NUR 6121 Exam 1 | Actual Questions and Answers | 2026
Update | 100% Correct - William Paterson University. - 140
Questions
Section 1: Nursing Process and Critical Thinking (Questions 1-15)
1 A nurse is caring for a patient with multiple chronic conditions. The nurse observes a gradual decline in
functional status over several days. Using the clinical judgment model, which step should the nurse prioritize
first to determine the underlying cause?
A) Formulate a nursing diagnosis based on the observed decline.
B) Collect additional subjective and objective data to identify patterns.
C) Implement a standardized fall prevention protocol immediately.
D) Evaluate the effectiveness of current interdisciplinary care plans.
Answer: B
Rationale: The first step in clinical judgment is cue recognition and data collection. Without gathering more data,
the nurse cannot accurately interpret the decline or formulate a diagnosis. Option A is premature, C is an
intervention without assessment, and D is evaluation, which occurs later.
2 When developing a plan of care for a patient with complex comorbidities, the nurse considers multiple nursing
diagnoses. Which approach demonstrates the highest level of critical thinking in prioritizing these diagnoses?
A) Rank diagnoses by the patient's stated preferences.
B) Use Maslow's hierarchy to determine physiological needs first.
C) Prioritize based on the potential for rapid deterioration.
D) Select the diagnosis most commonly associated with the primary medical condition.
Answer: C
Rationale: Critical thinking in prioritization requires identifying which diagnosis poses the greatest immediate risk
of harm. While Maslow's hierarchy is useful, it does not always reflect urgency (e.g., a risk for unstable blood
glucose may be more urgent than a physiological need for hygiene). Option A may not align with clinical safety,
and D is too simplistic.
3 A nurse is reviewing a patient's laboratory results and notes a potassium level of 6.2 mEq/L. The patient has no
ECG changes and is asymptomatic. Which action best demonstrates critical thinking in this situation?
A) Administer sodium polystyrene sulfonate as prescribed.
B) Recheck the potassium level with a new blood sample.
C) Notify the healthcare provider of a critical value.
D) Document the finding and continue monitoring.
Answer: B
Rationale: Critical thinking involves verifying unexpected results before acting, especially when the result does not
match the clinical picture. Rechecking prevents unnecessary treatment of a possible lab error. Option A is
premature, C may be appropriate after confirmation, and D is passive and could delay necessary intervention.
4 A nurse is evaluating the outcomes of a teaching plan for a patient with newly diagnosed diabetes. Which
finding indicates that the plan was effective and that the patient has achieved the desired outcome?
A) The patient can list three complications of diabetes.
B) The patient demonstrates correct insulin injection technique.
,C) The patient states they will try to eat healthier.
D) The patient reports feeling more confident about managing diabetes.
Answer: B
Rationale: Outcome evaluation must be based on observable, measurable behaviors. Demonstration of a skill
(insulin injection) is a concrete indicator of learning. Option A is knowledge recall but not application, C is a vague
intention, and D is subjective and not directly observable.
5 A nurse is using a reflective practice model after a critical incident. Which question is most important for the
nurse to ask to promote deep learning and improved future practice?
A) What did I do right in that situation?
B) How did my actions align with hospital policy?
C) What were the underlying assumptions that influenced my decisions?
D) Did the patient receive the best possible care?
Answer: C
Rationale: Critical reflection requires examining the cognitive processes and biases that shaped actions. Identifying
underlying assumptions allows the nurse to challenge and refine clinical reasoning. Options A and D are evaluative
but not reflective of the thinking process; B focuses on compliance rather than deeper learning.
6 During a team meeting, a nurse proposes a change to the unit's pain assessment protocol based on recent
evidence. Which response from the team best reflects critical thinking about implementing evidence-based
practice?
A) We should adopt the new protocol immediately to improve patient outcomes.
B) How does this evidence apply to our specific patient population and setting?
C) Has this protocol been approved by the hospital's evidence-based practice committee?
D) Let's wait until more studies confirm these findings.
Answer: B
Rationale: Critical thinking in EBP involves appraising the evidence for applicability to the local context. Immediate
adoption (A) may ignore implementation barriers; approval (C) is important but secondary to applicability; waiting
(D) may delay improvement unnecessarily.
7 A nurse is assessing a patient who reports chest pain. The nurse notes that the pain is reproducible with
palpation and worsens with deep inspiration. The patient's vital signs are stable. Which nursing action
demonstrates the highest level of critical thinking?
A) Administer nitroglycerin as per protocol for chest pain.
B) Document the findings and notify the healthcare provider.
