characteristic of critical thinking is used in determining the best response to this assessment
finding?
A) Extrapolation
B) Inference
C) Characterization
D) Interpretation
10. You have just taken report for your shift and you are doing your initial assessment of your
client’s. One of your client’s asks you if an error has been made in her medication. You know that
an incident report was filed yesterday after a nurse inadvertently missed a scheduled dose of the
client’s antibiotic. Which of the following principles would apply if you give an accurate response?
A) Veracity
B) Confidentiality
C) Respect
D) Justice
11. A nurse has begun creating a client plan of care shortly after the client’s admission. It is
important that the wording of the chosen nursing diagnoses falls within the taxonomy of nursing.
Which organization is responsible for developing the taxonomy of a nursing diagnosis?
A) American Nurse’s Association (ANA)
B) NANDA
C) National League for Nursing (NLN)
D) Joint Commission
12. In response to a client’s complaint of pain, the nurse administered a PRN dose of
hydromorphone (Dilaudid). In what phase of the nursing process will the nurse determine whether
this medication has had the desired effect?
A) Analysis
B) Evaluation
3
, C) Assessment
D) Data collection
13. A medical nurse has obtained a new client’s health history and completed the admission
assessment. The nurse has followed this by documenting the results and creating a care plan for the
client. Which of the following is the most important rationale for documenting the client’s care?
A) It provides continuity of care.
B) It creates a teaching log for the family.
C) It verifies appropriate staffing levels.
D) It keeps the client fully informed.
14. The nurse is caring for a client who is withdrawing from heavy alcohol use and who is
consequently combative and confused, despite the administration of benzodiazepines. The client
has a fractured hip that he suffered in a traumatic accident and is trying to get out of bed. What is
the most appropriate action for the nurse to take?
A) Leave the client and get help.
B) Obtain a physician’s order to restrain the client.
C) Read the facility’s policy on restraints.
D) Order soft restraints from the storeroom.
15. A client admitted with right leg thrombophlebitis is to be discharged from an acute-care facility.
Following treatment with a heparin infusion, the nurse notes that the client’s leg is pain-free,
without redness or edema. Which step of the nursing process does this reflect?
A) Diagnosis
B) Analysis
C) Implementation
D) Evaluation
16. The nurse has been assigned to care for a client admitted with an opportunistic infection
secondary to AIDS. The nurse informs the clinical nurse leader that she is refusing to care for him
because he has AIDS. The nurse has an obligation to this client under which of the following?
A) Good Samaritan Act
B) Nursing Interventions Classification (NIC)
C) The nurse practice act in the nurse’s jurisdiction
D) International Council of Nurse’s (ICN) Code of Ethics for Nurse
17. An emergency department nurse is caring for a 7-year-old child suspected of having meningitis.
The client is to have a lumbar puncture performed, and the nurse is doing preprocedural teaching
with the child and the mother. The nurse’s action is an example of which therapeutic
communication technique?
4
THINKING, ETHICAL DECISION
MAKING AND THE NURSING PROCESS
A nurse has been offered a position on an obstetric unit and has learned that the unit offers
therapeutic abortions, a procedure which contradicts the nurse’s personal beliefs. What is the
nurse’s ethical obligation to these client’s?
A) The nurse should adhere to professional standards of practice and offer service to these client’s.
B) The nurse should make the choice to decline this position and pursue a different nursing role.
C) The nurse should decline to care for the client’s considering abortion.
D) The nurse should express alternatives to women considering terminating their pregnancy.
1. A terminally ill client you are caring for is complaining of pain. The physician has ordered a
large dose of intravenous opioids by continuous infusion. You know that one of the adverse effects
of this medicine is respiratory depression. When you assess your client’s respiratory status, you
find that the rate has decreased from 16 breaths per minute to 10 breaths per minute. What action
should you take?
A) Decrease the rate of IV infusion.
B) Stimulate the client in order to increase respiratory rate.
C) Report the decreased respiratory rate to the physician.
D) Allow the client to rest comfortably.
2. An adult client has requested a do not resuscitate (DNR) order in light of his recent diagnosis
with late stage pancreatic cancer. The client’s son and daughter-in-law are strongly opposed to the
client’s request. What is the primary responsibility of the nurse in this situation?
A) Perform a slow code until a decision is made.
B) Honor the request of the client.
C) Contact a social worker or mediator to intervene.
D) Temporarily withhold nursing care until the physician talks to the family.
3. An elderly client is admitted to your unit with a diagnosis of community-acquired pneumonia.
During admission the client states, I have a living will. What implication of this should the nurse
recognize?
A) This document is always honored, regardless of circumstances.
B) This document specifies the client’s wishes before hospitalization.
1
,C) This document that is binding for the duration of the client’s life.
D) This document has been drawn up by the client’s family to determine DNR status.
