While assessing a patient, the nurse observes the patient's IV line is not infusing at the or-
dered rate. The nurse assesses the patient for pain at the IV site, checks the flow regulator
on the tubing, looks to see if the patient is lying on the tubing, checks the point of connec-
tion between the tubing and the IV catheter, and then checks the condition of the site where
the IV catheter enters the patient's skin. After the nurse readjusts the flow rate, the infusion
begins at the correct rate. This is an example of:
A. inference
B. Diagnostic reasoning
C. Competency
D. Problem solving - ANSWER D. Problem Solving
The nurse sits down to talk with a patient who lost her sister 2 weeks ago. The patient re-
ports she is unable to sleep, feels very fatigued during the day, and is having trouble at work.
The nurse asks her to clarify the type of trouble. The patient explains she can't concentrate
or even solve simple problems. The nurse records the results of the assessment, describing
the patient as having ineffective coping. This is an example of :
A. diagnostic reasoning
B. Competency
C. Inference
D. Problem Solving - ANSWER A. Diagnostic reasoning
A patient on a surgical unit develops sudden shortness of breath and a drop in BP. The staff
respond, but the patient dies 30 minutes later. the manager on the nursing unit calls the
staff involved in the emergency response together, The staff discusses what occurred over
the 30 minute time frame, the actions taken, and whether other steps should have been im-
plemented. The nurses in this situation are:
A. problem solving
B. showing humility
1
,C. conducting reflective practice
D. Exercising responsibility - ANSWER C. Conducting reflective practice
A nurse has worked on an oncology unit for 3 years. One patient has become visibly weaker
and states, "I feel funny". The nurse knows how patients often have behavior changes before
developing sepsis when they have cancer. The nurse asks the patient questions to assess
thinking skills and notices the patient shivering. The nurse goes to the phone, calls the physi-
cian, and begins the conversation by saying, "I believe that your patient is developing sepsis.
I want to report symptoms I'm seeing." What examples of critical thinking concepts does the
nurse show? (Select all that apply)
A. Experience
B. Ethical
C. Analyticity
D. Self-confidence
E. Risk taking - ANSWER C. Analyticity
D. Self confidence
A nurse who is working on a surgical unit is caring for four different patients. Patient A will
be discharged home and is in need of instruction about wound care. Patients B and C have
returned from the operating room within an hour of each other, and both require vital signs
and monitoring of their intravenous (IV) lines.
Patient D is resting following a visit by physical therapy. Which of the following activities by
the nurse represent(s) use of clinical decision making for groups of patients? (Select all that
apply.)
A. consider how to involve patient A in deciding whether to involve the family caregiver in
wound care instruction
B. Think about past experience with patients who develop postoperative complications
C. Decide which activities can be combined for patients B and C
D. Carefully gather any assessment info and identify patient problems - ANSWER A&C
2
, The surgical unit has initiated the use of a pain-rating scale to assess patients' pain severity
during their postoperative recovery. The registered nurse (RN) looks at the pain flow sheet to
see the pain scores recorded for a patient over the last 24 hours. Use of the pain scale is an
example of which intellectual standard?
A. deep
B. Relevant
C. Consistent
D. Significant - ANSWER C
During a home health visit the nurse prepares to instruct a patient in how to perform range-
of-motion (ROM) exercises for an injured shoulder. The nurse verifies that the patient took
an analgesic 30 minutes before arrival at the patient's home. After discussing the purpose
for the exercises and demonstrating each one, the nurse has the patient perform them. After
two attempts with only the second of three exercises, the patient stops and says, "This hurts
too much. I don't see why I have to do this so many times." The nurse applies the critical
thinking attitude of integrity in which of the following actions?"
A. "I understand your reluctance, but the exercises are necessary for you to regain function
in your shoulder. Let's go a bit more slowly and try to relax"
B. "I see that you're uncomfortable. I'll call your doctor to decide the next step."
C. "Show me exactly where your pain is and rate it for me on a scale - ANSWER A
The nurse cared for a 14-year-old with renal failure who died near the end of the work shift.
The health care team tried for 45 minutes to resuscitate the child with no success. The fam-
ily was devastated by the loss, and, when the nurse tried to talk with them, the mother said,
"You can't make me feel better; you don't know what it's like to lose a child." Which of the
following examples of journal entries might best help the nurse reflect and think about this
clinical experience? (Select all that apply.)