C) Consider musculoskeletal causes and perform a focused assessment.
D) Prepare the patient for an immediate ECG and cardiac enzymes.
Answer: C
Rationale: Critical thinking involves differentiating between cardiac and non-cardiac chest pain. The characteristics
(reproducible, pleuritic) suggest a musculoskeletal or pleural origin, not cardiac ischemia. Option A could be
harmful if cardiac cause is absent; D is appropriate if cardiac suspicion exists, but the findings point elsewhere.
Option B is passive.
8 A nurse is developing a care plan for a patient with a new colostomy. Which outcome statement is written in a
way that allows for objective evaluation?
A) Patient will accept the colostomy within one week.
B) Patient will demonstrate proper stoma care technique before discharge.
,C) Patient will have decreased anxiety about the colostomy.
D) Patient will understand the reasons for the colostomy.
Answer: B
Rationale: Measurable outcomes must use observable, behavioral terms. 'Demonstrate' is an action that can be
observed and evaluated. 'Accept' and 'decreased anxiety' are subjective and hard to measure; 'understand' is not
directly observable.
9 A nurse is analyzing data from a patient assessment: heart rate 110 bpm, blood pressure 90/60 mmHg, urine
output 20 mL/hr, and skin cool and clammy. The patient has a history of heart failure. Which nursing diagnosis
is most appropriate at this time?
A) Excess Fluid Volume related to compromised regulatory mechanisms.
B) Decreased Cardiac Output related to altered contractility.
C) Risk for Impaired Skin Integrity related to decreased perfusion.
D) Ineffective Tissue Perfusion related to hypovolemia.
Answer: B
Rationale: The data (tachycardia, hypotension, oliguria, cool skin) indicate decreased cardiac output, which is
common in heart failure exacerbation. Option A is opposite (fluid volume deficit is more likely), C is a risk but not
the primary problem, D may be related but the etiology is cardiac, not hypovolemia.
10 A nurse educator is teaching students about the nursing process. Which statement by a student indicates a
misunderstanding of the relationship between the nursing process and critical thinking?
A) Critical thinking helps me decide which nursing diagnosis is most accurate.
B) The nursing process is a linear, step-by-step algorithm that does not require judgment.
C) I use critical thinking to evaluate whether my interventions were effective.
D) Critical thinking allows me to adapt the nursing process to individual patient needs.
Answer: B
Rationale: The nursing process is a systematic, but not strictly linear, framework that requires critical thinking at
each phase. Option B incorrectly suggests it is a rote algorithm without judgment. The other statements correctly
link critical thinking to specific phases (diagnosis, evaluation, adaptation).
11 A nurse is caring for a client with a complex chronic condition who has been hospitalized multiple times in the
past year. The nurse notes that the client's current symptoms are similar to previous admissions, but the client
also reports a new, vague symptom of 'feeling different.' Using the nursing process, what is the nurse's most
critical initial action to ensure safe and effective care?
A) Document the client's statement and proceed with the established plan of care, as the pattern is familiar.
B) Reassess the client comprehensively, focusing on the new symptom and its potential implications, before
updating the plan.
C) Consult with the healthcare provider to order additional diagnostic tests to rule out complications.
D) Review the client's previous admission records to identify any missed interventions or patterns.
Answer: B
Rationale: The nursing process is cyclical and dynamic. The new symptom ('feeling different') represents a change
in status that requires reassessment (the first step of the nursing process) to gather new data before any other action.
Option B prioritizes this reassessment, which is critical for identifying potential complications or changes in the
client's condition. Options A, C, and D bypass reassessment and may lead to premature or incorrect interventions.
, 12 A nurse is developing a plan of care for a client with a new diagnosis. The nurse identifies several nursing
diagnoses, but the client's priorities differ from the nurse's clinical judgment. Which action best demonstrates
critical thinking in this situation?
A) Implement the nursing diagnoses in order of clinical urgency, as determined by the nurse's expertise.
B) Discuss the nursing diagnoses with the client, explaining the rationale and negotiating priorities together.
C) Document both the nurse's and client's priorities and proceed with the nurse's plan to ensure safety.
D) Reassess the client to confirm the accuracy of the nursing diagnoses before discussing priorities.
Answer: B
Rationale: Critical thinking in nursing involves integrating clinical judgment with client preferences and values. The
nursing process is client-centered, and the planning phase should include collaboration with the client to establish
mutually agreed-upon priorities. Option B reflects this by engaging the client in a dialogue to negotiate priorities,
which respects autonomy and promotes adherence. Options A and C impose the nurse's priorities without
collaboration, while option D delays necessary discussion and may not resolve the conflict.