4. A nurse has been providing ethical care for many years and is aware of the need to maintain the
ethical principle of nonmaleficence. Which of the following actions would be considered a
contradiction of this principle?
A) Discussing a DNR order with a terminally ill client
B) Assisting a semi-independent client with ADLs
C) Refusing to administer pain medication as ordered
D) Providing more care for one client than for another
5. A care conference has been organized for a client with complex medical and psychosocial needs.
When applying the principles of critical thinking to this client care planning, the nurse should most
exemplify what characteristic?
A) Willingness to observe behaviors
B) A desire to utilize the nursing scope of practice fully
C) An ability to base decisions on what has happened in the past
D) Openness to various viewpoints
6. Achieving adequate pain management for a postoperative client will require sophisticated
critical thinking skills by the nurse. What are the potential benefits of critical thinking in nursing?
Select all that apply.
A) Enhancing the nurse’s clinical decision making
B) Identifying the client’s individual preferences
C) Planning the best nursing actions to assist the client
D) Increasing the accuracy of the nurse’s judgments
E) Helping identify the client’s priority needs
7. A nurse is unsure how best to respond to a client’s vague complaint of feeling off. The nurse is
attempting to apply the principles of critical thinking, including metacognition. How can the nurse
best foster metacognition?
A) By eliciting input from a variety of trusted colleagues
B) By examining the way that she thinks and applies reason
C) By evaluating her responses to similar situations in the past
D) By thinking about the way that an ideal nurse would respond in this situation
8. The nursing instructor cites a list of skills that support critical thinking in clinical situations.
The nurse should describe skills in which of the following domains? Select all that apply.
A) Self-esteem
2
,B) Self-regulation
C) Inference
D) Autonomy
E) Interpretation
9. The nurse is providing care for a client with chronic obstructive pulmonary disease (COPD).
The nurse’s most recent assessment reveals an SaO2 of 89%. The nurse is aware that part of
critical thinking is determining the significance of data that have been gathered. What
characteristic of critical thinking is used in determining the best response to this assessment
finding?
A) Extrapolation
B) Inference
C) Characterization
D) Interpretation
10. You have just taken report for your shift and you are doing your initial assessment of your
client’s. One of your client’s asks you if an error has been made in her medication. You know that
an incident report was filed yesterday after a nurse inadvertently missed a scheduled dose of the
client’s antibiotic. Which of the following principles would apply if you give an accurate response?
A) Veracity
B) Confidentiality
C) Respect
D) Justice
11. A nurse has begun creating a client plan of care shortly after the client’s admission. It is
important that the wording of the chosen nursing diagnoses falls within the taxonomy of nursing.
Which organization is responsible for developing the taxonomy of a nursing diagnosis?
A) American Nurse’s Association (ANA)
B) NANDA
C) National League for Nursing (NLN)
D) Joint Commission
12. In response to a client’s complaint of pain, the nurse administered a PRN dose of
hydromorphone (Dilaudid). In what phase of the nursing process will the nurse determine whether
this medication has had the desired effect?
A) Analysis
B) Evaluation
3
, C) Assessment
D) Data collection
13. A medical nurse has obtained a new client’s health history and completed the admission
assessment. The nurse has followed this by documenting the results and creating a care plan for the
client. Which of the following is the most important rationale for documenting the client’s care?
A) It provides continuity of care.
B) It creates a teaching log for the family.
C) It verifies appropriate staffing levels.
D) It keeps the client fully informed.
14. The nurse is caring for a client who is withdrawing from heavy alcohol use and who is
consequently combative and confused, despite the administration of benzodiazepines. The client
has a fractured hip that he suffered in a traumatic accident and is trying to get out of bed. What is
the most appropriate action for the nurse to take?
A) Leave the client and get help.
B) Obtain a physician’s order to restrain the client.
C) Read the facility’s policy on restraints.
D) Order soft restraints from the storeroom.
15. A client admitted with right leg thrombophlebitis is to be discharged from an acute-care facility.
Following treatment with a heparin infusion, the nurse notes that the client’s leg is pain-free,
without redness or edema. Which step of the nursing process does this reflect?
A) Diagnosis
B) Analysis
C) Implementation
D) Evaluation
16. The nurse has been assigned to care for a client admitted with an opportunistic infection
secondary to AIDS. The nurse informs the clinical nurse leader that she is refusing to care for him
because he has AIDS. The nurse has an obligation to this client under which of the following?
A) Good Samaritan Act
B) Nursing Interventions Classification (NIC)
C) The nurse practice act in the nurse’s jurisdiction
D) International Council of Nurse’s (ICN) Code of Ethics for Nurse
17. An emergency department nurse is caring for a 7-year-old child suspected of having meningitis.
The client is to have a lumbar puncture performed, and the nurse is doing preprocedural teaching
with the child and the mother. The nurse’s action is an example of which therapeutic
communication technique?
4