A. Data entry of the time of day, who was present, and the condition or the child
B. Description of the efforts to restore the child's BP, what was used, and questions about
the child's response
3
dered rate. The nurse assesses the patient for pain at the IV site, checks the flow regulator
on the tubing, looks to see if the patient is lying on the tubing, checks the point of connec-
tion between the tubing and the IV catheter, and then checks the condition of the site where
the IV catheter enters the patient's skin. After the nurse readjusts the flow rate, the infusion
begins at the correct rate. This is an example of:
A. inference
B. Diagnostic reasoning
C. Competency
D. Problem solving - ANSWER D. Problem Solving
The nurse sits down to talk with a patient who lost her sister 2 weeks ago. The patient re-
ports she is unable to sleep, feels very fatigued during the day, and is having trouble at work.
The nurse asks her to clarify the type of trouble. The patient explains she can't concentrate
or even solve simple problems. The nurse records the results of the assessment, describing
the patient as having ineffective coping. This is an example of :
A. diagnostic reasoning
B. Competency
C. Inference
D. Problem Solving - ANSWER A. Diagnostic reasoning
A patient on a surgical unit develops sudden shortness of breath and a drop in BP. The staff
respond, but the patient dies 30 minutes later. the manager on the nursing unit calls the
staff involved in the emergency response together, The staff discusses what occurred over
the 30 minute time frame, the actions taken, and whether other steps should have been im-
plemented. The nurses in this situation are:
A. problem solving
B. showing humility
1
,C. conducting reflective practice
D. Exercising responsibility - ANSWER C. Conducting reflective practice
A nurse has worked on an oncology unit for 3 years. One patient has become visibly weaker
and states, "I feel funny". The nurse knows how patients often have behavior changes before
developing sepsis when they have cancer. The nurse asks the patient questions to assess
thinking skills and notices the patient shivering. The nurse goes to the phone, calls the physi-
cian, and begins the conversation by saying, "I believe that your patient is developing sepsis.
I want to report symptoms I'm seeing." What examples of critical thinking concepts does the
nurse show? (Select all that apply)
A. Experience
B. Ethical
C. Analyticity
D. Self-confidence
E. Risk taking - ANSWER C. Analyticity
D. Self confidence
A nurse who is working on a surgical unit is caring for four different patients. Patient A will
be discharged home and is in need of instruction about wound care. Patients B and C have
returned from the operating room within an hour of each other, and both require vital signs
and monitoring of their intravenous (IV) lines.
Patient D is resting following a visit by physical therapy. Which of the following activities by
the nurse represent(s) use of clinical decision making for groups of patients? (Select all that
apply.)
A. consider how to involve patient A in deciding whether to involve the family caregiver in
wound care instruction
B. Think about past experience with patients who develop postoperative complications
C. Decide which activities can be combined for patients B and C
D. Carefully gather any assessment info and identify patient problems - ANSWER A&C
2
, The surgical unit has initiated the use of a pain-rating scale to assess patients' pain severity
during their postoperative recovery. The registered nurse (RN) looks at the pain flow sheet to
see the pain scores recorded for a patient over the last 24 hours. Use of the pain scale is an
example of which intellectual standard?
A. deep
B. Relevant
C. Consistent
D. Significant - ANSWER C
During a home health visit the nurse prepares to instruct a patient in how to perform range-
of-motion (ROM) exercises for an injured shoulder. The nurse verifies that the patient took
an analgesic 30 minutes before arrival at the patient's home. After discussing the purpose
for the exercises and demonstrating each one, the nurse has the patient perform them. After
two attempts with only the second of three exercises, the patient stops and says, "This hurts
too much. I don't see why I have to do this so many times." The nurse applies the critical
thinking attitude of integrity in which of the following actions?"
A. "I understand your reluctance, but the exercises are necessary for you to regain function
in your shoulder. Let's go a bit more slowly and try to relax"
B. "I see that you're uncomfortable. I'll call your doctor to decide the next step."
C. "Show me exactly where your pain is and rate it for me on a scale - ANSWER A
The nurse cared for a 14-year-old with renal failure who died near the end of the work shift.
The health care team tried for 45 minutes to resuscitate the child with no success. The fam-
ily was devastated by the loss, and, when the nurse tried to talk with them, the mother said,
"You can't make me feel better; you don't know what it's like to lose a child." Which of the
following examples of journal entries might best help the nurse reflect and think about this
clinical experience? (Select all that apply.)
A. Data entry of the time of day, who was present, and the condition or the child
B. Description of the efforts to restore the child's BP, what was used, and questions about
the child's response
3