13 A nurse is evaluating a client's response to a new intervention implemented 24 hours ago. The client's condition
has not improved, and the nurse must decide on the next step. Which evaluation approach best reflects the
critical thinking required in the nursing process?
A) Continue the current intervention for another 24 hours to allow more time for effect.
B) Discontinue the intervention and immediately notify the healthcare provider.
C) Analyze the data to determine if the intervention was implemented correctly and if other factors may have
influenced the outcome.
D) Modify the intervention based on the nurse's intuition that a different approach might work better.
Answer: C
Rationale: Evaluation in the nursing process requires systematic analysis of outcome data to determine the
effectiveness of interventions. Critical thinking involves examining whether the intervention was delivered as
planned and considering confounding variables before deciding to modify, continue, or discontinue. Option C
demonstrates this analytical approach. Option A ignores the lack of improvement and may delay necessary
changes. Option B is premature without analysis. Option D relies on intuition rather than evidence.
14 A nurse is using the nursing process to manage a client with multiple comorbidities who is at risk for falls. The
nurse has implemented fall prevention interventions, but the client continues to have near-falls. Which step of
the nursing process is most critical for the nurse to prioritize at this point?
A) Reassessment to gather new data about the client's current risk factors and circumstances of near-falls.
B) Revision of the nursing diagnosis to reflect the ongoing risk and potential complications.
C) Implementation of additional fall prevention measures based on standard protocols.
D) Evaluation of the effectiveness of the current interventions and analysis of why they are not working.
Answer: D
Rationale: The nursing process is iterative. Since interventions have been implemented but desired outcomes are not
achieved, the nurse must first evaluate the effectiveness of those interventions and analyze reasons for failure (e.g.,
incorrect implementation, new risk factors). This evaluation step informs subsequent reassessment and revision of
the plan. Option D is the most critical initial step. Option A may be needed after evaluation, but without evaluation,
reassessment lacks focus. Options B and C skip the evaluation step.
15 A nurse is admitting a client with an acute exacerbation of a chronic illness. The client reports severe pain and
anxiety. The nurse must prioritize interventions. Which application of the nursing process and critical thinking
is most appropriate?
A) Address the pain first, as it is a physiological need, then manage anxiety after pain is controlled.
Update | 100% Correct - William Paterson University. - 140
Questions
Section 1: Nursing Process and Critical Thinking (Questions 1-15)
1 A nurse is caring for a patient with multiple chronic conditions. The nurse observes a gradual decline in
functional status over several days. Using the clinical judgment model, which step should the nurse prioritize
first to determine the underlying cause?
A) Formulate a nursing diagnosis based on the observed decline.
B) Collect additional subjective and objective data to identify patterns.
C) Implement a standardized fall prevention protocol immediately.
D) Evaluate the effectiveness of current interdisciplinary care plans.
Answer: B
Rationale: The first step in clinical judgment is cue recognition and data collection. Without gathering more data,
the nurse cannot accurately interpret the decline or formulate a diagnosis. Option A is premature, C is an
intervention without assessment, and D is evaluation, which occurs later.
2 When developing a plan of care for a patient with complex comorbidities, the nurse considers multiple nursing
diagnoses. Which approach demonstrates the highest level of critical thinking in prioritizing these diagnoses?
A) Rank diagnoses by the patient's stated preferences.
B) Use Maslow's hierarchy to determine physiological needs first.
C) Prioritize based on the potential for rapid deterioration.
D) Select the diagnosis most commonly associated with the primary medical condition.
Answer: C
Rationale: Critical thinking in prioritization requires identifying which diagnosis poses the greatest immediate risk
of harm. While Maslow's hierarchy is useful, it does not always reflect urgency (e.g., a risk for unstable blood
glucose may be more urgent than a physiological need for hygiene). Option A may not align with clinical safety,
and D is too simplistic.
3 A nurse is reviewing a patient's laboratory results and notes a potassium level of 6.2 mEq/L. The patient has no
ECG changes and is asymptomatic. Which action best demonstrates critical thinking in this situation?
A) Administer sodium polystyrene sulfonate as prescribed.
B) Recheck the potassium level with a new blood sample.
C) Notify the healthcare provider of a critical value.
D) Document the finding and continue monitoring.
Answer: B
Rationale: Critical thinking involves verifying unexpected results before acting, especially when the result does not
match the clinical picture. Rechecking prevents unnecessary treatment of a possible lab error. Option A is
premature, C may be appropriate after confirmation, and D is passive and could delay necessary intervention.
4 A nurse is evaluating the outcomes of a teaching plan for a patient with newly diagnosed diabetes. Which
finding indicates that the plan was effective and that the patient has achieved the desired outcome?
A) The patient can list three complications of diabetes.
B) The patient demonstrates correct insulin injection technique.
,C) The patient states they will try to eat healthier.
D) The patient reports feeling more confident about managing diabetes.
Answer: B
Rationale: Outcome evaluation must be based on observable, measurable behaviors. Demonstration of a skill
(insulin injection) is a concrete indicator of learning. Option A is knowledge recall but not application, C is a vague
intention, and D is subjective and not directly observable.
5 A nurse is using a reflective practice model after a critical incident. Which question is most important for the
nurse to ask to promote deep learning and improved future practice?
A) What did I do right in that situation?
B) How did my actions align with hospital policy?
C) What were the underlying assumptions that influenced my decisions?
D) Did the patient receive the best possible care?
Answer: C
Rationale: Critical reflection requires examining the cognitive processes and biases that shaped actions. Identifying
underlying assumptions allows the nurse to challenge and refine clinical reasoning. Options A and D are evaluative
but not reflective of the thinking process; B focuses on compliance rather than deeper learning.
6 During a team meeting, a nurse proposes a change to the unit's pain assessment protocol based on recent
evidence. Which response from the team best reflects critical thinking about implementing evidence-based
practice?
A) We should adopt the new protocol immediately to improve patient outcomes.
B) How does this evidence apply to our specific patient population and setting?
C) Has this protocol been approved by the hospital's evidence-based practice committee?
D) Let's wait until more studies confirm these findings.
Answer: B
Rationale: Critical thinking in EBP involves appraising the evidence for applicability to the local context. Immediate
adoption (A) may ignore implementation barriers; approval (C) is important but secondary to applicability; waiting
(D) may delay improvement unnecessarily.
7 A nurse is assessing a patient who reports chest pain. The nurse notes that the pain is reproducible with
palpation and worsens with deep inspiration. The patient's vital signs are stable. Which nursing action
demonstrates the highest level of critical thinking?
A) Administer nitroglycerin as per protocol for chest pain.
B) Document the findings and notify the healthcare provider.
C) Consider musculoskeletal causes and perform a focused assessment.
D) Prepare the patient for an immediate ECG and cardiac enzymes.
Answer: C
Rationale: Critical thinking involves differentiating between cardiac and non-cardiac chest pain. The characteristics
(reproducible, pleuritic) suggest a musculoskeletal or pleural origin, not cardiac ischemia. Option A could be
harmful if cardiac cause is absent; D is appropriate if cardiac suspicion exists, but the findings point elsewhere.
Option B is passive.
8 A nurse is developing a care plan for a patient with a new colostomy. Which outcome statement is written in a
way that allows for objective evaluation?
A) Patient will accept the colostomy within one week.
B) Patient will demonstrate proper stoma care technique before discharge.
,C) Patient will have decreased anxiety about the colostomy.
D) Patient will understand the reasons for the colostomy.
Answer: B
Rationale: Measurable outcomes must use observable, behavioral terms. 'Demonstrate' is an action that can be
observed and evaluated. 'Accept' and 'decreased anxiety' are subjective and hard to measure; 'understand' is not
directly observable.
9 A nurse is analyzing data from a patient assessment: heart rate 110 bpm, blood pressure 90/60 mmHg, urine
output 20 mL/hr, and skin cool and clammy. The patient has a history of heart failure. Which nursing diagnosis
is most appropriate at this time?
A) Excess Fluid Volume related to compromised regulatory mechanisms.
B) Decreased Cardiac Output related to altered contractility.
C) Risk for Impaired Skin Integrity related to decreased perfusion.
D) Ineffective Tissue Perfusion related to hypovolemia.
Answer: B
Rationale: The data (tachycardia, hypotension, oliguria, cool skin) indicate decreased cardiac output, which is
common in heart failure exacerbation. Option A is opposite (fluid volume deficit is more likely), C is a risk but not
the primary problem, D may be related but the etiology is cardiac, not hypovolemia.
10 A nurse educator is teaching students about the nursing process. Which statement by a student indicates a
misunderstanding of the relationship between the nursing process and critical thinking?
A) Critical thinking helps me decide which nursing diagnosis is most accurate.
B) The nursing process is a linear, step-by-step algorithm that does not require judgment.
C) I use critical thinking to evaluate whether my interventions were effective.
D) Critical thinking allows me to adapt the nursing process to individual patient needs.
Answer: B
Rationale: The nursing process is a systematic, but not strictly linear, framework that requires critical thinking at
each phase. Option B incorrectly suggests it is a rote algorithm without judgment. The other statements correctly
link critical thinking to specific phases (diagnosis, evaluation, adaptation).
11 A nurse is caring for a client with a complex chronic condition who has been hospitalized multiple times in the
past year. The nurse notes that the client's current symptoms are similar to previous admissions, but the client
also reports a new, vague symptom of 'feeling different.' Using the nursing process, what is the nurse's most
critical initial action to ensure safe and effective care?
A) Document the client's statement and proceed with the established plan of care, as the pattern is familiar.
B) Reassess the client comprehensively, focusing on the new symptom and its potential implications, before
updating the plan.
C) Consult with the healthcare provider to order additional diagnostic tests to rule out complications.
D) Review the client's previous admission records to identify any missed interventions or patterns.
Answer: B
Rationale: The nursing process is cyclical and dynamic. The new symptom ('feeling different') represents a change
in status that requires reassessment (the first step of the nursing process) to gather new data before any other action.
Option B prioritizes this reassessment, which is critical for identifying potential complications or changes in the
client's condition. Options A, C, and D bypass reassessment and may lead to premature or incorrect interventions.
, 12 A nurse is developing a plan of care for a client with a new diagnosis. The nurse identifies several nursing
diagnoses, but the client's priorities differ from the nurse's clinical judgment. Which action best demonstrates
critical thinking in this situation?
A) Implement the nursing diagnoses in order of clinical urgency, as determined by the nurse's expertise.
B) Discuss the nursing diagnoses with the client, explaining the rationale and negotiating priorities together.
C) Document both the nurse's and client's priorities and proceed with the nurse's plan to ensure safety.
D) Reassess the client to confirm the accuracy of the nursing diagnoses before discussing priorities.
Answer: B
Rationale: Critical thinking in nursing involves integrating clinical judgment with client preferences and values. The
nursing process is client-centered, and the planning phase should include collaboration with the client to establish
mutually agreed-upon priorities. Option B reflects this by engaging the client in a dialogue to negotiate priorities,
which respects autonomy and promotes adherence. Options A and C impose the nurse's priorities without
collaboration, while option D delays necessary discussion and may not resolve the conflict.
13 A nurse is evaluating a client's response to a new intervention implemented 24 hours ago. The client's condition
has not improved, and the nurse must decide on the next step. Which evaluation approach best reflects the
critical thinking required in the nursing process?
A) Continue the current intervention for another 24 hours to allow more time for effect.
B) Discontinue the intervention and immediately notify the healthcare provider.
C) Analyze the data to determine if the intervention was implemented correctly and if other factors may have
influenced the outcome.
D) Modify the intervention based on the nurse's intuition that a different approach might work better.
Answer: C
Rationale: Evaluation in the nursing process requires systematic analysis of outcome data to determine the
effectiveness of interventions. Critical thinking involves examining whether the intervention was delivered as
planned and considering confounding variables before deciding to modify, continue, or discontinue. Option C
demonstrates this analytical approach. Option A ignores the lack of improvement and may delay necessary
changes. Option B is premature without analysis. Option D relies on intuition rather than evidence.
14 A nurse is using the nursing process to manage a client with multiple comorbidities who is at risk for falls. The
nurse has implemented fall prevention interventions, but the client continues to have near-falls. Which step of
the nursing process is most critical for the nurse to prioritize at this point?
A) Reassessment to gather new data about the client's current risk factors and circumstances of near-falls.
B) Revision of the nursing diagnosis to reflect the ongoing risk and potential complications.
C) Implementation of additional fall prevention measures based on standard protocols.
D) Evaluation of the effectiveness of the current interventions and analysis of why they are not working.
Answer: D
Rationale: The nursing process is iterative. Since interventions have been implemented but desired outcomes are not
achieved, the nurse must first evaluate the effectiveness of those interventions and analyze reasons for failure (e.g.,
incorrect implementation, new risk factors). This evaluation step informs subsequent reassessment and revision of
the plan. Option D is the most critical initial step. Option A may be needed after evaluation, but without evaluation,
reassessment lacks focus. Options B and C skip the evaluation step.
15 A nurse is admitting a client with an acute exacerbation of a chronic illness. The client reports severe pain and
anxiety. The nurse must prioritize interventions. Which application of the nursing process and critical thinking
is most appropriate?
A) Address the pain first, as it is a physiological need, then manage anxiety after pain is controlled.
